Permit CITY OF TIGARD ELECTRICAL PERMIT
°. COMMUNITY DEVELOPMENT
PERMIT #: E 10/10/2007
DATE ISSUED: 10/10/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135CD-10900
SITE ADDRESS: 09735 SW NACIRA LN ZONING: R - 4.5
SUBDIVISION: NACIRA PARK LOT : 009 JURISDICTION: TIG
PROJECT: HOLMAN
Project Description: Install branch circuits for hot tub.
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 HMI 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:
BRIAN HOLMAN WILLAMETTE ELECTRIC INC
9735 SW NACIRA LANE PO BOX 230547
TIGARD, OR 97224 TIGARD, OR 97281
Phone: 503 - 639 - 9062 Contact #: PRI 503 - 624 - 3631
FAX 503 - 624 -2938
FEES
Description Date Amount Reg #: ELE 34 -283C
[ELPRMT] ELC Permit 10/10/200' $53.50 LIC 75059
[TAX] 8% State Surcharge 10/10/200' $4.28
SUP 4226S
Total $57.78 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
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Issued B • i / / �� / Permittee Signature: I/ 7 c'7
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
.,�.1' 09 2007 1:29PM WILLRMETTE ELECTRIC INC. 5555555555 p.2
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Electrical Permit Application �,, ;' 1 ,, *},r,'�, +1' � ,� ",I ),1l" h 0 y I in I( i1 ti Sl t bM1 U= '" ' [ '� s " ' " ''
t' k C i:i OR City f D I S
a 13125 STi ; Phone: 503.639.4171 F 508 6i1 E ' Plet),Revtew Other Permit: irub /1
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r "' ``r' Inspection Line: 503.639.4175 Date Read •/B :
aTILAK[) (� 5 Y ® SxPagelfor
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e r Internet: www.tigard or.gov CC T 0 Q t + . Notified/Method: , Supplemental Information
_ ^� '�g 5 �1 {� {l[13x _. : a!�$' ifl ! i. a ;,:191!(ir(itls a " +r' 13. t . - ` it .,.,f..a .. `!'ii tt`.. :?' '' .. PEsr ^�i t _ aF ... J rda z� mnir. }
J9t E �py� rt�t}({t��ft, 811 J '. }I I ' 111 )(�!dp- , 3ry. ({}��(IKyf•.:<3 �`E { :.�1� {�?�.y. - :.. ,,¢I ff �j( t{ (1i f ,C ,-. X11.3{{�.(E. Ol % '.E f `rzt�t 1)t (f�It�.�'lt�. t.!'v�..;�� "�yp.''dl i��.tt'I�l:41 3, 11'17 { )))rrraaa X 13I
u13�1��•.• 7Et�ili4{ il�����' a. �. 7. �I�tlNI! 7��1' 11�I�f1�( 19����3�iat4,.. �Iuxdkl! J) 7 IY. f' �'1^.1� 4!Et:731tltinifi3,l�?±'. �kr� . ��1f��tf11�1H��.l ��d E���lEt3Cti`1���1���(Il tiFt$ �M99: C. �i.:; �' li> 47AIItlllff[ ��Ifjlt f� :s��?i�a :itl���II'.il�f�
❑ New construction �� ' r • • • _, - • to t • pia. » - ' sa.. . I .r Please check all that apply (submit j sets of plans w /items checked below):
❑ Service or feeder 400 am or more ['Building over three stories.
❑ Demolition ❑ P. a a� �T, T"' F `.' 7 where the available fault current ❑ Marinas and boatyards.
y (. t jj ttff i t i J is J�3 i t put }rut r r an t rntri E { ° f { h m'il al y „41a {([ f (! exceeds 10,000 s at 150 volts or
:� 3 ill �k �1: :L ', litp > i u f l i K� : dl dt I .: i tr11 t' l€ !. iii' Vi isi 1 .)„:1 , :,.1 i iiii ❑ Floating buildings.
is dLt h i Ili , _ ; �E.a.•�>ufi a to u�rthw r •2a!fttt tn£ ..rIUR t eisin t.t. - # t less to Bound, or exceeds 14,000 ❑ Commercial -use agricultural
1- and 2- family dwelling ❑ Commercial /industrial 0 Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75 KVAor
}y ii l f�g . ° ". , ut rtt f :Fa d t c pr t ort nntiuc fr5y nlA !n}}} y,. �• } t }qq , a , : {$ , ❑ Emergency system. larger separately derived system.
1s " I rit ii 1 1 1 t' �IF;iY , I J 4 I i i i i I 1 ��d3 : AiT i l l iiiI si�. 'G,E � ' I Pa: l' t� �(�{} 1�..3.r .
t ,,...., t et tdi rtsriac& liaf t, ,I�a fat al tc eartu sr r w 'i ii St rtutr am inn1E1 t a4 - iliall I f[ _ �5� ❑ Addition of new motor load of ❑
Job no.: 115 Z lob site address: 9 ?35 S 1 ') r� I OOi1P or more. occupancy.
1I' ❑ S i x or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: I s �y - " pg. if ?�L 3 ❑ Health -care facilities. ❑ Supply voltage for more than
l ['Hazardous lowtsoos 600 volts nominal
Suite/bldg. /apt. no.: Project name: /. / , j /) p ❑ Service or f 60 or f { 3 € € ry � p f
nillitlI IIIIIlIIIIN?�I lltllIltr >�,.: �Q" °J� �r` 5.'0! 11341illi l ++.ill111Ellll 1 1i11111EI�tl�
Cross street/directions to job site: Description
Qty. Fa. Total •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'J 500 sq. 11. or portion 33.40 1
Tax trap /parcel no.: Limited energy, residential
kY.• I � 3 (!I ' I tlt�ltt`t3}
r, :'; tt7 Htt4 it) t'ni',2) tr. rr t ¢
i I } I 1: fl r 111 11' �i tt u i11 . Ilo d r E , :-',,, , ,:4,,, 1i ,�I (with above sq. ft.) 75.00 2
;�iIJIi�,. � , €�Ii t� I r t�s .h ,31. t �r u � Ei it ''r .r..5 .. � z r I
Limited energy, multi- family
75.00 2
bill rc biz, i j-µ, residential (with above sq. i)
Services or feeders installation, alteration, and/or relocation
t�ils'kf� » fli r1; M , � � , lis1r N t! �t » awrj �� Tra c. 7. illir, i 1 P �tuti
80.30 2
1 EII Ui. taa� t .<:3Hf ttE �rtc u��n 1k' le u q s & Na t t 11 I 1 i13.1:411/; ` �"d K"aa' 4 +irli dn� �! I � f :( 200 amps or less
201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: _ Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch dreuits - new, alteration , or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
1 4 1 { t�1(ru u I e x � try tit 1 . ' (}�' � �ra�� � {t' c3J�.w , N jr g iaaau ;u }rrUo r i .I It 1 r
!" . 7 7, 1 �fti t � �° , L•1 Fail N E lx�?i I , �Ntff .t .` €11t t, i1ii 1 " 11 7 1 1 1 : ii ��Prr; { rl l above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 u 1 13'5 2
Contact name: first branch circuit
Address: Each add'l branch circuit 1 6.65 b. GS 2
Miscellaneous (service or feeder aot included)
City /State /ZIP: Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2 _
E-mail: -- �H 1111tt((� ��II' ft�`,ti Ii II t f 1 t1rii }Igp1lt 9 th1{�It tI1 IpIIf((I�EE1 Pump or irrigation circle 53.40 2
a1E�E31 111111ll!111111 510 1 111'rG m ,l!,� rte' ti Bill ; ,,i ttllllIIrllAfll I iY!{NII €11'l.;eilfl�tlljE�@Illf Lin Sign or outline lighting 53.40 2
Business name: Willamette Electric Inc Signal circuit(s) or limited-
energy panel, alteration, or
Address: PO Boa 230547 extension. Describe: Page 2 2
City /State/ZIP: Tigard, OR 97281 Each additional inspection over allowable in any of the above
Phone: (503) 624 -3631 I Fax: (503) 624 -2938 Per inspection 62.50 Investigation per hour (1 hr min) 62.50
CCB Lic.: 75059 I Electrical Lic.: 34 -283C Suprv. Lic.: 42265 Industrial plant perihour 11�d:K it I < f 1 73.75 �� }
III II1Illl ERVA lkfi(I� `.,,.�, .I,I�Ir..,11 fI ;�1,9I ,t,EENRIEMP I I l
Suprv. Electrician signature, required: Subtotal: 5'3 , 6- . t
Plan review (25%n of permit fee):
Print name: David Fife Date_1 nn
: /e •-f® State surcharge (8% ofpeit fee): ii, Z
Authorized signature: TOTAL PERMIT FEE: 57 7g.
Print name; DBE: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
t•\ Building \Pamits\ELC- PermtApp.doc 05/23/06 440- 46157(1tfMS /COM/WP.B
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