Permit ELECTRICAL PERMIT
r •�',° CITY " TIGARD PERMIT #: ELC2008 -00388
COMMUNITY DEVELOPMENT DATE ISSUED: 7/8/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 115AD -04800
SITE ADDRESS: 16700 SW 108TH AVE ZONING: R - 4.5
SUBDIVISION: DOVER LANDING LOT: 031 JURISDICTION: TIG
PROJECT: NESVOLD
Project Description: Installing (1) branch circuit for ceiling fan.
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: SIGNAUPANEL:
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: d--. 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:
JUDY NESVOLD PARKIN ELECTRIC INC
16700 SW 108TH AVE 14001 FIR STREET
TIGARD, OR 97224 OREGON CITY, OR 97045
Phone: Contact #: PRI 503 - 657 - 4958
FAX 503 - 557 -1059
FEES
Description Date Amount Reg #: ELE 34 -4C
[ELPRMT] ELC Permit 7/8/2008 $46.85 LIC 35151
[TAX] 12% State Surchar 7/8/2008 $5.63 SUP 4241S
Total $52.48 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 By ' _ �% Permittee Signature: .... r.--_ i� � /G /
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.
r ... 07/07/2008 MON 13: 39 FAX 002/002
, 'Y ik
Electrical Permit Application ®® FOR,oFFCCE usE ONLY
City, of Tigard a ate /13Y � �p
f: .lr.... — Permit No.' �I�/ y.
rtl
- -Go 199
't 13125 SW Hall 131vd.,'I igard, OR 97223 Plait Rev
Phone: 503.639.4171 Fax: 503.598,1960 therPennic
JUL J U L 0 7 2 Q} Tvate / ; _ vv _ _
TIGARD Inspection One: 503.639.4175 Date Ready /13y: Janis: Ell See Page 2 for
- Internet: www.tigard- or.gov btif r lYY ed/Mediod• -r�^/; Supplemental Information
TYPE OF wo � o iILDl l G nlv,s1®!`j - PLAN REVIEW
❑ New construction Addition /alteration /r cplaccment Please •
check all that apply (submit 2 sets of plans w /items checked below):
['Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION . . exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
I - and 2- faintly dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings.
[1] Multi-family ❑ Master builder El Other: ❑ Fire pump. 0 Installation of 75 KVA err
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor road of ❑ "A ", "E- ", "1 - 2", "1 - ",
Job no.: Job site address: -7 / jj 4s- 100HP or more occupancR
O / oV — ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 1 ,• �,,� y '70';V ❑ Health-care facilities. ❑ Supply voltage for mote than
1 ( ' ./ / ❑ Ilazardous locations. 600 volts nominal,
Suite /bldg. /apt. no.: Pr r ect name: fez ❑ Service or feeder 600anipsormore.
FEE SCHEDULE
Cross street /directions to - job site: Description 17)7, J I'rr. ( 'total 1 • _
New residential single- or multi - fancily dwelling unit.
I Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R. or less 145 15 4
- - --- .III_ - - -_ --- - Ea. edd'1 500 sq. R. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above s<Ln� ___ __- -____
Limited energy, multi- family
C Z C6i /j 7 — residential (with above sq. ft.) 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: JLA 5110 g 401 amps to 600 amps — 160.60
— - /� 601 amps to 1,000 amps 240.60 2
Address: 1 7 QO / o8 — N -- — _— Over 1,000 amps or volts 454.65 2
City /Slate /ZIP: y services or feeders
Temporary installation, alteration, and /or
r����, oK 9�aay relocation _
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 signature: Date: Branch circuits - new, alteration,, or extension, per panel
___ -- — A. Nee for branch circuits will
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
- -� -'— each branch circuit 6.65 2
Business name: - --
. — Tv__-_- _-.. -. -. - 13. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 y/0 2
first branch circuit
Address: Each add'I branch circuit 6.65 2 •
' --- ---- -- • Miscellaneous (service or feeder not included)
City / Stale /ZIP: Each manufactured or modular
90.90 2
Phone: ( ) Fax:: ( ) dwelling, service and /or feeder —
Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2 j
CONTRACTOR ' Sign or outline lighting 53.40 2 '
Business name: } yy , c � L C , -- Signal circuit(s) or limited-
a l Lt_u energy panel, alteration, or
Address: v 40. 1 F 1r ,St rat ) ] � extension. Describe: Page 2 2
City /State /ZIP: oK' Gn1'I l � t Ore G ( 10 Z 5- _Each additional inspection over allowable in any of the above
_.__- —_
Phonc: (SD3 57 `, (5g Fax: ( 03) 5 IU5�1 Per inspection 62.50 — -
i ^ Investigation per hour () br min) 62.50 1
CCB Lic.: 35 1 G) I Electrical Lie.: J Li _ till s um. Lic.: %ago , i j hlduslnal plant per hour' 73.75
di 1 - ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ,,,, I
.,
��a I" Subtotal: y‘, 8$
� Date: - Plan review (25% of permit fee):
Print name:
Day V l d --pox }C l +� -- - ,._,.- State surcharge (12% of permit fee): 5. 6, 3
Authorized signature: TOTAL. PERMIT FEE: 59 41 t
- Print name: Date. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Number of inspections allowed per permit.
I V3uitdingV'cnnit wLC•PenniiApp,dac 05/23/06 440- 4615T(I I /05 /COMAVGa
CITY OF TIGARD
BUILDING DIVI$i6N • PERMIT #: ELC200B-00388
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/8/2008
Phone: (503) 639 n•1m t 1 +I
Inspection Requests (24 Hrs.): (503) 639 -417 III..,
INSPECTION WORKSHEET FOR DATE: 7/15/2008 TIME: 7 :00AM PAGE: 47
SITE ADDRESS: 16700 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: DOVER LANDING LOT #: 031 TYPE OF USE:
PROJECT NAME: NESVOLD
DESCRIPTION: Installing (1) branch circuit for ceiling fan. 7/11/2008 ADDED (2) branch circuits.
OWNER: NESVOLD, JUDY PHONE #:
CONTRACTOR: PARKIN ELECTRIC INC PHONE #: 503-657-49,58
Inspection Request Scheduled For: Date: 7/15/2008 Pour Time:
Code # Inspection Description Confirm- Contact # Message
199 Electrical final \ -U1 503-657-4958 N
Corrections /Comments /Instructions:
i5 t ,v1 d
•
WA
•
0 PASS I I PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
[� IL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � Is3e LE Date: 1,16 Phone #: (503) 718- Vi