Permit 7 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC201300241
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/29/2013
Parcel: 1 S125DB09700
Jurisdiction: Tigard
Site address: 7110 SW LOLA LN
Project: Casey Subdivision: RAZBERRY PATCH, THE Lot: 17
Project Description: (3) branch circuits for kitchen remodel
Contractor: BENTLEY ELECTRIC INC Owner: CASEY, CLIFFORD K & NAKIA D
41330 SW EDNA LANE 7110 SW LOLA LN
GASTON, OR 97119 TIGARD, OR 97223
PHONE: 503 - 789 -4229
PHONE: 503 - 807 -1175
FAX: 503 - 985 -9595
FEES
Quantity Description Date Amount
1 ea 12% State Surcharge - 04/29/2013 $8.52
Specifics: Electrical
3 crt Branch Circuits wo /Purchase 04/29/2013 $71.02
Type of Use: SF Service or Feeder
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through 0 R X / 52 -001 / -- 090. You may obtain copy of the rules or direct questions to OUNC by calling 503.232.19877 or 1.800.332.2344.
Issued By: Wl.(� Permittee Signature: Dl A PPUC 'o" r
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project
Approved plans are required on the job site at the time of each Inspection.
Apr 29 13 10:44a Bentley Electric, Inc. 5039859500 p.1
Electrical Permit Application RECEIVED
111: f)1: 1 1t l' 1 ‘t: u\l_1
City of Tigard APR 2 9 2013 ed 194 13 S
Pa �� 3 `
1,1 13125 SW Hall Blvd., Tigard, OR 97223 C�a
= Phone: 503.718.2439 Fax: 5°3.598.1 fTY Plan Review
I Line: 503,639.4175 � I D� �IG I�� Date/By: �RPantit"
T 1 L.: n )t U Date Ready/By:
Internet: tiv Line: 1)3.63 BUILDING DIVISION I N odf� � b } � p lei ..l taformatioa
TYPE OF WORK PLAN REVIEW
plans w
0 New construction ® Addition/alteration/replacement Please check a ll that
apply (submit 2 sets of 'items checked below):
❑ Demolition Other: Service or feeder 400 amps or more ❑ Building ova three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
® ry 1- and 2 - family dwelling ❑ Commercial/industrial ❑ Accessory building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
amps for all other installations. buildings.
Multi - family 0 Master builder 0 Other: 0 Fire pinup
❑ lustaflalion of 75 KVA or
.10/1 SITE INFORMATION AND LOCATION • ❑ erSmey system. larger separately derived system.
❑ Addition of new motor load of 'A^ E •1 _�•• I -
Job no.: I Job site address: 7110 SW Lola Lane 10014P or more. occupancy.
❑ Six or mere residential units. ❑ Recreational vehicle parks
Cit3 Tigard, OR 97223 ' ❑H t;
ealth -care facilities. ❑ Supply voltage for more tha
❑ Hazardous locations. 600 volts nominal.
Suitc/bldg. /apt. no.: Project name: Casey ❑ Service or feeder 600 amps or more.
Cross street/directions to job site; FEE SCHEDULE
Description I ate. 1 Fee. I Total I ,
New residential single- or mufti- family dwelling unit.
Includes attached garage.
Su Ix! ivision: I Lot no.: 1,000 sq. R. or less
168_54 4
Tax map:parcel no.: • Ea. add'I 500 sq 0. or portion 33.42
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
3 new circuits, kitchen remodel Limited energy, multi- family
' residential (with above sq ti.; 75.00 2
Renewable Eaeryy El See Page 2
Services or feeders installation. alteration, and/or relocation
® PROPERTY OWNER ❑ TENANT 200 amps or less 100 70 2
Name: Nakia Casey 201 amps to 400 amps 133.56 2
401 amps to 600 amps _ _
Address: 7110 SW Lola Lane _
601 amps to 1.000 amps 301.04 2
2
City /State /ZIP: Tigard, OR 97223 Over 1,000 amps or vats 552.26
Temporary services or feeders installation, alteration, and/or
Phone: (503)807 -1175 , Fax: ( ) relocation
Owner installation: This installation is being made on property that I own which is not - 200 amps or less J 59.96 I
intended for sale- tease, rent, or exchange, according to ORS 447. 449, 670, and 701. _ amps to 400 amps 125 a8 2
Owner signature: Date: 401 amps to 599 amps 168.54 l 2
r Branch circuits - new, alteration. or extension, perpanel
® APPLICANT
I ❑ CONTACT PERSON A Fee for branch circuits nub
Business name: Bentley Electric, Inc. service feeder fee,
each branch circuit 7.42 2
Contact name: Jay Bentley B. Fee for branch circuits without
service or feeder fee. first r 56.18
Address: 41330 SW Edna Lane branch circuit 56.IR 2
Each add•I branch circuit I 2 7.42 14.84 2
CitylState'ZIP: Gaston, OR 97119 Miscellaneous (service or feeder not included)
Phone: (503) 789 - 4229 Each manufactured or modular
Fax: ' (503) 985 - 9595 dwelling, service and /or feeder 67.84 I 2
E - mail: jay ( gbentleyeiectricinc.com - Reconnect only 67 84
CONTRACTOR Pump or irrigation circle 67.84 2
Sign or outlin lighting 67.84 2
Business name: Bentley Electric, Inc.
Signal circuit(s) or limited-energy '
Address: 41130 SW Edna Lane panel. alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: Gaston, OR 97119 Additional inspection (1 hr min) 662 hr
Investigation(1 hr min) 66.25; hr
Phone. (503) 789 -4229 Fax: (503) 985 industrial plant (1 hr min)
78.18; hr
CCA Lie.: 44467 I Electrical Lic.: 2 -20C I Suprv. 36355 Inspections for which no fee is
specifically listed (i( hr m :n) 90.00/ hr I
Suprv. Electrician signature requir d: /3�_ _ ELECTRICAL PERMIT FEES
Print name: James Powell �"�1 111111 Subtotal: 71.02
—
Date: 9/29/2013 Plan review (25% of permit fee);
•
Authorized signature: I- Slate surcharge (12% of permit fee): 8
TOTAL PERMIT FEE: 79.54
Print name: J Date: This permit application expires if a
days after it has been accepted obtained within
cepted as complete.
180
[ 18 uitdingtPetmitssELC _PettniiApp 040913. Number o! inspections allowed
440 - 46157(1! /05/COMrl9FB Per permit
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
7110 SW LOLA LN, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
06/03/2013 00:00
ELC2013-00241
Scheduled
Violation Summary:
Inspector Contractor