Permit :' CITY OF TIGARD ELECTRICAL PERMIT
II
PERMIT #: ELC2008 -00614
1 C OMMUNITY DEVELOPMENT DATE ISSUED: 10/31/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112CC-22400
SITE ADDRESS: 15767 SW 81ST AVE ZONING: R -12
SUBDIVISION: GAGE FOREST LOT : 031 JURISDICTION: TIG
PROJECT: ROTH
Project Description: (4) branch circuits (hot tub, 2 tv plugs, 4 dimmers and relocate 1 outside plug)
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: 3 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:
JT ROTH • CARTON ELECTRIC INC
12600 SW 72ND AVE #200 PO BOX 860
PORTLAND, OR 97223 AMITY, OR 97101
Phone: 503 - 639 -2639 Contact #: PRI 503 - 435 -1600
FAX 503 - 835 -0539
FEES
Description Date Amount Reg #: ELE 36 -120C
[ELPRMT] ELC Permit 10/31/2001 $66.80 LIC 159713
[TAX] 12% State Surchar 10/31/2001 $8.02 SUP 50755
Total $74.82 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 dos _ '- . - - • dance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more tha :0 days. ATTE ' ON: 0 - =.n law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 9 : - 001 -0010 through OA' • s -001 9 9 ' You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issue. By: � � / ; Permittee Signature: /
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or!),.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INS , LLATION ONLY
SIGNATURE OF SUPR. ELEC'N: �� lL. :i / G _= 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.
' ` Electrical Permit Applicatio ! • , 5 ,+ F ' ` ; " I "
'' C of Tigard P �'ti.r Received
2 P No.: /" 1/
- , n
-- Date/By: � 7l Q g €4G�oOq��(/t
- 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
4 11 _,,,_,.4) - Phone: 503.639.4171 Fax: 503.598.1960 (• ' , i 31) "� Other Permit:
31) Date/By:
--*•-•:• Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for -
TICARD g g CITY OF 1 4* J'r =+* Internet: www.ti ard -or. ov �± DIVISION Supplemental Information
TYPE OF ''' 1 [ZINC D ,�0 V ISION PLAN REVIEW •
❑ New construction Xddition /alteration/replacement . Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE' INFORMATION AND LOCATION. ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: y G a I OOHP or more. occupancy.
�� �1 �C�C ❑Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: '^'\ C � �
/ 0 R ❑ Health -care facilities. ❑ Supply voltage for more than
s ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
• FEE SCHEDULE' .
Cross street/directions to job site: Description 1 Qty. 1 Fee., 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF, WORK (with above sq. ft.) 75.00 2
t; ` Limited energy, multi - family 75.00 2
Wyt �L elms :A , L�1 - Tv cA I Oa, lyH,e -fs residential (with above sq. ft.)
r Q
_ Services or. feeders installation, alteration, and/or relocation
1 D CA \e- ( ' t o ` rc e- �J� . 200 amps or less 80.30 2
❑' PROPERTY OWNER • ❑ TENANT' • 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: ( ) 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 circuits — new, alteration, or extension, per panel
Owner signature: Date: . A. Fee for branch circuits with
X APPLICANT 0, CONTACT PERSON above service or feeder fee, 6.65 2
� E IEC.�TR
each branch circuit
Business name: `` �C . B. Fee branch for branch cia rcuits
Contact name: c��C3 �� !o without service or feeder fee, 1 46.85 f4,. 2
first branch circuit
Address: -. 9,0, x, %gip Each add71 branch circuit 3 6.65 /9 • Q ' 2
Miscellaneous (service or. feeder not included)
City/State /ZIP: rl" 1 .,,,, ..V DR 9 k Each manufactured.or modular 90.90 2
- � �+ dwelling, service and/or feeder
Phone: ( 4 �
3) 0531
Reconnect only 66:85 2
E -mail: �r-4 €( r.c. F ax:: (50.3 8 JV- � v may . tjk+A' Pump or irrigation circle 53.40 2
CONTRACTOR _ Sign or outline lighting 53.40 2
Business name: j� Signal circuit(s) or limited -
a(j r � To Y1 e je , energy panel, alteration, or
Address: p,0, Tpx, Isbo extension. Describe: Page2 2
City/State /ZIP: A 4.1 O Q r-7 1 D 1 Each additional inspection over allowable.in any of the above
i Per inspection 62.50
Phone: (5o3 ) % 4,55 -/600 Fax: (5 ) e35 -0 539 Investigation per hour (1 hr min) 62.50
CCB Lic.: 159 -7/3 Electrical Lic.: 3j, -' ?C C Suprv. Lic.: 5.6755 3 Industrial plant per hour 73.75
/�
..—�J ELECTRICAL" PERMIT FEES. '
Suprv. Electrician signature, required: Subtotal:
a-
Print name: e3.y -4 Date: 10 -31 -Vi Plan •review.(25 %of permit fee): �j-�
State surcharge (8% of permit fee): . D 2
Authorized signature: /e TOTAL PERMIT FEE: 7. 8-,
Print name: e,6 Y1 C4.✓4t D ate : lb-3/-0T 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.
1 :\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK _ONLY;'
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ B urglar Alarm
❑ G arage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ V acuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:,
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ F ire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ L andscape Irrigation Control*
0 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
P.\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
A 4'
BUILDING DIVISION ' PERMIT #: EL.C2000- 00614
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/3 1/10178
Phone: (503) 639 -4171 r �l1 I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/3/2008 TIME: 7:00AM PAGE: 35
SITE ADDRESS: 15'767 SW 81ST AVE CLASS OF WORK:
SUBDIVISION: CAGE FOREST LOT #: 031 TYPE OF USE:
PROJECT NAME: RoTI1
DESCRIPTION: (4) branch circuits (hot tub, 2 tv plug: 4 dirnmeis and relocate •1 outside plug)
OWNER: ROTH, Sr PHONE #: 603 - 639.2639
CONTRACTOR: CARTON ELECTRIC INC: PHONE #: 503.43E-1600
Inspection Request Scheduled For: Date 11/3/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 electrical f 077529-01 503 -753 -8034 \ ¥
Co : ctions /Comments/ , - ions:
I _
e 4, ( f 3' O c.BN' &
0 P N 1 c _ t 1 ' kc -I ,- 'k0 A AoW15 l y �
1
wi\ ,
T. � 2, (e
dog -P r? klvt. of ou
a_ _
-z-\%3\0°‘
_ -›. 6-
PASS) ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
-FAQ- CALL FOR INSPECTION ❑ADDITIONAL FEES ASSESSED
Inspector: 6^, N 64' Date: _ _ 1 A Phone #: (503) 718- _l_q_q_t_