Permit UI1`�\ - ..Fr_, CITY OF TIGAR® •
ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT#: ELC2007
DATE ISSUED: 11/9/2007
'TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S1 11 AD - 16600
SITE ADDRESS: 09033 SW WESTLUND CT ZONING: R -4.5
SUBDIVISION: MALLARD LAKES LOT : 032 JURISDICTION: TIG
PROJECT: MEDINGER
Project Description: Replace AC, furnace and 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: 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:
i
Owner: Contractor: ■
MEDINGER, JOANNA EILEEN JACOBS HEATING AND NC
9033 SW WESTLUND CT 4474 SE MILWAUKIE
TIGARD, OR 97224 PORTLAND, OR 97202
Phone: 503 - 598 - 3933 Contact #: PRI 503 - 234 -7331
FAX 503 1 SOg' °1
FEES
Description Date Amount Reg #: ELE 26- 807CRE
[ELPRMT] ELC Permit 11/9/2007 $53.50 LIC 1441
[TAX] 8% State Surcharge 11/9/2007 $4.28
SUP 704LHR
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. 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: � •
7
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.
. „ 41
i . . 4
Electrical Permit Application IOR OFFICE 1,SL ONLY
City of Tigard D
r Rectcv ntII Ia •42
d Phone: 503.639.4171 Fax: 50 t l:CO 7 DareB .
I I t A Ic a Inspection Line: 503.639 4175 ' ` "' Dale Ready/By. eReady/By. Ready/By. lust: gee Page 2 fur
Internet www.tigard- or.gov t.IQV 1 r9 'ZOQ I , Notified/Methnd I Supplemental Information
t "'Y "»�� ' f� , : lir..,Y a.l 3' 2f4ti': it " a Cl, � ,1 r Y: '-C +. i� �j ii i l 1 j l � 1'/ ii• r xv i ,:� j �, r �, , r?� 1�t'A` `�.3�P au�dir3 �
��7'u'+wvrl vv i , 1 ;I 11l' 1.. •w r , i 't� ��M1 ;�i��
', Illi ifn f tilj l � ' .'. � I lt ll X 11 l,, fi r` • t, uy'i.} J r . :r.�.' �.1ir'-',ic I I ,, - O .5; i i1 n !t1: N i ii 41 rL " '"IA''tAl +r I °!''j;: 11,� �n1 ppi'er Lf`.� fifitgg�� 1 • rr - t�.l - . .i._ - :r,t.,. h l -' i : .. „,:�1i'Ydi . Q (R- plans rrtclac11 • bole w)'
J
❑ New construction 17 Add --. ,,+, i r ,” . Please chock all that apply (submit sere orplaoa wlitema checked bolaw)
■ ❑ Service or feeder 400 amps or more D Building over three stories
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards.
r
rr trt+ 1 n,iltn rt in-x,r { ( - ..u: a. t 1 , : H'fi fur ein,••' ^cis
1 +trt!,+II, ,; �.t }a it �" ,�, o,f I dx �, r e1` ' r c- 1, 4 �� I v- 1 t � a, , � a 1 +,,, exceeds l0 000 amp at lSO volts or ❑ Floating buildings. .y l f F _ ,Le....rll •t .^ "r., ,a. ,-x a2, a . :;_:Z ,.1,,...r,, I ' ili� >� r o- , �a 3i''w I��I.L';,�1tlten . I + k ro Micros, o sexes 14,000 ❑ Commercial -use agricultural
V 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building amps for all other installations, buildings.
❑Multi family 11 Master builder 0 Other: ❑Fire pump O installation of75KVAor
r + p,1 y 1,2 „,,,•,jl I t f r a L,- ,a.p ;wc.rr y ` -4 I t r ti al t. +vr 4 • rfl„ , t I I i t +r ,, rv„ ❑ Emergency system larger separately derived system.
3 r,.1 p�� t li p t L i is i�r •Pu a u ? ..:.,1'9 ` na.. +_ i,cli'eSi a• . f , �...,. il 1 I ” ,..+: I if I ❑Addition of new motor load of
Job no.: /6 Job site address: / D lA) u n t lid' et re residential ocwpa oY
�■ ❑ Su or more residential units, ['R vcbicW parks
0 Health -care facilities 0 Supply voltage for more theta
City/ State/ZIP: i+ d 9 / ZZ 0 Haeardoua locations 600 volts nominal.
Suite/bldg. /apt. no.' Project name; ❑ Stay or feeder 600 amps or more
sat i7• -i',ij ,V vF 1 . '1.',,4•,- ;-:>I tr itW e. UurV :!tM
Cross street/directions to job site: Description gat res Total •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Es. add'l 500 so. ft or portion 33.40 1
Tax map /parcel no
,1,r tl � , r 1, v. vl Cr'w ,r r nrle w Y� Iw,�uurtau�., Ill �Sv.1449,•' �1 ea'ijr� p M „� t.07 � � Limited energy. residential
n1 , v o 1 t sal v rap{ t' 75.00 2
E ' '.al ' l i .!!t�r �, E ,i.;itiit1,I10),� 1 �1 H ; 4 (, IV,li i�x1, > +.i'� ti.:. "Yl1 ;�l 13' t 4{ 1 . w f R „�{41G (with ah°v° sq' ft.)
Limited energy, multi - family 75.00 2
I / (,l_. A l. !� i 4- , uz,— v .. residential (with above so ft.)
Services or feeders installation alteration relocation
7,9 re c J .>:r yyu„ w+,erl ,,u tlgh —,, FA:i41 tlJ ., ( q r T 11't'�t �� ft tv + yY tp Z00 amps or Zees 80,30 2
h
d7���rl t i :mil �� �l_�.� ,.�,, 'I:rr . ;k'. h�".Lfyai " �1,:,.a. f1,,,t ;�r�i � �f1E,u J. T�t�it.li » IRiul�iEq � 1� t 201 amps to 400 amps 106.85 2
401 tamps to 600 amps 160.60 2
601 amps tet 1,000 amps 240,60 2
Address:
Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and /o
relocation
—
Phone: (5 y22 - — Fax; ( ) 200 amps or less 66.85 1 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 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, . r panel
"1 i tr, 'L N?t+l� ti. s
c'" kI ' !' 6 ^r {x t t o �t.-a'14 w,yv A. Fee for branch cirutitd with • ► ��4{ �aiii ;i` �c r: W, ' ;u a� l eis . .. ., - �t 1 . .1 .'": ... a,.+ .. .... L, , above service or feeder fee,
each branch circ=uit 6,65 2
Business name: B. Fee for branch circuits Lilp.ir
wirhoru scnice or feeder fa,
Contact name: first branch circuit 46,85 : " • 2
Address: Each add'l branch circuit 6 65 .4 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 53.40 2
r4tl rsgma p o- I pri t i 'i1 ” nl} p t . ,+ ' 111I� iH t 1 t ,f.�r u ! w
SE 7� li” t l I, i i� ",�.,� d5i+l�,t ��t ''�.`•gl 4+ 2iii�irJ.' ' z:� .:'itT7Ju,I� Sign Or outline lighting 53,40 2
Business name: Jacobs Heating and Air Conditioning • Signal circuit(s) or limited -
energy panel, alteration, or
Address: 4474 SE Milwaukie extension. Describe: Page 2 2
City/State/ZIP: Portland, OR 97202 Each additional inspection over allowable in an of the above
Per inspection 62.50
Phone: (503) 234-7331 Fax: (503 808 -9108
� Investigation per bocci (l hr mip) 62.50
IMZEIMEIra E icaYL,ic.: 6 1 :07 • Suprv. Lie.: 704LHR Industrial plant per hour 73.75
l Eiil•::,ig, ". gar, yr ri4::u ,?N " " I l' .. l
t.ri,�I ' '.Ja eti.'l ri i
t
Suprv. Electrician sign • i Subtotal ' ifialitr '.52,
Print name: Fred Piatkin D Plan review (25% of permit fee):
I I7 I �� State surcharge ) - erg
argc (8% of permit fee)' �'"� .
Authorized signatu , l , 1 • ' TOTAL PERMIT FEE' . rc.T"'
This permit applleadon if a permit is not obtained wi . • • •'+
Print Dame: Michelle LeClair pate: II .g. days after it bus been accepted as complete. jeS„? .7�)
• Number of inspections allowed per parrot
d
1. 113uildina \Permlts1Et,C- PsrmitApp,doc 05/13/06 440.46157(1 uos/col,vwea
E0 /E0 39dd 9NIll73H SHOOVC L5Z6ET8E05 85 :5T L00Z /L0 /T1
CITY OF TIGARD -
• BUILDING DIVISION PERMIT #: Fl. 07007
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/9/2007
Phone: (503) 639 -4171 I
Inspection Requests (24 Hrs.): (503) 639 - 4175 %'I I-.
INSPECTION WORKSHEET FOR DATE: 1/23/2008 TIME: 7:00AM PAGE: 14
SITE ADDRESS: 09033 SW WESTLUND CI CLASS OF WORK:
SUBDIVISION: MALLARD LAKES LOT #: 032 TYPE OF USE:
PROJECT NAME: MEDINGER
DESCRIPTION: Replace AC, furnace and reconnect
OWNER: MEDINGER, JOANNA Ell_EEN, PHONE #: 503 -598 -3933
CONTRACTOR: JACOBS HEATING AND NC PHONE #: 503-2347331
Inspection Request Scheduled For: Date: 1/23/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
190 Electiical final 063746-01 503- 234 -7331 N
Corrections/Comments/Instructions:
. 4 /17\(..- �/ __; 4
• G - V Iii all / n/ .../1■
Al , � d '
� �
PAS /1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL pi CALL FOR INSPECTION ❑ ADDITIONAL FEE ASSESSED
O
Inspector: , Date: I �� �b Phone #: (503) 718-
9
\