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Permit (58) CITY OF TIGARD ELECTRICAL PERMIT 44 COMMUNITY DEVELOPMENT Permit#: ELC2017-00607 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2017 Parcel: 2S114BD01000 Jurisdiction: Tigard Site address: 9920 SW RIVERWOOD LN Project: Nelson Subdivision: PICK'S LANDING NO.2 Lot: 71 Project Description: (2)branch circuits for heat pump installation. Contractor: NORMANDIN ELECTRIC Owner: NELSON, LISA K LIVING TRUST 51086 NW CLAPSHAW HILL RD 9920 SW RIVERWOOD LN FOREST GROVE, OR 97116 TIGARD, OR 97224 PHONE: 503-357-5380 PHONE: FAX: 503-357-4878 FEES Quantity Description Date Amount Specifics: 2 crt Branch Circuits wo/Purchase 08/15/2017 $63.60 Service or Feeder 1 ea 12%State Surcharge- 08/15/2017 $7.63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throug a°R'-- -00'+. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. War Issued By: �/ {� _ Permittee Signature: OA/ �!/ 'A/ i'I n 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' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 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. Electtrie Permit A p .canon -FIVE , 14311 01 1 U I I \I. 0\I.1 City of Tigard Received - • 13125 SW Hall Blvd..Tigard,OR 97223 is U( 2 01 T Aim x i /".(- 7 4 �, t r: "LC i/7-!)t 7 6 0 7 11 Phone: 503.718.2439 Fax: 503.598.1960 Inspection Line; 503.639 4175 `'3 q °' Related Per*4: i t i si f) Internet: Lille: C. T O Z IGA R ' y I?ateli y' Notthedllvsethod: / f l'J H see Petse 2 for Supplemental Infonn tadon Q New construction PLAN REVS Addition/alteration/replacement Please dick ail that apply(submit lsers of plans wiltems checked) Q Demolition Q Other: 0 Service or feeder 400 amps or more 0 where the available fault current. Marinag.Duraohtya stones. CYTEGOR OF CONSTRLGfION 0 Flo ting and boatyards. ,�.� exceeds 10,000 amps at 150 wits or 0 Floating 331-and 2-family dwellii 0 Co cial/industriats �Multi-family 0Accessory building less to t3r�m exceeds 14,000;: 0 4 ommear�ai-u�agricultural Q Master builder [�Other: ampsfor all other ineallarions. buildings_ JOB SITE INFORMATION AND LOCATION 0 Fire pump. 0Installation:of 150 KVA or //� O Addition of new motor load of ! larger separately derived Job#: Job site address: 7120 5j, ) f/�yj1 y aqe system ��/�/ Gf/ 10t3HP or more. 0"A","E",-1-2","2-3", City/State/ZIP: :` e r{ D q7Z , I 0 Six or more residential . Dewey. Suitelbldg./api.#: � I /,r / /�'1� ©x�-ire facilities, 0 Reeeatrottal vehicle parks. ProJ4xt name: 0 Hazardous locations. 0 Supply voltage for more than Cross shneetldlreetlorls to job site: 0 Service or feeder 600 amps or moue. 600 volts nominal, tam.SOIEDULE Descripttoa J Qty. 1 Earn I Taal I = Subdivision: New resideutlal single-or said-family dwelling unit Lot#: Includes attached garage. Tax rnag,'parcelf: l,000 sq.R.or less — 16&.54 4 DESCRIPTION OF WORK" — Ea add'i 500 sq.ft.or portion 33.92 l -ioLimited energy;residential 75.00 2 ill �e0 (with above sq.ft.) Limited energy multi-family 75.04 2 `� tC L1f f residential(with above sq.ff) PROPERTY0 OWNER 1 Renewable Energy 0 See Page 2 0 TENAN # Name: A K�. Servicers or feeders lsstit#latlou,aheratl4►tt,sad/t►r reloca un !v � 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 City/State/ZIP: 401 amps m boa amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 + 2 Email: Temporary services or feeders installation,alteration,and/or Owner installation:This installation is be' made on r00 amps o intended for sal lease, exchange, �according property that I own which is not 200 aolps of fess 59.36 I e, rent,or to ORS 447,449,670 and 701, 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 3 168.54 2 0 APPLICANT I C `CtA'VTALT>tE tSCtN Branch circuits— ,al roti n,or extension, r panel Business name: A Fee for breach ciresiits frith above serviceor feeder fee, Contact name: each branch circuit 7.42 2 B.Fee for branch circuits without ddress: service or feeder fee,f rst 1 56.1 8 f‘...1' 2 branch circuit ,47... ( CitylState/ZIP: Each add'i branch circuit / 7.42 I"�7 2 Phone:( ) E ::( ) Miscellaneous(service or feeder not included) 1 Each manufactured or modular ' Email: dwelling,service andtor feeder 67.84 2 s a £TQB` Reconnect only 67.84 2 . Pump or irrigation circle 67.84 2 Business name:/ e)//�,l/ , / ,,,:21 sign or outline lighting 67.84 2 Address:5—'16�6�,// 1� 6Ac,tg . / , a Signalnel,circuit(s)or limited-enrrgv Panel alteration,or extension. 0 See Page 2 2 City/State/Zip: r • �� p 76, Each additional inspection over allowable in any of the above /`,_ Additional inspection(1 hr min) 6625/hr Phone:( 357.5:1 FD Fax!(1�G 374 4 g 7� Investigation(1 hr min) 90.00/hr Email: /140)//7 j /� Industrial plant(I lir min) 78.18/hr p t tee,/i `-V t Inspections for which no fee is CCB Lic.:,� / er Electrical Lica-, 5 e,Suprv.Lic.g�- specif`aiIy listed(h hr min) 90_t3o/hr Suprv.Electrician signature,required: , ELICFRIGIlIEM}T FS / Half_ Subtotal: � bprintname /J`�...71 1 0 0 Plan Review Required(?5°!o of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: // Z 3 Print name: T Pest application expires if a permit is not obtained within 180 I}ate: days after it bas been accepted as complete. Number of inspections allowed per permit. 440-4615111IJQi/CGia41WE8 t- iPesmita�C PerteitApp ELR ERE.doc Rev�06/i7 15 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 9920 SW RIVERWOOD LN, TIGARD, OR, 97224 Record Type: Record ID: Residential - Electrical ELC2017-00607 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor