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Permit
CITY OF TIGARD ELECTRICAL PERMIT ` ' :• - ` COMMUNITY DEVELOPMENT Permit #: ELC2011 00068 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/28/2011 Parcel: 1 S125DC01100 Jurisdiction: Tigard Site address: 7225 SW VENTURA DR Project: Clark Subdivision: /ASHINGTON SQUARE ESTATES NO. Lot: 1 Project Description: (1) branch circuit for hot tub. Contractor: COHO ELECTRIC INC Owner: CLARK, WAYNE PO BOX 40 7225 SW VENTURA DR WILSONVILLE, OR 97070 TIGARD, OR 97223 PHONE: 503 - 582 -9774 PHONE: 503 - 341 -6009 FAX: 503 - 582 -9840 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 01/28/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/28/2011 $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 0 • ' - •.2 - 001 - 0090. You may,obtairra-eap •f the • - • •' ect questions to OUNC by calling 503.1987 or 1.800.332.2344. Is By: _ .`- �� �t Permittee Signature: v _.. iL .._ Lr A ..... 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. 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 Application AA r1fi 01'1 J( F: 11: cl�t.ti' City of Tigard ` '�t: Re set ,'"t III w ° � DatcJS . I + Ap PermitNo.: C LC , 4. r 131 SW Hall Blvd., Tigard, OR 97223 c � ' I l - d , Pbonc: 503,639.4171 Far: 503.598.1960 '"" ftQ \' s a Other Inspection Line: 503.639.4175 D for TIC; A E. F., q o e fied/Methocl U , 1 , � See Pa Z Intam wtvw itgatd OC.�UV �p enta Information N •N ti 7 Supplemental cm it ., ..._ , ."Jr .r ,a fi ,`:.,.:':' ^..' ...':.: .:`��+,'axiw .,,{ 7 -Ar .. Y.",\� J !! .... u,,, ... ..1 ,.., . a..,.......C} .. v. .a..d, \_.......,... a �.,'. \\ v .,...1"'�.` .,.(..�. \. .\ s.,., ".,l ",�, "r �.,F..,.,.x :hl.'.� , r .. a... d. ..., .. ..... . . .... ... ............ h ,. , ., n a•, ,. n ,.,..:C .,F, � � '" 5", .. . \ , .,. "\.'.\ .M... .... t G( ,G, � r , ,,,aa, .�r.. ,. �` .. , . c n.. ,. ,.. a...... L,.o.a .5., . , a, . , .nw \ , v , ('e „1...,,.., . . ".a:� , .;:�i , \ .� \ � l, M w. w, . O,v , w,,.r. � .., H . nx,..1 w , ",,raa,"a... ..,..,�.„. �v.. xk. , �. ,.x „ a... , ,a a. , � \ \..x "'�ei. ��.,,," .'� �i „ x,V�:::::ix�.. a ,!va.Y:r,,..h„vr"4x�..aaWc. ,., rw ,✓',v.�,...a.......,:1. � .. ,,.:k , ..:,;7Jn(,1w:o(,��C:. \..5. \.....M\,M4.. ",a,. k \, .. S.( v.. a. t... .. .n. «.,' v.n..ud: :,,,,,,:;,;k.,,:,,,,,,, �=r ^�t,.e�:+; .H�J . `��'.. „C.. \ l „, i:( , ,—, , , ,. , n a,...,., ,<fie� . i «t.�,..Q„_....._......,..n ^r.., E `�, S 'v , ,.• ; ,"" ...�, �a\� \9„ w,.S .. a „, ..: n. ,,.,....r._ ,,.>a... ... . w„. " " ti ., Ca `.w";' ,. a \.. ❑ New construction i74 Addition /alterationfreplace$i ���i y L '' . Pigmy chuck all thaz apply (su g sets of _ „ • Other: �,, ' amps or more y o:F 0 Demolition Building ID Service 400 am plans erns check, , low): Scrvic¢ or ❑ Bu il over three st . r:ar: °> c °a. •.t m2 S'.c N' n:x:a;; _ !. ;;s -7 '> - a , ,• : n'; w fire available fault dent n Marinas and boatyards. r'' ";t.k _ F � a G ' � - i ' , ; ;:.. , YY . ^� \ v,,1\, `, ? '4 exceeds 10000 flip sa 150 volts x'""412:,. i ..,' , 4\t: :','' ',1'12d,.:v „J. „ ',.c S =' t , , xrek !" ' x Or 1:I Floating n 941 o,x._:.. ,,.,. ^- a, leas to orext',aeds14,000 71 1- and 2- family dwelling 0 Commercial/industrial 0 Accessory building amps far other ao Commercial s. °fit 'ai • Multi - family ❑ Master builder ❑ Other: EJDire ..... q.. •:,,� ” e• n..,.,, ty`;•:.:: 4 ::.o:a:.r::,,a aS,n.,,: ;rd'r:: -': h ,., � ati, n t � (� +i < - (. c � a v a a r r 3 , aeon of 75 I�VA or -'21 .2'..„s,r 4 a ti I ( w o + u \ e ❑ 8moracn o system " A", ` separately d system. r . M...1...1a,, ,,,Wa,., a\ . v , s h?I � . t o.,.a,. ..;,_v.: ,,, {: ❑AddiuonoPnevmotorloadof CI "A", ..E,: "1-2'71-3', Job no.: 1 5%' `I � 1- Job site address: 1 ool->p ar more. occupanc � ���� v �� ''� Q Six o; tluore tesidet}dal units, ❑ ZtecresIiotlfll vehicle parks. City/State/ZIP: ;' r r ` e . ❑ Health facilities. 1] Supply voltage for more than "`` 0 Hazardous locations. 640 volts nominal. Suite/bldg. /apt. no.: Project name: eh El Service or feeder 600 amps or more. .,,;;t,., ..,'I,(:,,,la ' ; ;, ;:d\9, r.';+;w.tir, .ry ?i "ci; ', a;: s. 4M th;Y4ti;�'G;Ni;N„aV'`^1: >c�' ;, Cross street/directions t job slid ti , . r ",. ,yuw tide . >;s,; s.:;;n * ?°: n of site' ::,.: > :' .... ::.: ::..::. :. , ,:. ......, : � h;'„, ,,�;; ' r d New I,! or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,0.00 sq. rt. or less 168.54 4 Tax map/parcel no -: 1 i t . P l v ;,' ,i;F, l� r ,� r :z :': a N t' h ( (\, v r !;, ) d y : s \ � 2 ��, r �7� ", Nl� .,., t ?o� ,h a� . r.. .r.} \way' emir 1 a � ay.,, r,, „,(� ' �. �C\ t a 'v C h �ra"^i \ 5 residential with above .. ill ■ _ .,,,,,...,,.o.:,,R, ... P � , afw"tatr � h, '=Q; , > y H a \r S� y a ,v , , j . . 0 , .a( t to ,t1' 1 1 t :, 400 100.70 1.1111n1 4, Z ervices or feeders installation alteration, and/or relocation \ al.ca`...2,t 2 J >v}.xc.„1 "..,,:.. S\,ra.; :;, ! � tl .1 „, S: . °^\ "'A :...., � tii,: ” cx S. „ f ,:;, \ xna : `\ " : 201 amps to 400 Stn man© Name: 401 amps to 600 amps MI 20034 min Address: 601 amps to 1,000 amps 301.04 m ' — - v .— Over 1,000 amps or volts _ 552.26 ingmaii City /State/ZIP: \--",‘ _ - Cb Q Temporary I . relocation Phone: ( ) \ — Xz,0 c • Fax: (. ) 200 amps or less U Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 mops ' ` amps _ 168.54 Branch Owner signature: D alteration FAME .;• :.�h:.; v A, Pee fbr branch circuits with � ih(dE t ^4 �` y (, ,, , '4 Ell , z"!l ti'S ,aMY'r ) s1 '� > r �, ��,,,,,.: ir ...:;.. rSy.y i r ",cxiwt.�c'!ld J , \r�sa�:i.a.,t} �'�, � \ik; �.. "i' ��a\. ,.a, �u. � � u 1.a 1 S , r . 1 e ♦ t , 2 Business name: B. Fee for ti 11111 I without service or feeder fee, 1 56.18 + 2 Contact name: first branch circuit .5 h Address: Each ackl'l branch circuit 7,42 Eil Miscellaneous or feeder not included City / State/ZIP Each manufactured or modular El Phone: ( ) Fax: ( ) . ♦ 2 Reconnect only 67.84 2 K"3 ) C. a ,,, �v (T l.. �,a"1� �, a "C\ r, r at.. t7 .a ^ ` 2 .., d„v^:,. F,... ,a , ,,, �, ;1 c, : , .,a�:�t.. � rc• ' .r ti„ t �' _d � (t , ". N.. ,�., l ! 11 S }. (.+.; �k,. S 2sn. -. ♦ . . _ Business Dame: Signal circuit(s) r 2 to tO hulked- ' } energy panel, alteration, or Address: ��` 11 "• .. '--i e , extension. Describe: Page 2 Ell City / State/ZIP: `..31 ct ' 1 tL `Ul-h . (Ai ( . 3 -- ,... Each additional ins .ection over allowable in an of the above Phone: $ — � L" V 66.25 , �1�1�� Fax:(. ) � ' .. M 66.25 IIIIIIII- CCB Lie,: 1 1 k 1 Electrical Lic.: — 7 Suprv. Lic.: 5 -1 4 S Industrial plant per hour ,,.. � � Suprv. Electrician signature, required: '� ,,;m ,,a,,,., „ ,...r., � 1 . , t : ,.,.. Subtotal: . l ■ Print name: Y l . l� 0 Q'{ el tj c % ^ 1 Plan review (25% of permit �); ,J t ` 1 r State surehazge (12% of permit fee): ,' 3'1 Authorized signature: .., 0 TOTAL PERMIT FEE: (�� Print name: t J Dale: This permit application expires if a permit is not ob ' ned within 150 fit, 4 p ,� days after it has been accepted as complete. 1: 1aui1d1 ;181Farmits(Er,C,PermiCApD.d to/ollDy * Number oriuspectionsallowed *40- 4615T(1 I/U9/GAt t/Wgg