Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00550
l ie iI DEVELOPMENT I E S SERVICES
97223 503 - 639 -4171 DATE ISSUED: 8/3/2005 Hall PARCEL: 2S 103 B D -05300
SITE ADDRESS: 12639 SW 116TH AVE ZONING: R -4.5
SUBDIVISION: HUNTER'S GLEN LOT : 009 JURISDICTION: TIG
Project Description: 2 branch circuits wiring hot tub and recpt.
•
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:
MARTHA CARLSON SPARK ELECTRICAL CONSTRUCTION
12639 SW 116TH AVE 4508 NE 123RD
TIGARD, OR 97223 VANCOUVER, WA 98682
Phone: 503 - 313 -2506 Phone: 503 - 701 -7822
FEES Reg #: LIC 143886
SUP 4394S
Description Date Amount ELE 26 - 9970
[ELPRMT] ELC Permit 8/3/2005 $53.50
[TAX] 8% State Surcharge 8/3/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other ap•licable 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, • wo is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notifi - 'in n •ose
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or dire questi. o OU C -
503- 246 -6699 or 1 t:4-332- , 4.
Issued By: la _ , A 1r Permittee Signature: %_ fig
OWNER INSTALLATION ONLY AllOW
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.
RECE V ED
Electrical Permit Application pp� ,i k t If r - z cl 'O l• ,
.m ,,. `J 0o V '1 A Y . t t ! h P . Vr , ; ,.'0. , � w/ 1 . ,1 i ' 4:0 1, 4 . ' a" ;g1 .: b
Ir a
City of Tigard Da a 1 � 6� P ermit Non 6 _x05 p
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie '
Phone: 503.639.4171 Fax: 503.598.196Q;1TY OF TIGARD�� 1 t `i ?1 ' �
BUILDING MIS! . __' • Date/By Other Permit:
Inspection Line: 503.639.4175 1 r It _ i Date Ready/By: 1a�s See Paget for
• Internet: www.ci.tigard.or.us Notified/Method: r/ H � Supplemental Information
PE OF WORK PLAN REVIEW
❑ New construction r D ,( Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ID Service over 225 amps, cotnm'I ['Hazardous location
❑Service over 320 amps — rating ['Bulldog over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
. JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
Job no.: Job site address: /2g 39 .('w ,.y - 4 Q,r,,‹ ❑Health -care facility DOther:
Submit 2 sets of plans with any of the above.
City /State/ZIP: 7,�a -,,, ( e 9 7 2 Z 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE -
f / / Description I Qty. J Fee. I Total
/45 {
Cross street/directions to job site: l� x ay, (,, a vi^ New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
/ dwelling, service and/or feeder 90.90 2
/ / Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
. ' ❑ PROPERTY OWNER I . ❑ TENANT 201 amps to 400 amps 106.85 2
h � 401 amps to 600 amps 160.60 2
/�/
Name: t a r L
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: (SY) 3) 3i3 _ 2.S'• G Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that 1 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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT . 0 CONTACT PERSON ' A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, /
each branch circuit 46.85 2
Address: Each add'I branch circuit / 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone:( ) Fax::( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTO R energy panel, alteration, or
extension. Describe: Page 2 2
Business name: j� L �� v,- t r P
Address: 4 so 4 AJL= / 2 3 1.. C .we___ Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: (��a , 14- '(P'e ' Investigation per hour (I hr min) 62.50
Phone: O OS) 70 (.-- 7' 2 2- Fax: ( 340) 'y / .- y 7 (--) Industrial plant per hour 73.75
ELECTRICAL .PERMIT FEES* .
CCB Lic.: / Y3 8 d' G' Electrical Lic.: 2 6- 3 97r Suprv. Lic.: 43C lfer' Subtotal S3 - eY-,
Suprv. Electrician signature, required: .d �/ Plan review (25% of permit fee)
/ State surcharge (8% of permit fee) T - 2,S
Print name: � � Z - , r44 g ate: D�'Cj / / �
� TOTAL PERMIT FEE 51 '74E( Authorized signature: /_/_. 2 C- This permit application expires if a permit is not obtained within 180
■
/ , days after it has been accepted as complete
Print name: / c • r fr-r , � e c� Date: p �� • Fee methodology set by Tri- County Building Industry Service Board
v " Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PennitApp.doc 12/03 440- 4615T(1 02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
f COMMERCIAL WORK ONLY.
Fee for each commercial system $75.00
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El I nstrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El 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
i:\ Building \Permits\ELC- PermitApp.doc 04/03
OFTIGARD -
I LDING DIVISION PERMIT #: EL Zola 0550
411 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 8/3/2005
Phone: (503) 639 -4171 hnnrho j
Inspection Requests (24 Hrs.): (503) 639 -4175 1 L
INSPECTION WORKSHEET FOR DATE: 8/11/200 TIME: 7 :09AM PAGE: 23
SITE ADDRESS: 12639 SW 116TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 0Q9 TYPE OF USE:
PROJECT NAME: CARL SON
DESCRIPTION: 2 branch circuits wiring hot tub and recpt.
OWNER: CARLSON, MARTHA PHONE #: 503 - 313 -2506
CONTRACTOR: SPARK ELECTRICAL CONSTRUCTION PHONE #: 503 - 701 -7822
Inspection Request, For: Date: 8/11/2p06 Pour Time:
Code # Inspectio •escription Confirm # Contact # Message
199 Electrical final 0133,41 503- 701 -7822 N
Corrections /Comments /Instructions: -. 10 1- p, Iln.
\.,
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 11 N L--.. Date: Si I11O5 Phone #: (503) 718-7-A‘.