Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00422
COMMUNITY DEVELOPMENT
DATE ISSUED: 6/20/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103CA -02600
SITE ADDRESS: 11905 SW JAMES CT ZONING: R -4.5
SUBDIVISION: TRAVPORT PARK LOT : 006 JURISDICTION: TIG
PROJECT: PEDERSEN
Project Description: 200amp panel change and (3) branch circuits.
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: 3 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FOR: 0 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 0 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:
MARK & JODI PEDERSEN ALL THINGS ELECTRICAL INC
11905 SW JAMES CT 10004 NE 7TH ST
TIGARD, OR 97223 VANCOUVER, WA 98664
Phone: Contact #: PRI 360- 604 -0241
FAX 360- 604 -3025
FEES
Description Date Amount Reg #: ELE 37 -811C
[ELPRMT] ELC Permit 6/20/2007 $100.25 LIC 132095
[TAX] 8% State Surcharge 6/20/2007 $8.02 SUP 4665S
Total $108.27 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.
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Issued By: - j Ljj A l c� %" Permittee Signature: i2 A I c r )1
ow 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.
Jun 21 07 07:44a ALL THINGS ELECTRICAL INC 3606043025 p.1
44,
Electrical Permit Application FOR OFFICE USE ONLY
_:; . City of Ti alyd >l R r iv e d i° 5u rerroirNo.: E-LG2p0�„1�olza
r" 0 13125 SW Hall Blvd., Tigard, f • • ' �.,, -clan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T (CARD Inspection Line: Y50 . 63 .4175 CI 2U�7 Date Ready/By 11 4.-r� la Page 2 for
Internet: www.ti d or. ov JUN 2 (J N oti 6 ed,Method: � /}}} 1` // Supplemental Information
TYPE p p y p PLAN REVIEW
y�` Please c all that apply (submit 2 sets of plans %Y./items checked below):
❑ New construction *cAdditi e 1 Ma ce e `
I=1 B' D , S ❑ Service or feeder 400 amps or mart ❑ Building over three stories.
❑ Demolition Other ,� `N DIVISION 1 t' where the available fault current ❑ Marinas and bauyands.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. •
- Loss to ground, or exceeds 14,000 ❑ Commercial - use aaicultural
- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: Q Fire pump. ❑ Installation of 75 KVA or
JOB SITE IIVFORbfATIQN AND LOCATION 0 Emergency system. larger separately derived system.
❑ Addition ofnew motor load of ❑ "A ", "E ", `I -2 ", "l -3
lob no.: Job site address: /1010 5 5 J c+: IOO ormore sesi R occupancy. etion
/ 0.•'`'t'PS ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State!ZIP' ❑ health-care facilities. ❑ Supply voltage for more than
t yc{ vc � dIZ
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ripr
Dcs[ioo I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 145.15 4
Tax mapipareel no.: Ea. add'] 500 sq. ft. or portion 33.40 l
Limited energy. residential
DESCRIPTION OF WORK (with above sq. ft. i 75.00 2
Limited energy. multi - family
P75.00 2
C�y�,e C � _ te _ ? t/c5-4 � ley( - C k-1-� residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less + 80.30 iT 3 0 2
E. PROPERTY OWNER ❑ TENANT 20I amps to 400 amps 106.85 2
Name: Ni 401 amps to 600 amps 160.60 2
(� K P�'cl-e r 5 e 60I amps to 1,000 amps 240.60 2
Address: -S A _ ,) / r Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary 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
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
la APPLICANT I 0 CONTACT PERSON above service or feeder fee, 3
6.65 6. G /) each branch circuit
Business name: >(/ y 5 2
-
A 1 I �I4l vtl.(r , / C !i f i CG B. Fee for branch circuits
f without service or feeder fee,
Contact name: first branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling. service and /or feeder 90.90 2
• Phone: ( ) Fax:: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.4D 2
• j I , J je CONTRACTOR Sign or outline lighting 53.40 2
Business name: A' / 7 , nQ s F +� f . t'CC„ Signal circuit(s) or limircd-
I �t, C t energy panel, alteration, or
Address: / 0 (DQ £ ` 1 71-k 5j' ' extension. Describe: Page 2 2
City /State/ZIP: v ,, cow vex 1 V./ .4 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (2)) 6 0 (4- - D ?..!+ ) Fax: (3e ,662c f 3 C.'d.„ `7 Investigation per hour(' hr min) 62.50
/0 , CB Lie.: /3.z09 S Electrical 7 c,�// Suprv. Lie 1-/ 66 5 ' 5 Industrial plant per hour 73.75
I 7 .4. /0C).„ - ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required Q. Subtotal: /p QS"
Print name: V , 4 D�yv,v I Date: lc,/ 0:rte Plan review (25% of permit fee):
State surcharge (8% of permit fee): S3 , 0 ).
Authorized signature: TOTAL PERMIT FEE: j(8, -7
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.
l: 1 13uild ing'Permits\ELC- PerntnA3p.doc 05 /23/06 440- 4615T(11 /05 /CO,LVW'EB
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007-00422
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/2007
Phone: (503) 639 -4171 i t El�°
Inspection Requests (24 Hrs.): (503) 639 -4175 ,�' W 'IL
INSPECTION WORKSHEET FOR DATE: 6/26/2007 TIME: 7:00AM PAGE: 16
SITE ADDRESS: 11905 SW JAMES CT CLASS OF WORK:
SUBDIVISION: TRAVPORT PARK LOT #: 006 TYPE OF USE:
PROJECT NAME: PEDERSEN
DESCRIPTION: 200anzp panel change and (3) branch circuits.
OWNER: PEDERSEN, MARK & JODI PHONE #:
CONTRACTOR: ALL THINGS ELECTRICAL INC PHONE #: 360 - 604 - 0241
Inspection Request Scheduled For: Date: 6/2612007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
106 Underground/slab cover 050949-01 503. 572 -6017 ` V
cse\ c‘ci 1-4NAO - ve ..0 ..4k
rrections /Commen /Instructions.
- SAC VA( P� I'
l
X PASS n PARTIAL APPROVAL ❑ CANCEL NO ACCESS
I I FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: , V6e0 LE Date: to - 2O • 09 Phone #: (503) 718- V'