Permit CITY OF TIGARD ELECTRICAL PERMIT
p COMMUNITY DEVELOPMENT Permit#: ELC2020-00614
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/9/2020
Parcel: 2S112BB00200
Jurisdiction: Tigard
Site address: 14010 SW HALL BLVD
Project: Gurin Subdivision: WILSON ACRES Lot: 1
Project Description: Adding 50 amp breaker and trenching in electrical line to new hot tub pad
Contractor: OWNER Owner: GURIN, CHRISTINA J &TED A
14010 SW HALL BLVD
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 12/08/2020 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/08/2020 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 through�pf OAR 952-001-009/0'.. You may
obtain a copy of the rules or direct questions to OUNC by calling 50`3..22332.19887r`orrr1.800.332.2344.
tjIssued By: \ c�) U a QC. a Permittee Signature: ci 1 a1.fiCt
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.
j . 27i)
Electrical Permit Application ��1V 1 FoR thrif t: I ,I. ()., ,
Received/ q^�I'
- City SW Tigard Pla Re''
e' �(22O ,l1 Permit#FiC2.'2D 4b61
• 13125 Hall Blvd.,Tigard OR 97223 E C 2020 Plan Review
t Phone: 503.718.2439 Fax: 503.598.1960 gamey: Related Permit N:
Tns on Line: 503.639.4175 C ryry y'y R ea Date/By: lurk: El See Page 2 for
TIGARD Pit CITY OF 1 It,;l,�i I �' dY
Internet: www.tigard-or.gov ro I i n rh 4 )I '(�i •'Cud/Mcthod: �� Suppkmcntal Information
TYPE OF WORK PLAN REVIEW
fl New construction Addition/alteration/replacement Please check all that apply(submit a sets of plans wrtemschecked):
['Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition Other: where the available fault current ['Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
121 1-and 2-family dwelling EllCommercial/industrial 0 Accessory building lets to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
El Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION //�� ❑Emergency system. larger separately derived
lt/1(O .W (f Nlv'd . ❑ 00HP or more.motorAddition of new load of system.
Job#: Job site address: ❑"A","E"."1-2","1-3",
c�,�, ❑Six or more residential units, occupancy.
City/State/ZIP: '"'�' (Jovfr.cI�r (l Vi 9�d.• ❑Health-care facilities. 0 Recreational vehicle parks.Project nitme: I b r CL�� ❑Hazardous locations. 0 Supply voltage for more than
Suitelbldg./apt.#:
t 0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 1_6 `i . �„l Y ,'�,-,1 FEE SCHEDULE
�•^ a_ ' ,- "\ 1MRlitioa I Oly. I Each I T066
AA r cry j L.SA-. G(¢a rw�v.eLA fr A flri---d'r t�,L101cy New rendentlal single-or multi-family dwelling unit
Subdivision: I Lot#: `d Includes attached garage.
Tax map/parcel#: 0 5 ) 1 5a.5 hood sq. t.w 168.54 4
Ea.add'I 500 sqq..ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
AA �' -t g� t (with above sq.R) 75.00 2
itAC�v(e1°7 SD Ut n p hr�A Fe✓ awl V)rin4n Ir) Limited energy,multi-family 75.00 2
eleCAVI,-J,f II { f, � 1 k L ,1 �ct residential(with above sq.ft.)
4T i r Q W Ylo T Y/ Renewable Energy ❑ See Page 2
al PROPERTY OWNER 0 TENANT Services or feeders hustallationralteration,and/or relocation
Name: Ted ri.0 200 amps or less 100.70 2
t t �
Address: /I t7 I O S W l FR (t Bt(V d • 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: ( 3 ck y,( t c,>2 7)- -' 1 601 amps to 1,000 amps 301.04 2
Phone:(9 7 i ) c{O 4 -94? g I Fax:( ) Over 1,000 amps or volts 552.26 2
r- �pT Temporary services or feeders installation,alteration,and/or
-r
Email: Clrls' . 01tJ 143,4.) (r 9 lyt o i � , ( yyl relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature:_ r/'__ /( )- —._ Date: .L2,/2/Zo2 p 401 amps to 599 amps 168.54 2
0 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 1 742 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 1 56.18 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuits)or limited-energy 0 See Page 2 2
Address: v-1t ) panel,alteration,or extension.
City/State/ZIP: I� 1� Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/la
Phone:( ) Fax:( ) Investigation(1 lie min) 90.00/hr
Email: Industrial pit(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lk: Suprv.Lie.: specifically listed(54hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 3(0,($
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): v
Authorized signature: -7/ /f�_ 7 DTA PERMIT FEE. rj(p u 0
^ �' C This permit application expires if a permit Is not obtained within 180
Print name: Te(Jl A.- /��V\h Date: 12.../3 2_07-0 days after it has been accepted as complete.
V • Number of inspections allowed per permit.
1\Buddvg\Permit.\BLC PennitApp_ELR_EREko< Rev 06/17/2013 140-4615T(1 I/05/COMIWEB