Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00012
DEVELOPMENT SERVICES DATE ISSUED: 1/13/04
" I'll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 104 D D - 07500
SITE ADDRESS: 13712 SW 130TH PL
SUBDIVISION: MOUNTAIN HIGHLANDS NO.3 ZONING: R-4.5
BLOCK: LOT : 033 JURISDICTION: TIG
Project Description: (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: 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:
JADRANKA MRKELA OWNER
13712 SW 130TH PL
TIGARD, OR 97223
Phone: 503 - 579 - 5491 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/13/04 $46.85
[TAX] 8% State Surcharge 1/13/04 $3.75 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 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 di ec estions to NC at ( �33 . -6699 or
1- 800 - 332 -2344.
Issued By: � j A LI Permit Signature: , � , L� d U
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 639 -4175 by 7:00pm for an inspection the next business day
„-- .... 6 • .
Electrical Permit 1 A w 1 ED . .
, , FOR OFFICE USE ONLY' - • ,
City of Tigard Received n ,
Date/B : up / - / ...1 --
Permit No.:
13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.639.4171 Fax: 503.598 th 11A Date/B : Other Permit:
Inspection Line: 503.639.4175 .*6 N 1 3 2004 ,
-..a.i; n2j.:„ Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information
I lit n-- ING_ ,----• ,-, ••.•,• ---1,,,,,,,, „ _,„, ,...,., .„ .,,, ,...__.
inginaMiniria:773F5PFVYMMktRigftWW:107.1ii,': i.,:64 •0 'T
El New construction 0 Addition/alteration/replacement Please check all that apply:
OService over 225 amps, comm'l 0 Hazardous location
0 Demolition D Other:
,. . . OService over 320 amps - rating ElBuildng over 10,000 sq. ft.,
:,-, a'' ' :;•';,•41VAtif ',
CIONSIIIM1, '',,,,',4, of 1- and 2-family dwellings 4 or more new residential
...,..,:adii....-,:-......4-...--..,:,,,,,-,,.- .,_ t .kmi..*, ,, ..WOM,I,ATI,Mato,, :. Vieiriiiii? iiieis'esiniiniZiliefaiii3di1iMi
CI 1- and 2-family dwelling ['Commercial/industrial CI Accessory building OSystem over 600 volts nominal units in one structure
OBuilding over three stories OFeeders, 400 amps or more
0 Multi 1: Master builder 0 Other:
DOccupant load over 99 persons CIManufactured structures or
I NNAT.,,WitialialfeW5RIVieN4I4rOCE3R111a4k'Z I Nirteitin” ID E —greSS- --g---ng /1 i h ti p lan RV park
'
Job no.: Job site address: i 57 12 5w 1, 30 ii 0 Health-care facility DOther:
Submit 2 sets of plans with any of the above.
City/State/ZIP: TI o Al2.0 OR a t 12,7)3 The above are not applicable to temporary construction service.
rintiNIVatAt..P '-''.: '', ' ' • ''''' . ''';
Suite/bldg./apt. no.: Project name: WI gr-EL
Description Qty. Fee. Total **
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. addl 500 sq. ft. or portion 33.40 1-
Limited energy, residential 75.00 2
Tax map/parcel no.:
,,_ Limited energy, non-residential 75.00 2
IMikPA4flInit-PWIXI:tij'Egt.,fioTstralWejiklin11::;:k4V, liparfirWrgAt Each 4,k0,1,,,,,,.„,:omi, manufactured or modular
E(2-+,.)ke dwelling, service and/or feeder 90.90 2
z To sppv
Services or feeders installation, alteration, and/or relocation
200 amps or less - 80.30 2
201 amps to 400 amps amps
RfftntOriecliiiiliXiii(Niiiitlg.i 'i:7: '*i liTgr■rANT,,,, ,,,, 106.85 2
401 amps to 600 160.60 .)
Name: XADIZAWIA VA f2kE1A 601 amps to 1,000 amps 240.60 2
Address: I37 t Z L. 130114 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: - t - (6 1\12-D Q_ Temporary services or feeders installation, alteration, and/or
Phone: (5) 6 5A9S. \ Fax: ( ) relocation
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;nt, oreZilan e, ac rd g to ORS 447, 449, 670, and 701. .
,-' 401 amps to 600 amps 133.75 2
Owner signature: •""f ,...m Date: //i VC f/
Branch circuits - new, alteration, or extension, per panel
tWg ;, ,,,; A. Fee for branch circuits with
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
I each branch circuit 46.85 2
Address:
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
LNIMNRMIMEITVISIM:T*S:btNVEM energy panel, alteration or
extension. Describe: - Page 2 2
Business name: C) (JO &
. Each additional inspection over allowable in any of the above
Address:
Per inspection 62.50
City/State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
WriMPIVEIPM:# ' -l'i ..'
CCB Lie.: Electrical Lie.: Suprv. Lie.: .
Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: Date:
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
i:\Building\Permits\ELC-PermitApp.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard • a { ,
Page 2 - Supplemental Information
ifs .,.
LIMITED ENERGY PERMIT FEES:
rR SIDENT7WW ORK ®,� 04:1 7:11 .: µ �y, , V . 3 _,..'. i I
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Setr l.:1 ,:R ,M WOR MIATV gi=n %MM. •
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
•
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ 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
\ Building \Pemtits \ELC- PemtitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3- OO�j1
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP 4 60 c3 L
Received 2 Date Requested 3 3 AM PM BUP
Location 1 3 7 J /3 () '' L. Suite MEC
Contact Person Ph ( )
Contractor Ph ( ) SWR
UILDIN ~ ° Tenant/Owner ELC 1/ �d /?-
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
I!
D PART FAIL
BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL \\\\
r CHANL
Posf&
Rough -In
Gas Line
Smoke Dampers
PART FAIL
��R C
Service
Rough -In
UG /Slab
Low Voltage
Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
igN ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA Approach/Sidewalk Date / 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL