Permit ir; ;w CITY OF TIGARD ELECTRICAL PERMIT
AILV PERMIT #: ELC2007 - 00387
COMMUNITY DEVELOPMENT DATE ISSUED: 6/7/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S110BA - 08100
SITE ADDRESS: 11532 SW COLE LN ZONING: R -4.5
SUBDIVISION: EVERGREEN SPRINGS LOT : 006 JURISDICTION: TIG
PROJECT: GRIEB
Project Description: (1) branch circuit for jacuzzi.
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: 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:
CAMERON & TRICIA GRIEB A TEMP ELECTRICAL SERVICES
11532 SW COLE LN 19220 SW KINNAMAN RD.
TIGARD, OR 97223 BEAVERTON, OR 97005
Phone: Contact #: PRI 503 - 642 -9707
FEES
Description Date Amount Reg #: ELE C286
[ELPRMT] ELC Permit 6/7/2007 $46.85 LIC 176026
[TAX] 8% State Surcharge 6/7/2007 $3.75 SUP 4051S
Total $50.60 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.
Issued By: C *i7� /2A CX Permittee Signature: �� --
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.
Electrical Permit Applic ton_ � " `' << )ii <sni �'� i i � i c i e r; r 5 ' ' `°
sim . bat r 1Q?t+ ' -!:1' icifi silk 's filar. :. 14.i ?3 k 'w "': : > `.: „ r..-�i1F
4 ' C i ty of Tigard h i f r ' t " �' es : (O A M Permit No. ^ •• •
• ...4 Or
{ .e ' ' • 13125 SW Hall Blvd., Tigard, 4R t ?• f t M, ' ''Ian Review
1
ii.. + ii 11 y Phone: 503.639.4171 Fax: 503.598.1960 Date/Ely: Other Permit:
c:i I C A T '� Inspection Line: 503.639.4175 pp'� J� /� Date Ready/By: Jur s � ® See Page 2 for 1
y�t.�.>sl�>t
�T Ll,c)( Internet: www.tigard- or.gov J1IV. D / 2007 Notified/Method: Supplemental Information �
TYPE (''1 rk+ l i PLAN REVIEW
❑ New construction ❑ Ad�{�,�,,{1 Mir � Please check all that apply (submit a sets of plans w /items checked below):
"-O 'l.l'd l�'�a / J J `i ❑ 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
® 1- 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION [(Addition of new motor load of ❑ °A ", "E ", "I 2 ", "I - 3 ",
•
Job no.: Job site address: 11532 S C ole Lane I0OHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard d Or ❑ Healthcare facilities. ❑ Supply voltage for more than
g ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: V yi e \ ❑ 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
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
50 amp circuit Jacuzzi residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
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
(a v 0 1 i Tr 1 C \ Y I �i1 n 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, Q er panel
Owner signature: • Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 1 46.85 46.85 2
Contact name: first branch circuit
Each add'I branch circuit 6.65 2
Address:
Miscellaneous (service or feeder not included)
City/ State/ZIP: Each manufactured or modular • 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: A Team Electrical Services energy panel, alteration, or
Address: / 9 0 2 0 5/t) 1` 1 yI n tit ! / Cc.,YI � extension. Describe: Page 2 2
• City/State/ZIP: beaverton Or 97005 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( 503 ) 642 -9707 Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: 176026 gq-ial Electrical Lic.: C286 iiik iii Suprv. Lic.: 4051S . I D/11,0?- Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 46.85
Plan review (25 %'of permit fee):
Print name: Herb Damwijk� /' - _ Date: 06 /05/07 State surcharge (8% of permit fee): 3.15
Authorized signature: . • TOTAL PERMIT FEE: b6 . (
This permit application expires if a permit is not obtained within 180
Print:name: Jacqueline Reid . Date: 06 /05/07 days after it has been accepted as complete.
• Number of inspections allowed per permit.
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ileet l �!erlmlt •
gl aty of Tigard 1111
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
htspection Lie: 503.639.4175 Dam Ready/0y: hds r
Monet: www.tigatd.orgov No d d: � ?.�•
TYPE OF WORK • PLAN REVIEW
Q New consftuction ❑ Addition/alteration/replacement Please check aft that apply (submit I sets drib= wittems checked below):
® 17 Service of feeder 400 amps or more O over three stories.
0 Demolition where the available bah cxment 0 Marinas and boatyards.
• CATEGORY OF CONSInu noN exceeds 10,000 amps at 150 volts at O Floating buildings.
1 • and 2 dwelling 0 Commercialfmdustrial ❑ Accessory building a to ground «exeeeda installations. : O Commercial ,
amps for an other ialdiuge.
❑ Muld- fmnily ❑ Master builder ❑ Other. O Fim pump - 0 tananation of 7S KVA or
SITE INFORMATION AND LOCATION O Emergency system. larger derived system.
JOB O Addition of new meta bad of O A °, "E": "1-2 °. "1-3 ".
Job no.: I Job site address: 11932 SW Cole 1000 at more. oowpancy.
OSia« MOM residential units. 0 Reandintla ve t&puke.
City/State/ZIP: Tigard CO 0HedaKans O burly voltage far mwelbw
Q Hasat bas location. 600 van noodnd.
Su ./am. no.: I Project name: 0Servioo or feeder 600 amp er sore.
•
Coss sl eet/ditecdons to job site: o FEE SCHEDULE .
New residential situ or muld4bmilly threaten sift.
Inclades tam tter'a0i .
Subdivision: I Lot no.: 1,000 sq. R or leas ' 145.15 4
Tax map/pared fro.: • Ea. add, 500 sq. !t•. or potion 33.40 t
Lamed energy, residential 75.00 2
91TTON OF WORK (with above sq. 9.)
Limited 75.00 2
residential (with above eq. d.)
' Setykes or Seders iastdWiea, a tera ion, and/or ry r1Holi
200 amps or less • 80.30 2
0 SWEE EY OWNER 1 0 TENANT - 201 apps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 awes 240.60 2
Address: Over 1,000 maps or volts 454.65 2
CilydStat /Z1P: Temporary services et hers hastallatloo, atiatht ost, and/or
•
relmo an
one: ( ) I Fax ( ) 200 sops a lea 66.E " I
Ph
Owner This installation is made being ma on poperty that 1 own which is not tot ampa to 400 cops 100.30 2
intend For sale, lease, rent, or ext:l e, want* to ORS 447, 449, 670, and 701. 401 amps to $99 amps 133.75 2
Smell cheats Owner signature: Date: -�" 4 V$I0srar extrados, _
A. Fee for branch ciresift with
0 APPLICANT 1 0 CONTACT PERSON above service or feeder fee. 6.65 2
6
Business tame:
each branch circuit
circuits
B. Fero for bre citcrata
Contact name: first service or feeder £e0. 46.85 2
Post branch
Address: Each midi brooch cheat 6.65 2
Miseellancess (servleefor feeder not
City/State/Z1P: . Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation erode 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: A Team Weariest! Services Ile Signal dreads) or limited -
or
Address: :me aw Klansman RD extension. gibe: Payee 2 2
Chy/Sta1eeZ1P: lkartae OR 97005 FAA *Wend heneedon tar allowable 112 - tithe above
Per inspection 62.50
Phone: (213)6*4757 I Fax: O . Invesdgation per hour (1 irr min) 62.50
C C B Lie.: 1 7 6 0 2 6 1 Electrical Lic.:. C286 . I,, St v.l f.: 1S Inds Industrial plant per hour 73.75
. .. ._ ELECTRICAL PERMIT FEES e
Suprv. Electrician signature, required: . • •z, .. .. i' v ., " ,.' Subtotal: - 7 12 -`6`7
Print ire: Herb ! i Dale: O6I 7A17 Plat review (25% of permit ftx;):
f . _ - Stare surcharge (8% of pe t the): 'Jj .14
Authorised lure: TOTAL PERMIT FEE: . (Q 0
.Frith tanner Jacalueline Reid • ' E' , ° , . pp.; „ ►joy, 'dust wait W E p caiddlI
4 %. ' ."47'.''' ti.... • Nambeerding:untioes allowed parpweait
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