Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00504
DEVELOPMENT SERVICES DATE ISSUED: 7/14/2005
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 2S109DD -BV022
SITE ADDRESS: 12658 SW REMBRAN T LN ZONING: R -7
SUBDIVISION: BELLA VISTA 6 017 LO T : 022 JURISDICTION: TIG
Project Description: Temp power pole forkrailer.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 2 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
RIVERSIDE HOMES BEAR ELECTRIC
1925 NW AMBERGLEN PKWY #150 P.O. BOX 389
BEAVERTON, OR 97006 DONALD, OR 97020
Phone: 503 - 645 - 0986 Phone: 503 - 678 - 1355
FEES Reg #: LIC 20919
Description Date Amount ELE 24-107C
SUP 4902S
[ELPRMT] ELC Permit 7/14/2005 $133.70
[TAX] 8% State Surcharge 7/14/2005 $10.70 REQUIRED ITEMS AND REPORTS
Total $144.40
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: J/, Zi(1 r Permittee Signature: 5J, c',"V \ `\
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'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
111
l'ectrical Permit
1 'A
FOR OFFICE USE ONLY . - . . . . . .. .
•
W ' .
13125
City SW Ball B of Tigard lvd., TIgard, OR 97 2005 r ,Re a zzd, 7 _.) zi).- ,D6(._ ?emit No. :_ e_
tEN 1 Plan Review
Phone: 503.639.4171 Fax: 503.59811960 4 '
-. a t;''t - V . :iiii i . bilz.43y: Other Permit:
. '
Inspection Line: 503.639.4175 ---04.- °..I.„ Date Ready/By:
Internet: www.ci.tigard.or.us CITY OF TIGARD Nod6ecumethod;
- Vr . s p Information
li 5 T ' !:r i li2Aiiiri l iggigINVAINAVA41,'' DIMFAMSINENFAVail. ... .. ' ... • . . 1:
N-New construction 0 'Addition/aheration/replacement Please check all that apply:
El Demolition ES Other: a T . , A.z.4.4 4- 7 i kadefr. OService over 225 amps, come] OHazardous location
. .
of over 320 amps-rating OBuildng OM 10,000 sq. ft.
ffiffaillEft.1 of 1- and 2-family dwellings 4 or more new residential
0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building E3System over 600 volts nominal units in one structure
°Building over three stories ['Feeders, 400 amps or more
E1 Multi 0 Master builder 2 Other
0Occupant load over 99 persons OManufactured structures or
."-V.*:-:140.21-414516•I'W'.; f OBSmssilighting plan RV park
°Other:
lob no.: Ti„ 1,,,,,. Job site address:a c, 5 k --4 i R.A ........... ' . 4 ) 0 ._ ,..- \- ,..... Dikalth-care facilit
Submit 2 sets of plans with any of the above.
1 /;" ..
City/State/ZIP: 7-f The above are not applicable to temporary construction service.
Ti rd d k elo-r% q 7 2 -
- §u p - iielbldgia - pl. no.: • Project name. i g .1
6 //4, ViS 61u • • • • Ve : .7 :.:•• • . " 77..'.
Description 1 qty. ' 'CC. I Tot11
Cross street/directions to job site: 4 if,,,,,, ig..,,st # g€4.14 ihel , New residential single- or multi-family dwelling unit.
, - Includes attached garage.
1,000 sq. ft. or less 145.15 4
. . . _ . . . .
Subdivision: IS 11 ec t 4 t ejea , s . 4 4 44 2 4 . no.: I . ' Ea. adtri 500 sq: ft: or n . • • 33.40 r- 1 •
' Limited energy, residential 75:00 2
Tax map/paroel no.: .
.. ,. . Limited energy, non 75.00 • 2
Mk.1.7.10 ,,. Each'Inanufactured or :nodular
krvicc and/or feeder 90.90 2
I`ely aLoe.A 04 # 1141 .7b dwellinse ha l Aa • -
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
106.85 2
: 41: 7 7,:isoLv . i3m , :::. A. L . r i g i vg*An .:, rigt:E.... .:. allyaw 4 2 0 0 1 1 a amp inps s t 4 :mis
160.60 2 •
.
Name: u-c.3 \ A e- " .. 2 1 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 . 2
Address: / 91 r k ,) C Q adt,./ \ jt_x_/ , ) , L. ,,, 74. i. .
Reconnect only 66.85 2
City/State/ZIP: 7).As 1 0 61, Temporary services or feeders installation, alteration, and/or
relocation
Phone: (36 7) 6 (../5"-cg( I Fax: 0 ) 6 9 0 , 200 amps or less i 7.- 66.851/33, 70 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 I 2
Owner signature: . -- Date: Branch circuits - new, alteration, or extension, per panel
4 )4 L .:::,,,,ITE.; s i.:,: . 1),T'fi:.: : z . ;FZ : 77 : jil i gafa A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: •
without service or feeder fee,
46,85 2
each branch circuit
Address:
Each add'I branch circuit 6.65 2
City/State/ZIP: • Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: : ( )
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
MattriariSF . .-ategIVAMOVA.7401 6 R.27,40.ratMeiltaVIT I RREAM r x er rtn gY is o li °n ' °T
Page 2 2
/Business name: 4 ear p ie_. z
Each additional inspection over allowable in any of the above
Address: A a 4 3 6 9 7
Per inspection 62.50
City/Stare/ZIP: /Dim di 0 it . q 7o 2 0 . Investigation per hour (1 hr nun) 62.50
Phone: ( Se3) 4 76 - 1 Lt g 5 Fax: (So; ) 4 7,6' II OW Industrial plant per hour 73.75
ERaggrraMegtaiX047. ....:.'-.- PTPV.71.r."-iT,IfM,
CC13 Lie.: A I i el Electrical Lie.: 2 y ,. /c , 7 c Suprv. Lic.:S 9 I O a Subtotal / 3 ,, 7c,
Suprv. Elechician signature, required: R p Plan review (25% of permit fee)
Stare surcharge (8% of permit fee) ) a . 6 q 0
Print name: g n O 0 T 611 I Date: 7j , 6 5
TOTAL PERMIT FEE / qv 347- y g
Authorized signature: Thle permit application n 3
atr
tieta has pire Is u no within 180
Print name: Date: • Fee methodology set by Tri-County Building Industry Service Sparc)
" Number of inspections per permit allowed.
.
irAlluildinercrroits\ELOTcrrmlApp.eloc 12/05 oes-esirgionnicomewers .
CITY OF TIGARD
i BUILDING DIVISION PERMIT #: ELC2005 -00504
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/14/2005
Phone: (503) 639 -4171 lir
I nspection Requests (24 Hrs.): (503) 639 -4175 J _..
INSPECTION WORKSHEET FOR DATE: 7/26/2005 TIME: 7:07AM PAGE: 46
SITE ADDRESS: 12658 SW REMBRANDT LN CLASS OF WORK:
SUBDIVISION: BELLA VISTA LOT #: 022 TYPE OF USE:
PROJECT NAME: BELLA VISTA
DESCRIPTION: Temp power pole for trailer.
OWNER: RIVERSIDE HOMES, PHONE #: 503 - 645 -0986
CONTRACTOR: BEAR ELECTRIC PHONE #: 503 - 678 - 1355
Inspection Request Scheduled For: Date: 7/26/2005 Pour Time:
Code # In • - - 'an ' escrip io Confirm # Contact # Message
110 Temporary electrical service 012151 -01 503-678 -1355 N
Correctio ens .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6 '0 U Dater 1445 Phone #: (503) 718-
IIIW OF TIGARD . _ -1,(e Pi..t./14. f>12...e_ c aarq
BUILDING DIVISION PERMIT #: ELC2005 90504
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/14/2005
Phone: (503) 639 -4171 i,,z, 4,���, f �
Inspection Requests (24 Hrs.): (503) 639 -4175 ° `'1 L .
INSPECTION WORKSHEET FOR DATE: 7/19/2005 TIME: 7:08AM PAGE: 77
SITE ADDRESS: 12656 SW REMBRANDT LN CLASS OF WORK:
SUBDIVISION: BELLA VISTA LOT #: 022 TYPE OF USE:
PROJECT NAME: BELLA VISTA
DESCRIPTION: Temp power pole for trailer.
OWNER: RIVERSIDE HOMES, *- PHONE #: 5Q3 -615 -0986
CONTRACTOR: BEAR ELECTRIC PHONE #: 503-678-1355
Inspection Request Scheduled For: Date: 7/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
110 Temporary electrical service 011684 -01 503 - 678.1355 N
Corrections /Comments /Instructions:
T(2-0 %Qrt `t'•(). 0- Cramp V N RQ, 6 PE1IL--
;t<t...\1 10 SAID c>F'F►c .
V s S vc cill S Fba. P RsYstty (1 vreC
gt4b FEZ. -G pv9\3 c^. iks Sod ►v
E.%.,V 49.13 2 1 t 1) c d6s .
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
XFAIL V CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: &Ni • -S4 \- Dater N I C I 3( Phone #: (503) 718 -1 X14,