Permit r CITY OF TIGARD - ELECTRICAL PERMIT
" PERMIT #: ELC2007 -00431
COMMUNITY DEVELOPMENT DATE ISSUED: 6/22/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 110AD -06500
SITE ADDRESS: 10570 SW DEL MONTE DR ZONING: R -12
SUBDIVISION: LANG HILL NO.2 LOT : 057 JURISDICTION: TIG
PROJECT: SHERON
Project Description: (2) branch circuits for heat pump.
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: 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: 1 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:
LINDA SHERON SIMPSON ELECTRICAL CONST.
10570 SW DEL MONTE ST 2145 NE MCDONALD LN # C
TIGARD, OR 97224 MCMINNVILLE, OR 97128
Phone: 503 - 314 -8519 Contact #: PRI 1 -503- 472 -2530
FAX 1- 503 - 435 -0157
FEES
Description Date Amount Reg #: ELE 36 -82C
[ELPRMT] ELC Permit 6/22/2007 $53.50 LIC 133886
[TAX] 8% State Surcharge 6/22/2007 $4.28 SUP 5093S
Total $57.78 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. ou may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued : • /f / , /, R _/ • / Permittee Signature: _...)..9_,(_ / ka -WM
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 22 07 10:39a KEVIN IMPSON 503 - 435 -0157 p.2
4 i : <, FOR OFFICE. USE ONLY
. etrical Permit a` + tt el i
{ o s Received 7 Electrical
Date/By: �f e l)t Permit No.:t Electrical „._. -6()431
City of Tigard JUN 2 2 2007 Planning Approval Sign
Date/By: Permit No./
13 125 SW Hall Blvd. CITY OF TIGA I Plan Review Other
Tigard, Oregon 97223 agLg ®lVI f ®N Post R Post -Ry: eview Permit No.: �'C, ?,( --
Phone: 503 -639 -4171 Fax: 503-5v6-1 j '' Land Use
Internet: tuww.ci.tigard.or.us l e J l Date/By:
Caotta Case No.:
ntact See rage z for
24 -hour Inspection Request: 503 - 639-4175 "' ” " ``" Name /Method: Supplemental Information.
TYPE OF WORK ' PLAN REVIEW (Please check all that apply)
• n New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
El] Addition /alteration/replacement 0 Other: n Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF - CONSTRUCTION I & 2 family dwellings four or more residential units in
[1 1 & 2- Family dwelling (1 Commercial/Industrial El System over 600 volts nominal one structure
❑ Building over three stories 0 Feeders, 400 amps or more
n Accessory Building ❑ Multi - Family o Occupant load over 99 persons 0 Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan p Other:
JOB SITE INFORMATION and LOCATION - Submit ^ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: /(y - 7( c,� _ .) � V r 'l�l . St FEE* SCHEDULE
Suite #: Bldg. /Apt Number of inspections per permit allowed
' Project Name: Description Qty Fee (ea.) Total 1
New residential- single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 - 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: _ Lot # . Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK - service and/or feeder 90.90 , 2 ,
I f' 1 /^ Services or feeders - installation,
Y P 'ti CAYC Cut 1, ' i / (apCY I alteration or relocation:
200 amps or less 80 -30 2 —
A 1 L 201 amps to 400 amps 106.25 _ 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER 1 0 TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts _ 454.65 2
Name: J il k a ''- Vt'Irk Reconnect only 66.85 2
Address: 1()f >'1() , Sl',D ` 1 _- ir�1.. H Temporary services or feeders - installation,
? 6 , alteration, or relocation:
City /State /Zip: ) - � [r J6( b C 9 i a -i- / 200 amps or less 66.85 l
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of ' T
Address: service or feeder fee, each branch circuit 6.65 — CD ' 1
City /State /Zip: B. Fee for branch circuits without purchase of // -- CC��
service or feeder fee, first branch circuit 1. 46.85 if& 'dJ 2
Phone: Fax: Each additional branch circuit { 6.65 6 .46 2 I
E -mail:
Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) ora limited energy panel,
/i alteration or extension I Page 2 2
Business Name: �i ( Y \ - 1k_. f E l i (,.t7? / Co w p 1 o t Description• Il
Address: IJL )11 e \ v - Each additional inspection over the allowable in any of the above:
City /State/Zip: ,'k ( k), y Zn irit e � q7/`0- Per inspection per hour (min. 1 hour) ' ' 62.50 I
Phone:6 - ti -5 Fax: '5,0 Lr)j ()1 -7 Investigation fee:
Other:
CCB Lic. #: 1-3 s ic. #: t ��,, r S' 2 C Electrical Permit Fees*
Supervising electrician Subtotal $ 5 3 , r
signature required:
an Review (25% of Permit Fee) $
i f Print Name: 4t) i II S)/1 S - Lic. #: dajci ~'j 7 State Surcharge (8% of Permit Fee) 5
TOTAL PERMIT FEE $ $ tt --; f
Authorized Notice. This permit application expires if a permit is not obtained within
Signature: Date: 180 days after,it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i \Dsts\Permit Forms \ElcPermitApp.doc 01/03
CITY OF TIGARD
BUILDING DIVISION p-W w1gA PERMIT #: ELC2007 -00431
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/22/2007
Phone: (503) 639 -4171 • 4 1L � e o������b4Ni ��i i A _ II
Inspection Requests (24 Hrs.): (503) 639-4175 . _.. `_
INSPECTION WORKSHEET FOR DATE: 8/1612007 TIME: 7:00AM PAGE: 64
SITE ADDRESS: 10570 SW DEL MONTE DR CLASS OF WORK:
SUBDIVISION: LANG HILL NO.2 LOT #: 067 TYPE OF USE:
PROJECT NAME: .SHERON •
DESCRIPTION: (2) branch circuits for heat pump.
OWNER: SHERON, LINDA PHONE #: 503-3148519
CONTRACTOR: SIMPSON ELECTRICAL CONST. PHONE #: 1- 503-472 -2530
Inspection Request Scheduled For: Date: 8/16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 053917-02 503- 314 -8510 N
Corrections /Comments /Instructions: ..-)\—'\''''''
•
pkt PASS n PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
I I FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: V 0 Date: t/C i 07 Phone #: (503) 718- •