Permit CITY OF TIGARD , ELECTRICAL PERMIT
. . r PERMIT #: ELC2003 -00693
,111� DE 5E M (5 639 -4171 DATE ISSUED: 11/25/03
PARCEL: 2S 103AD -05500
SITE ADDRESS: 12760 SW 111TH PL
SUBDIVISION: WILDERNESS ZONING: R-4.5
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: (1) branch circuit 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 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 FOR: 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:
PETER SAVAGE OWNER
12760 SW 111TH
TIGARD, OR 97223
Phone: 503 - 780 -3986 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/25/03 $46.85
[TAX] 8% State Surcharge 11/25/03 $3.75 Rough -
Elect'I Final
Total $50.60
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 re than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
fon OAR 952 - 001 -0010 through OA 52- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 0- 332 -2344.
* V .•
Issu � _ _ • P ermit Signature: _L /
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: (' l DATE: `7 6
N III CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application._ • FOR OFFICE USE ONLY
Received Electrical
Date/By: Permit No.:
City of Tigard Planning Approval Sign
DateBy: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use
Internet: www.ci.tigard.or.us yad ""' "'i)' '' I ' Date/By: Case No.:
•1 Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition /alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 1 2 �() ((1' ' -L, FEE* SCHEDULE
Suite #: I i Bldg. /Apt. #: Number of inspections per permit allowed
h
Project Name: , {��
Description Qty Fee (ea.) Total i
�
Cross street/Directions to job site: New residential- single or multi - family per
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, 75.00 2
Ry, non residential
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
�- n � n � Services or feeders - installation,
r E_ Ar c .2_ 'Y WI alteration or relocation:
../ 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
jiEr PROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: ,, _SaLuasiL, Reconnect only 66.85 2
Address: 1. %u_D m`vi- PC_ Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: -T't t (Li d DTL 'Y1 Z 200 amps or less 66.85 I
Phone: �^ 43 Fax: 201 amps to 400 amps 100.30 2
� ��'�l 401 to 600 amps 133.75 i 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
Address: A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2 ,
City /State /Zip: B. Fee for branch circuits without purchase of p�
service or feeder fee, first branch circuit / 46.85 •O �' 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: (DUO 0 ee----- alteration, or extension — Page 2 2
Description:
Address:
City /State /Zip: Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. I hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other:
Electrical Permit Fees*
Supervising electrician Subtotal $ -9' .
signature required: Plan Review (25% of Permit Fee) _ $ /
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ 73
TOTAL PERMIT FEE $ , &
Authorized �� 1/ Notice: This permit application expires if a permit is not obtained within
Signature: tor, / Date: a 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts \Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
El Burglar Alarm
El Garage Door Opener
Ell Heating, Ventilation and Air Conditioning System
Vacuum Systems
El Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
ri Boiler Controls
E Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
LI Landscape Irrigation Control
n Medical
Ei Nurse Calls
ri Outdoor Landscape Lighting
n Protective Signaling
El Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection tine: 1503) 639 -4175
INSPECTION DIVISION Busiptss Line: (503) 639 -4171 MST
BUP
Received Date Requested l —3 AM PM BUP
Location / ? /// f1— Suite _ MEC
Contact Person � -� Ph ( ) l eU -3? r6 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner �,( ELC - 06 6.9
Footing j (
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling Al e , -
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
r. g - I.
UG lab /
Low Voltage 4 I - A/o. y
Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
" ' SS PART FAIL
SITE Ei Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date / 2 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Jo to.
PASS PART FAIL