Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2021-00283
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/25/2021
T I i;A R Try9 Parcel: 2S 114 B B 13100
Jurisdiction: Tigard
Site address: 16465 SW 104TH AVE
Project: Phoebus Subdivision: SWANSON'S GLEN NO.2 Lot: 72
Project Description: Install hot tub;circuit breaker GFCI,sub panel GFCI,wire to hot tub buried 24"deep.
Contractor: OWNER Owner: KELCHNER,AMY C
PHOEBUS, KAMBRA
16465 SW 104TH AVE
TIGARD, OR 97224
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 05/24/2021 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/24/2021 $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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or11..8�00_.333-2.2344.
Issued By: j{bUyVAAL De,Weae Permittee Signature: On/0lpphcatwrt
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. I,
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.
EIVEC)
Electrical Permit ApplicaaC I't Ili 111/1/I1'h:l:4C 0AI.1
City of Tigard p n 21121 pee Received J Permit€(. ^� d' ill
13125 SW Hall Blvd.,Tigard,OR 972x� ' `� Plan Review
I� a Related Permit g:
Phone 503 718.2439 Fax: 503.598.1960 py r y Darc/B
Inspection Line: 503639.4175 CITY OF TIGARD Ready DatetB): IMMIll Zi See Page 2 for
11 G:V:U Interact wwu tigurd or gov i- .. /.v I pp
Notified/Method: Sakmental Information
TXPE..OiWotk e, ::4 4 � :.rl v..0 4,%?-`'"4'ear `>-v-.441f"..`:,ston ,. + 5a»?) ) .v ^`.
❑New constructionPlease check all that apply(submit a sets of plans w/item checked).
ES Addition/alteration/replacement
0 Service or feeder400 amps or more 0 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.
Is] I-and 2-family dwelling ❑Conunercial/industrial ❑Accessory building kss to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑A4ulii-tdntll' amps for all other installations. buildings.
) ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system larger separatelyderised
: r / ,r� ,, ! ❑Addition of new motor load of system.
Job N
Job site address: t 6 ti S lid 10)'-r,s- w,,/. . I00HP or more.
()Six or more residential units. occupancy.
City/State/ZIP: T1 G,r , Q R [3 1 3-`a +4-- 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: J Project name: lf0t 4-(,(b ❑Hazvrdous locutions. 0 Supply voltage for mum than
()Service or fender 600 amps or more. hilt)volts nominal
Cross street/directionstojobsite: .5� r�e-r%+ ,a z , „, EDUL,,, _tt- ,
na cdknoo I OM. I Each I Toro I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage,
Tax map/parcel#: 1,000 sq.R.at less 168.54 4
Ea add')500 sq.ft.or portion 33.92 1
*'•; k'a' '5 +'».:' .., < !t r Limited ever 75.00 2
i n k o1 r { _�� 13 rt.- (with above sq.ft.)
1 !7 y f(0Y77Lt t 1J G}�'ySu Limited energy,multi-family 75.00 2
l r t1 f C�' ' W i raec -{o YtDT lµ b u Trite( 2'}i1 see reeidmnal(with above sq.ft.)
,v+± - . , „ Renewable Energy ❑ See Page 2
=k--) 'a - �',- '`" .-'h' -4::'..:;::...."::;• _- -. -( ' S' , Services or feeders installation,alteration,and/or relocation
Name: l-ca yl$r o . P k Op‘c.u s n 200 amps or Icss 100.70 2
Address: 1( io 5 S W 1D 9 t'f v f j(s 201 amps to 400 amps 133.56 2
i 0 R. ^ 7^ 2 + 401 ampsp to 1,0 amps P 301.04 2
City/State/ZIP: '"r�pQr l�l 4 601 amps to 1,000 amps 301.04 2
Phone:("707) 3 oily—geo l a/ . Fax:( ) Over 1.000 amps or volts 552.26 2
y�Y1 t e b L ( i /'rl Q!/ (D� Temporaryservices or feeders installation,alteration,and/or
r
Email: relocation
nHon
Owner installation:This installation eing made on property that I own which is not 200 snaps or less 59.36 1
intended for sale,lease,rent,or exchange iisac<ording to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
q
Owner signature:_ 0..v>^-fi'"Nr,_ s"' Date: 57l`tj}) f _ 401 amps to 599 amps 168,54 2
El APPLICANT Y I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,Brat
Address: branch circuit / 56,18 2
City/State/ZIP: Eachadd9 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: ( ) Each manufactured or modular 67.84 2
-_. --_---- -- dwelling,service and/or feeder
Email:
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: µ-0r;,,f-.. UU,:t..-1„,,- Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy () See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable hi any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(I In min) 78.18/hr
Inspections for which no fee is 90.00'hr
CCB Lic.: Electrical Lie.: Suprv.Lic.: specifically listed('a hr min)
- ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
' Print name: Date: 0 Plan Review Required(25%of permit fee):
__ LL State surcharge(12%of permit fee):
Authorized signature:
f/LeAtir� TOTAL PERMIT FEE:
1 This permit application expires If a permit Is not obtained within 180
tPoint name: le.„am b r 0. nib e,bus Date: 5 J)9 12 I e days after it has been accepted as complete.
t. Number of innpedions allowed per permit.
I Jiuildog,PeraioaL PmmitApp ELR ERE doe Rev06/17/2015 440-4615TII1105/COM/w'PB
Electrical Permit Application—City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY:
aeeertpnon Qty. E ch I Tohd
Fee for all residential systems combined: $75.00 Renewable electrical energy systems
Check Type of Work Involved: kva or leas 00.70 2
5.01 to 15 kvn 133.56 2
❑ Audio and Stereo Systems* 1s 01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* 100 kva(fee in accordance 552.26 2
with OAR 918.309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems In excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
(� Each additional inspection over allowable in an of the above:
Other: H C5 +IA b Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90 00r hr
siertficatty listed S'h hr mm)
COMMERCIAL WORK ONLY . P r m. m' cipa wNa Pf$$, e-$
Fee for each commercial system: S75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) Number of inspectiom allowed per pemnt.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
LI Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I7AulWIng.Pcrma%tLC PermitApv_ELR ERE doe Rev 06/I712015