Permit `. , 'a•,� CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00327
1 . 4 COMMUNITY DEVELOPMENT DATE ISSUED: 5/14/2007
'T It 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
agoirommowl PARCEL: 1S134BD - 08000
SITE ADDRESS: 11652 SW PENN CT ZONING: R - 4.5
SUBDIVISION: PENN LAWN ESTATES LOT: 008 JURISDICTION: TIG
PROJECT: HELD
Project Description: Branch circuit for heat pump.
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: 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:
HELD MOLLY SIMPSON ELECTRICAL CONST.
11652 SW PENN CT 2145 NE MCDONALD LN # C
TIGARD, OR 97223 MCMINNVILLE, OR 97128
Phone: 503 - 524 - 4637 Contact #: PRI 1- 503 - 472 -2530
FAX 1- 503 - 435 -0157
FEES
Description Date Amount Reg #: ELE 36 -82C
[ELPRMT] ELC Permit 5/14/2007 $46.85 LIC 133886
[TAX] 8% State Surcharge 5/14/2007 $3.75 SUP 410 -S
Total $50.60 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued B ' 0' /� iut_ Permittee Signature: .12_,12_, T1- r j �
OWNER INSTALLATION ONLY /-
b. 61,-1 The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY •
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
May 14 07 08:24a KEVIN IMPSON 503 - 435 -0157 p.1
`1e a ical Permit A lication
' 1 74 614FORkQFFICE ,USE ONLY4
B Received c . Al Electrical
ti � �^ ,, . - , Date/By: 5 / I , 4 / 3 JNV Permit No.: 1-� - (�32, -, ii City of Tigard ' a. • v 1 r Plannin Appr Si
Y_� ME � — 00 271
g Plan Review Permit No.:
13125 SW Hall Blvd. Plan Review Other 11
Tigard, Oregon 97223 HAY 1 , ' • i I Date/By: Permit No.:
Post - Review Land Use
Phone: 503- 639 -4171 Fax: 503-598-1960 e iy t 1 eta Date /By: Case No.:
Internet: www.ci.tigard.or.us C`. i ) 4 )/. ='k; I F.
.s y, 1. Contact . ®Sec Pa 2 for
24 -hour Inspection Request: - X0„3 i 6.39r4.1,75tn T$ . � TI Name/Method: Ju 1 C-65- s Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ S ervice over 225 amps- ❑ Health -care facilit
❑ ew construction Demolition Y
commercial ❑ Hazardous :ocation
lacement ❑ Other:
Additionfalteration /rep ❑ Service over 320 amps-rating _ of 0 Building over 10,000 square feet.
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
m‹ 2- Family dwelling ❑ CommerciaL'Industrial ❑ System over 600 volts nominal one structure
12 El over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi-Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
n Master Builder n Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: J �� c) j,l 1 v er b -, C•{- FEE* SCHEDULE •
Suite #: I Bldg. /Apt.#: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total i
Cross street/Directions to job site: New residential - single or multi- family per
J dwelling unit. Includes attached garage.
Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq, ft. or portion thereof 33.40 I
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling I
DESCRIPTION OF WORK service and /or feeder 90.90 2
Services or feeders - installation,
1 1 c ; .'t f jk,t. /1 ?/) ( ..(...L.f alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER i ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: /1'1)1144 �� ? - (1 Reconnect only 66.85 12
{ L
Address: f j b (,, . f " y Cy Temporary services or feeders - installation,
City/ State/Zip: lteration, or relocation:
p: ' 1 i 7, L/L Ci ox 200 amps or less 66.85 1 I
Phone: t3 � ti — q X5 Fax: 201 amps to 400 amps 100.30 2 1
401 2
El APPLICANT circuit APPLICANT ❑ CONTACT PERSON to r 133.7_
Branch cs -new, alteration, or
Name: extension per panel:
Address: A . Fee for branch circuits with purchase of
service or feeder fee, cacti branch circuit 6.65 2
City/State/Zip: B. Fee for branch circuits without purchase of �(� �
service or feeder fee, first branch circuit t 46.85 if'�, b 5 2
Phone: I Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
<• • alteration, or extension Page 2 2
Business Name: 31 iy �� �' c. iN ,.� Cm-; I' D escr i p ti on:
:9-1 -, k. irk ( .')1(. � jd c .jr 0
Each additional inspection over the allowable in any of the above:
Cityi State /Zip: m ( t q - 7/9 4 Per inspection per hour (min. 1 hour) • 62.50
Phone: 503 —‘174-3-534.) Fax: 031 5-7 Investigation fee:
CCB Lic. #: Lic. #: 36- ga L Other:
3a d r0 Electrical Permit Fees*
Supervising electrician ! S W'.5 signature required: C Plan Review (25V0 of Permit Fee) S ' , 75
Print Name: . Al ,1b.. Lic. #: p State Surcharge (8% of Permit Pee) I $
TOTAL PERMIT FEE I $ . j, (p(J
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\ElcPcrmitApp.dac 01/03
CITY OF TIGAIRD
BUILDING DIVISION PERMIT #: ELC2007.00327
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5114/2007
Phone: (503) 639 -4171 rs1lil
Inspection Requests (24 Hrs.): (503) 639 -4175 :
INSPECTION WORKSHEET FOR DATE: 6/21/2007 TIME: 7:03AM PAGE: 104
SITE ADDRESS: 11652 SW PENN CT CLASS OF WORK:
SUBDIVISION: PENN LAWN ESTATES LOT #: 008 TYPE OF USE:
PROJECT NAME: HELD
DESCRIPTION: Branch circuit for heat pump.
OWNER: MOLLY, HELD PHONE #: 503 - 534-4637
CONTRACTOR: SIMPSON ELECTRICAL CONST. PHONE #: 1- 503.4/2 -2530
Inspection Request Scheduled For: Date: 6/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 050463 -01 503 -524 -4637 N
T .—
Corrections /Comments/ Instructions:
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K PASS VA PARTIAL APPROVAL n CANCEL n NO ACCESS
n FAIL a ALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspecto _ — �� Date: C Z% Phone #: (503) 718- 2&-/7