Permit CITY or 'TIGARD ELECTRICAL PERMIT
'PI PERMIT #: ELC2008 -00637
COMMUNITY DEVELOPMENT
DATE ISSUED: 11/17/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103 BA -00114
SITE ADDRESS: 11825 SW ANN ST ZONING: R -4.5
SUBDIVISION: LERON HEIGHTS LOT : 014 JURISDICTION: TIG
PROJECT: EEFSEN
Project Description: Service installation.
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: 1 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:
MARIE EEFSEN PARKIN ELECTRIC INC
11825 SW ANN ST 14001 FIR STREET
TIGARD, OR 97223 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 11/17/2001 $80.30 LIC 35151
[TAX] 12% State Surchar 11/17/2007 $9.64 SUP 4241S
Total $89.94 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: f_ i/ Permittee Signature: ,p� cn i✓
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
11/17/2008 MON 10:09 FAX -•--. City of Tigard 2002/002
, 0.
Electrical Permit A liCat 'cIJ 'ED — — ------ F;�OR- OFE'ICEUSE`ONLY
City of Tigard L lzeees, -ed ' j r „tut Ne.: 3 7
.t Date /13y: ,
M ill
13125 SW (Mall Blvd., Tigard, OR 97223 200$ Plan Review
21 : Phone: 503.639.4171 Fax: 503.598.1 ®V Date/By: OtherPeimir.
TIGARD Inspection Line: 503.639.4175 R D D ate Ready /By: leas' 61 See Page 2 for
Internet: www.tigard-or.gov
CV QFTIG�+ ON Notified/method. Supple Information
TYPE OF viv o() PLAN REVIEW
Q New construction gAddit ion /alteration /replacement 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.
Demol10011 ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
g] I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", °ti ", "1- 2 ", "1 -3 ",
Job no.: Job site address: I i 8075 5 4r - ) 10011P or time occupancy.
❑
fQi( ❑ Ste of more residential units. Recreational vehicle pat ks.
City /State /ZIP: '' a , O R ❑health -care facilities ❑ Supply voltage for more than
--- _._�_� /_. l/ ❑ Hazardous locations. 600 volts nominal.
I10.:
f
Suite/bldg./apt. r I t [ Project name: �� C/�/ ❑ Service or feeder 600 amps or more.
..,_.
FEE SCHEDULE
Cross street /directions to rob site' Description 9tY. Pcc. 1 '1'olal 77
New residential single- or multi- family dwelling unit.
_ Includes attached garage.
Subdivision. — —_ Lot no.: 1,000 sq. ft. or less 145.15 4
________ . — Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: ___ Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq, (t.)
-
Limited energy, multi- family 75.00 2
�Q� t � I 4 (JZ tesidenhal (with above sq. 0.) _
Services or feeders installation, alteration, and /or relocation
.___- 200 amps or less 1 80.30 60,30 2
jg PROPERTY OWNER . '❑ TENANT 201 amps to 400 amps 106.85 2
• Name: 40 ��� —^ 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 11 _Jij _GA.) 4-nn Over 1,000 amps or volts 454.65 2
City/State/ZIP: 77 ,4 �4 Tempora services or feeders installation, alteration, and /or
/ 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. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service of feeder fee, 6.65 2
— each branch circuit
Business name:
_ 13, Fee for branch circuits
• Contact name: without service or feeder fee, 46.85 2
first branch circuit
• Address: Each adtl'I branch circuit 6.65 2
Miscellaneous service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2 .
dwelling, service and /or feeder _
. Phone: ( ) Pax:: ( ) Reconnect only 66.85 2
E-mail: —
•
Pump or inigation circle 53.40 2
CONTRACTOR . ' Sign or outline lighting 53.40 2
Business name: �a.� 4 E l i e`.,_I ne _ Signal eirenit(s) or limited -
energy panel, alteration, oI
Address: ,4l l0 I F C-�--ra-�• extension. Describe. Page 2 2
City /State /ZIP: O / D11 l'i i. t, 0 V q �OL�S - Each additional inspection over allowable in any of the above
V J Per inspection 62.54
� ) V L Pa ( ) C C � �
Phone: ( —
�' / �U ? 1 - nvestigatiarperhour(lhrmin) 62.50
-- ? S 1 31 4 _ p7y/ 1 In dustrial plant per hour 73.75
3 5 503 55 —
C PP Lie.: g g lectrical Ltc.: Suprv. Lie.:
T�;LECTRICAL PERMIT FEES
Sup! Electrician sl nature, re uited: A' � , � I. Subtotal - aQ r f
— Plan review (25% of permit fee).
Print name :1) 1 d ,e, . --pw, (G, 1.v Date: .—
-- _. ___ _ Slate surcharge (12% of permit fee). q . ( y
. Authorized signature: TOTAL PERMIT FEE: 1 67, y y `
This permit application expires if a permit is not obtained within 180
Print name: Date:
days after it has been accepted as complete.
° Number of inspections allowed per permit.
1 \Bo tiding 1 Permits 1ELC -Perm it App doe 05/23/06 440 - 4015'1'(1 I /05 /CO\MAVttB
.- 111111 '
CITY OF TIGARD -
1 BUILDING DIVISION PERMIT #:
i
E 0f1
LC20-00637
DATE ISSUED:
13125 SW Hall Blvd., Tigard, OR 97223 ,
1'1/1712008
Phone: (503) 639-4171 j
Inspection Requests. (24 Hrs.): (503) 639-4175 .4.161■ `' l ....
INSPECTION WORKSHEET FOR DATE: 11125000 TIME: 7 PAGE: 42
SITE ADDRESS: 1 126 SW ANN ST CLASS OF WORK:
SUBDIVISION: LFRON HEIGHTS LOT #: 014 TYPE OF USE:
PROJECT NAME: EEFSEN
DESCRIPTION: s erv i ce i
OWNER: EEFSEN, MARIE PHONE #:
CONTRACTOR: PARKIN ELECTRIC INC PHONE #: 503-657-4958
Inspection Request Scheduled For: Date: 11/2&2008 Pour Time: ) 1 S
Code # Inspection Description Confirm # Contact # Message
115 Electrical service 078451 503 N
Corrections/Comments/Instructions:
l
....,..11■.- /
PARTIAL APPROVAL 0 CANCEL El NO ACCESS
FAIL ig CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector:. . A,AIIIIIIIIIL,._ Date: 1/ S .11 Phone #: (503) 718-
f �
CITY OF TIGARD ,• v4,. '; ,z. '=).
BUILDING DIVISION A ° % PERMIT #: ELC2008-00637
13125 SW Hall Blvd., Tigard, OR 97223 V1; DATE ISSUED: 11/.170 008
Phone: (503) 639 -4171 ���u� i ° T \
Inspection Requests (24 Hrs.): (503) 639 -4175 � L
INSPECTION WORKSHEET FOR DATE: 11/19/2008 TIME: 7:02AM PAGE: 21
SITE ADDRESS: 11825 SW ANN ST CLASS OF WORK:
SUBDIVISION: LERON HEIGHTS LOT #: 014 TYPE OF USE:
PROJECT NAME: EEFSEN
DESCRIPTION: Seivicc installation.
OWNER: EEFSEN, MARIE PHONE #:
CONTRACTOR: PARKIN ELECTRIC INC PHONE #: 593- 657 -4958
Inspection Request Scheduled For: Date: 11/19/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
'115 Electrical service 078242 -01 503 -657 -4958 N 3 1 l
Corrections /Comments /Instructions:
1 r 16/1 / 444 AV L60
P ' .
.7 (mut,' # iwg 1144x AiLs-,-___Lic
n PASS PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
X AIL CALL FO INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718 -
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: -,&- 8 z)G3? REQUIRED ON GREEN INSPECTION CARD.
✓ Code Inspection Description PASS Dale BT BT-I Code Inspection Description PASS Date B
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
_ 415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG- Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post /beam structural 150 Hot tub /spa /pool
230 Underfloor insulation , Misc. inspection:
•
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
. 260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG- Structure set -up MEC - Mechanical Permit
280 Insulation 605 Post /beam mechanical
285 - Drywall nailing 610 Gas line
287 Suspended ceiling _ 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final _ 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post /beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 322 Shower pan
999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert /catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinlder supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
I:\ Building \Forms \InspCard- AOP- Blank.doc 02/02/07
• n ELECTRICAL PERMIT
CITY OF TIGARD
PERMIT ISSUED: ELC2008-00637
COMMUNITY DEVELOPMENT
DATE ISSUED: 11/17/2008
TtGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103BA -00114
SITE ADDRESS: 11825 SW ANN ST ZONING: R -4.5
SUBDIVISION: LERON HEIGHTS LOT : 014 JURISDICTION: TIG
PROJECT: EEFSEN
Project Description: Service installation.
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: 1 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:
MARIE EEFSEN PARKIN ELECTRIC INC
11825 SW ANN ST 14001 FIR STREET �_
TIGARD, OR 97223 OREGON CITY, OR 97045 l'4\"111
Phone: Contact #: PRI 503 - 657 -4958 • T .
FAX d 9 . •
FEES
Description Date Amount Reg #: ELE 34 -4C O
[ELPRNfT] ELC Permit . 11/17/2001 $80.30 LIC 35151 0
[TAX] 12% State Surchar 11/17/200! $9.64 SUP 4241S CO
Total $89.94 REQUIRED ITEMS AND REPORTS
O
w
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 'V
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: 1 /
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.