Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT DATE ISSUED: PERMIT #: 10/25/2007 ELC2007 -00731
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 10368 -08100
SITE ADDRESS: 12290 SW 124TH AVE ZONING: R -4.5
SUBDIVISION: LAKE TERRACE LOT : 008 JURISDICTION: TIG
PROJECT: HINDS
Project Description: Replace service panel and add (1) branch circuit to 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: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
TOM & JUDY HINDS OWNER
12290 SW 124TH AVE
TIGARD, OR 97223
Phone: 503 - 590 -5295 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 10/25/200' $86.95
[TAX] 8% State Surcharge 10/25/200" $6.96
Total $93.91 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 -00 ! e 0 through 0. - 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issue By: • %l ! Permittee Signature: y ('
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: x I DATE: /6 1.5/07
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 Application FOR OFFICE U ONLY
• City of Tigard RDa e y:
J or 7 Permit No. at iv V7 3�
a 13125 SW Hall Blvd, Tigard, OR 97223 Plan Review ( ` "
11
g view Other Permit.
" , Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
T 1 G R D Inspection Line: 503.639.4175 Date Ready/By: I El See Page 2 for
Internet: www.tigard or.gov Notified/Method //I Supplemental Information
____...- _an .., .....", >........,.: € ` -, -. ..a+ '< a _r-= -it _,.141 _ -_
n.� c �,�.,��s��`s = Vii` "= .�.,�._ � xrv..- °e���` - �Y;� '�; ��_ �" �r`�:�_ �;��""'� �_
. ril a` t ' . 4 � � . kr- PLAN REV7 ". :x.... t -
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❑ New construction ® Addition /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 stones
❑ Demolition ❑ OtheI: where the available fault current ❑ Marinas and boatyards
, zv;::si xXN X .t.�N r e =-t:z '_Y, ;any .p £ . s ,,.aH =:ate �- - _..,: „ems ' u 4. - u ' exceeds amps at 150 volts or ❑Floatin buildin
._° mtg ;r - v. .: exec d 10 000
-xte x CATEGORY QF CONS yr ,_-4 .s4' m
less to ground, or exceeds 14,000 ❑Commercial -use agn cultural
— -
® 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
_ , __ R rw c_ e .=,, - j5i7 °ice M .tea_; , .t;.' ❑ Emergency system. larger separately derived system.
1 ; R� � U$ -'SITE xINFURIVIATION__AND LOCATION_ t, 4 , r a r I ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ". "1 -3 ".
Job no.: Job site address: 12290 SW 124 Ave. 100HP or more. occupancy
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ID Health-care facilities. 1:1 Supply voltage for more than
ty g ar ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Hinds ❑ Service or feeder 600 amps or more.
=� , F `nom `
Cross street/directions to job site: 121' to Walnut to 124 Ave. Description r Qty. + Fee. ' Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lake Terrace Lot no.: 1,000 sq. ft. or less 145.15 4
I
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
g . - ., ,�,:k.T-u_ -r.. _ . - = , .; �zr'- °�.T - ; ri, t'.113 75.00 2
. w. s ��;t�"� �-� ��� ��:i,�DESCRIP�TION OF. �VQRK _�:�== _:_= W.�- �_�_� �.�3 ( with above sq. 0)
Limited energy, multi- family 75.00 2
Replace existing 200A panel with new panel, same capacity; add dedicated circuit residential (with above sq. ft)
Services or feeders installation, alteration, and/or relocation
for hot tub. 200 amps or less 1 80.30 80.30 2
_.r .. ___'___°'. ,.'^'^>' .:.°�.a .r.. a %,- .,�.,�- =:, >.= ` s � = �< W :;-,a..._- .r.- 4 e- ,- t .5 .'.+�::. _ w .'" w..'- : •yam - ��z :::
°� PRDPERTY OWN_ ; ER �, 4 =TENANTS , 1 201 amps to 400 amps 106.85 2
Name: Tom & Judy Hinds 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 12350 SW 124 Ave. Over 1,000 amps or volts 454.65 2
City /State/ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)590 -5295 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, re or exchang-, 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
"- `°�' - , ; F xot Ap1 i ANT (( e lla i -CO NT' AGT PERSON ; 'C A:=7 7 above service or feeder fee 1 6.65 6.65 2
...I... w I ..... _... - .....— . _-
�" each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add't branch circuit 6.65 2
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
Y' 1" =' tt'd :db :r .' .. r Si or outline lighting 53.40 2
��r':i��:z�<:�������:��xs"=' _ _ TURD- ��' w %�,__��� �;�;; -.t� -, Sign P� g
�:�;���E�.�:���,x��;::i`y �� _s ��,n�iCON'iCR't -. ^ 'i� -�;� -�,, ,:. ?ata� r <.
Business name: /�_ 1 11 U \ �fl/CJ__. Signal circuit(s) or limited -
l `�/ t energy panel, alteration, or
Address: extension. Describe: Page 2 2
City / State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
t
;t-� <•e� � ' NEIEC7 RIC AIIPERiYtI1'FEiSrigentiallt lgf
Suprv. Electrician signature, required: Subtotal: 86.95
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): (0094'.
Authorized signature: TOTAL PERMIT FEE: 95 9/ 9/
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has heen accented as complete.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007- 00731
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/2G/2007
Phone: (503) 639 -4171 p �'q�� ii"
Inspection Requests (24 Hrs.): (503) 639 -4175 ...'��'ll..
INSPECTION WORKSHEET FOR DATE: 3/7/2000 TIME: 7:00AM PAGE: 56
SITE ADDRESS: 12290 SW 124TH AVE CLASS OF WORK:
SUBDIVISION: LAKE TERRACE LOT #: 008 TYPE OF USE:
PROJECT NAME: HINDS
DESCRIPTION: Replace Yer ice panel and add (1) branch circuit to hot tub.
OWNER: HINDS, TOM & JUDY PHONE #: 503 -590 -6295
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 3/7/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
'199 Electrical final 06624641 503.590.5295 Y 3 - r 2
2v /
Corrections /Comments /Instructions:
7/
/7 I /
PASS ❑ PARTIAL APPROVAL El CANCEL • Ii NO ACCESS
,AIL ❑ CALL FOR . NSPECTION ❑ ADDITIONAL FEE ASSESSED
, i
Inspector: .4 ' Date: ° Phone #: (503) 718 -
.,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FL-C2007 -09731
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/25/2007
Phone: (503) 639- 4171 . I
Inspection Requests (24 Hrs.): (503) 639 -4175 'IL
INSPECTION WORKSHEET FOR DATE: 11/1912007 TIME: 7 :01AM PAGE: 44 •
SITE ADDRESS: 12290 SW 124TH AVE CLASS OF WORK:
SUBDIVISION: LAKE TERRACE LOT #: 008 TYPE OF USE:
PROJECT NAME: HINDS
DESCRIPTION: Replace service panel and add (1) branch circuit to hot tub.
OWNER: HINDS, TOM & JUDY PHONE #: 503- 5905295
CONTRACTOR: • OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
195 Misc. inspection 0598556.01 5003. 590-5295 N
Corrections /Comments /Instructions:
P( o'►r0 c) .'5‘ to
G'Gi o V j t4.1
L X 2 11 11� • ( ■N P - R o 1) 1 4 3c ' i i e
b2 h0 t oNt • ovr, LtP Wfl .,,)►`Q --►
6 ��,.i�c�� \ V • - ItZ• Q_ R 41 G-F9
c.) lc) ° rc\
cAU . cam. G E t
❑ PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
f FAIL )\CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v • VN b'V Date: � c l 61 Phone #: (503) 718-