Permit CITY OF TIGARD • ELECTRICAL PERMIT
PERMIT #: ELC2008-00426
COMMUNITY DEVELOPMENT
DATE ISSUED: 7/24!2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 125DC -02400
SITE ADDRESS: 07020 SW VENTURA DR ZONING: R -4.5
SUBDIVISION: WASHINGTON SQUARE ESTATES LOT : 027 JURISDICTION: TIG
PROJECT: BROWN
Project Description: Altering (4) branch circuits for kitchen remodel.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 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: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 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:
RONALD BROWN MT HOOD ELECTRIC INC
MELGREEN, MELISSA PO BOX 1270
7020 SW VENTURA DR WELCHES, OR 97067 -1270
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 622 -1305
FAX 503 - 622 -1277
FEES
Description Date Amount Reg #: ELE 3 -517C
[ELPRMT] ELC Permit 7/24/2008 $66.80 LIC 147640
[TAX] 12% State Surchar 7/24/2008 $8.02 SUP 4828S
Total $74.82 REQUIRED ITEMS AND REPORTS
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 a obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332 2344
��✓ Issued By: , .� � ` � `��/ Permittee Signature:
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.
Jul 23 08 11:10p Mt. Hood Electric, inc 5036221277 p.2
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Electrical Permit ApplicationS F OR OFFICE USE ONLY
`J Tigard 1i
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Cl of Tigard Recei
r�O p /' 13125 SW Hall Blvd., Tigard, OR 97223 4 4 O D a Plan Rn R ��
. ' Pcmtt No : /l eview
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"' . Phone: 503 639 4171 Fax. 503.596.1960 0-
Ai ate/By: Other Permit TIGARD Inspection Line: 503.639.4175 LG to Ready/By: 1u s: B See Page 2 for
Internet: ww.ligard -or gov �`, O Nonted/Me ,r ./h Supplemental Information
TYPE OF WOR v\\.. PLAN REVIEW
I] New construction Addition/a[teration,replacement Please check all that apply (submit z sets of plan; u /liens c racked below).
❑ ❑ Service or feeder 400 amps or mere ❑ Building over three stories.
❑ Demolition Other:
where the available fault current ❑ Manua; and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 '.0 is or ❑ rloating buildings.
® I - and 2- family dwelling ❑ Commercial/industrial less to ground, or exceeds 14,000 ❑ Comn,c :cial -use agricultural
❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other ❑ Fire pump. Dltistallaiion of 75 KVA
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑' A ", ^B" °l •• 1 g^
Job no.' Job site address: 7020 SW Ventura Dr. 1001-1P or more, occopa
❑ Six or more residential units. 0 Recreational vehicle parks
City /State /ZIP: Tigard, OR ['Health facilities 1:1 Supply wltage for more than
❑ Hazardous locations. 600 volts nominal
Suite /bide /apt. no.: Project name: Cascade Cab ['Service or feeder 600 amps or store
FEE SCHEDULE
Cross street/directions to job site:
Description I Qty I Fee I Total
Nero residential single- or multi - family duelling unit.
Includes attached garage.
Subdivision: Lot no : 1,000 sq. ft. or less 145 15 4
Ea add'I500sq R. or portion 33.40 1
Tax map/parcel no.: _ Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. it)
Limited energy, multi- family
Kitchen Remodel - Alter4 exist circuits residential (with above sq. fl.) 75.00 2
Services or feeders installation, alteration, and%or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 'e l l / vN (4 er , n„ / 401 amps to 600 amps 160 60 2
. "' ��\ v � `� 601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts I I 454 65 2
City /State/ZIP: Temporary services or feeders installation, alteration. and/or
relocation
I Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2
Owner sinature: Date: Branch circuits — new, alteration, or extension, per panel
A Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch c.rcutt 6 GS 2
Business name Mt. Hood Electric, Inc B. Fee for branch circuits
withour service or feeder fee, 1 46.85
Contact name: Vitaliy Berezin first branch circuit 46.85 2
Address: PO Box 1270 Each add'I branch circuit 3 6.65 19.95 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Welches, OR 97067 Each manufactured or modulai I 90.90 2
dwelling, service and /or feeder
Phone: (503) 703 -2571 Fax. . (503) 622 -1277 Reconnect only 66 85 2
E -mail: mt.hoodelectric@verizon.net Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 53 40 2
Signal circuit(s) or limited.
Business name: Mt. Hood Electric, inc energy panel, alteration, or
Address: PO Box 1270 extension. Describe: Page 2 2
City /StaterZIP: Welches, OR 97067 Each additional inspection over allowable in any of the a bove
Per inspection 62 50
Phone: (503) 622 -1305 • Fax: (503) 6224277 Investigation per hot.r (1 lu ntin) I 62 50
CCB Lie.: 147640 Electrical Lic.: 3 -5I7C Suprv. Lic . 4828S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 66.80
Print name: Maurice Grcven q c: 7/23/2008 Plan review (25% of permit fee)
VVV - State surcharge (12% of permit fee). 8.0k
ifiA
Aut horized signature: TOTAL PERMIT FEE. 74.8411
Thi perm application expires if a permit Is not obtained within ISO
Print name: Date: 7/23/2008 e: Maurice Greven days after it has been accepted as complete.
— ' Number of inspections allowed ncr permit.
I :IBmldingrPern,'tstELC- Perm nAw dor 05!23,00 440 -46 i 51(11.05,COM'W5B
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: ELC2008 -00426
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/24/2008
Phone: (503) 639 -4171 h ,• • I A,
Inspection Requests (24 Hrs.): (503) 639 -4175 e1I �..
INSPECTION WORKSHEET FOR DATE: 8/21/2008 TIME: 7:02AM PAGE: 7
SITE ADDRESS: ()7020 SW VFNTURA DR CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE ESTATES LOT #: 027 TYPE OF USE:
PROJECT NAME: BROWN
DESCRIPTION: Altering (4) branch circuits for kitchen remodel.
OWNER: BROWN, RONALD PHONE #:
CONTRACTOR: MT HOOD ELECTRIC INC PHONE #: 503- 622_130E,
Inspection Request Scheduled For: Date: 8/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 074479 -01 503 -622 -1305 N
Corrections /Comments/ Instructions:
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0 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ ' ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ` N O8 Date: %. Z i Phone #: (503) 718- 1 t
•
CITY OF TIGARD 1
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 S , DATE ISSUED: 7 /2 013 00426
Phone: (503) 639 -4171 ,I 7 LC2 00f3
Inspection Requests (24 Hrs.): (503) 639 -4175 "I�..
INSPECTION WORKSHEET FOR DATE: 7/28/2008 TIME: 7:03AM PAGE: 8
SITE ADDRESS: 07020 SW VENTURA DR CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE ESTATES LOT #: 027 TYPE OF USE:
PROJECT NAME: BROWN
DESCRIPTION: Altering (4) branch circuits for kitchen remodel.
OWNER: BROWN, RONALD PHONE #:
CONTRACTOR: MT HOOD ELECTRIC INC PHONE #: 503 -622 -1305
Inspection Request Scheduled For: Date: 7/28/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electiical rough -in - 073304 -01 503-622-1305 G
Corrections /Comments /Instructions: \ R
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TLvo e co vNJ `V L - :rf E DI I,v o <:.
R. ,'v (LE_ (Z , . of �Z; cq p.E bF
s,-, \` I s csa .. -Na. . pi 143.52_
qecuYi I s&61A\\\0, NcePss (
0 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C-) NOG Lt; Date: 1' IA' 0J Phone #: (503) 718- 14