Permit V �
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ELECTRICAL PERMIT
CITY OF TIGARb PERMIT #: ELC2007 -00482
, . COMMUNITY DEVELOPMENT DATE ISSUED: 7/16/2007
T I G A R D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S102BD -00904
SITE ADDRESS: 09985 SW WALNUT ST ZONING: R -12
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT : 006 JURISDICTION: TIG
PROJECT: PELLETIER
Project Description: Reconnect
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS.AREA/SPEC OCC:
Owner: Contractor:
PAXMAN, SUSAN + MID WEST HEATING LLC
NATION, KURT 2872 SE BRENT
6003 SW CORBETT AVE HILLSBORO, OR 97123
PORTLAND, OR 97201
Phone: Contact #: PRI 503 - 640 - 5197
FEES
Description Date Amount Reg #: ELE C87
[ELPRMT] ELC Permit 7/16/2007 $66.85 LIC 165491
[TAX] 8% State Surcharge 7/16/2007 $5.35 SUP 1285S
Total $7210 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 99 or 1.800.332.2344.
Issued By: o S Permittee Signature: W
C
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.
Electrical Permit Ap � � FoR OFFICE SE ONLY
I
h ation _ _
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City of Tigard 'Cr' , Received -, x 9,„
N
q g £ � p Date/ /R % 1 J Permit N./ / i - 00
p
13125 SW Hall Blvd , Tigar 97223 Plan Rev w
IQ Phone: 503 639.4171 Fax 503.598.1960 Date/B • Other Permit
TI G A R D Inspection Line. 503.639.4175 jU L 1 6 2007 Date Ready /By lunsc El See Page 2 for
Internet www tigard -or gov v a Notified/Method Supplemental Information
T 'P �FNW* I i6 !`l ) PLAN REVIEW
❑ New construction �j DI i 'Fi1S/teDIa & ION Please check all that apply (submit 2 sets of plans %querns checked below)
3 f V rJt 1 ❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ Demolition Other: where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
,$(1- 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 denved system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: y-f �� �� /� �� ❑ S ix or Six or or more occupancy
❑ p
Y more re residential units Recreational vehicle parks
City /State /ZIP: - /0 . 5.- A �p ❑ Health -care facilities 0 Supply voltage for more than
❑ 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: Description I Qty. I Fee. I Total I •
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 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft ) 75 00 2
Limited energy, multi - family 75.00 2
— residential (with above sq ft )
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
Nam 9X �, 401 amps to 600 amps 160.60 2
" ' i /- � - f l // 1 1 - L- - 601 amps to 1,000 amps 240 60 2
Address: ✓ Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
-- relocation
Phone: ( SZ23) 7'o 9— 3 . / Fax: ( ) 200 amps or less 66 85 1
Owner installation: This installation n 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 or feeder fee,
each branch circuit 6 65 2
Business name: B. Fee for branch circuits
Contact name: witho service or feeder fee, 46.85 2
first branch circuit
Address: Each add] 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: ( ) Fax: : ( )
Reconnect only i 66 85 2
E -mail: Pump or irrigation circle 53 40 2
C I N . • • 4 Sign or outline lighting 53.40 2
Business name: 4 rte/ / r Signal circuit(s) or limited -
C f .0" 1 1 A k energy panel, alteration, or
Address: e f 7 f 6 A h�/ O extension. Describe Page 2 2
4 City /State /ZIP: + f . / i- 0 z � Each additional inspection over allowable in any of the above
1111 Per inspection 62.50
�)
Phone: t ) G `/6 - / qi 7 I Fax
( ) •1 % I \ O
Investigation per hour (1 hr min) 62.50
CC 6 i lectrical Lic.: C f'7 Suprv. Lic.:/2, 5 5 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician sigrr viequired: r h �t W f. k . T- / t Subtotal: &( .y� Print name: Z. N Date: -7/4‘,--...07 Plan review (25 %of permit fee).
State surcharge (8% of permit fee). ..� 35
Authorized signature: AGd/ TOTAL PERMIT FEE: -73%. .. 4..) Print name: This permit application expires if a permit is not obtained within 180
Date: � ��C17 days after it has been accepted as complete.
• Number of inspections allowed per permit
I \ Bwldmg\Permits\ELC- PermitAppdoc 05/23/06 440- 4615T(II/05 /COM/WEB
1 I
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00482
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/16/1007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 'I �..
INSPECTION WORKSHEET FOR DATE: 7/18/2007 TIME: 7:01AM PAGE- 24
SITE ADDRESS: 09985 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT #: 006 TYPE OF USE:
PROJECT NAME: PELLETIER
DESCRIPTION: Reconnect
OWNER: PAXMAN, SUSAN +, PHONE #:
CONTRACTOR: MID WEST HEATING LLC PHONE #: 503 - 640.5197
Inspection Request Scheduled For: Date: 7/18/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 99 Electrical final 052256-01 503-640-5197 Y
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL [1] NO ACCESS
FAIL ❑CALL FOR INSPECTION
III ADDITIONAL FEES ASSESSED
Inspector: 14R(`).4..A Date: Phone #: (503) 718 -