Permit l -,-; , PTY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00178
COMMUNITY DEVELOPMENT DATE ISSUED: 3/28/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 109DA -10700
SITE ADDRESS: 12946 SW BLACK WALNUT ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT : 096 JURISDICTION: TIG
PROJECT: TUCKER
Project Description: Installing (2) branch circuits for hot tub and indoor plug.
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: 1 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:
SAUNDRA TUCKER ABC ELECTRIC
12946 SW BLACK WALNUT 135 NE 9TH AVE
TIGARD, OR 97224 PORTLAND, OR 97232
Phone: 503 - 642 - 5300 Contact #: PRI 503 - 233 -7551
FAX 503 - 233 -7552
FEES
Description Date Amount Reg #: ELE 161501
[ELPRMT] ELC Permit 3/28/2008 $53.50 LIC 26 -1226C
[TAX] 12% State Surchar 3/28/2008 $6.42 SUP 5096S
Total $59.92 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. Ynti m obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: _ j��4:" -40,i� rmittee 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.
MAR -28 -2008 10:238 FROM: TO: 81P5035981960 P.1
UA. '� i
Application FOR OFFICE USE ONLY
Electrical Permit AAp ti � S
r
City of Tigard M I • . a li 0 v 13125 SW Hall Blvd., Tigard, OR 97223 ,- \( ®l ' � p ,�Pla ''' Other Permit: h •
0 Phone: 503.639.417 Fax: 503.598.1960 t � �> �. \ m ale ® Sao Page 2 for
Q �,{�� Date Ready/By: iur>x
Int Line: 5036394175 V� Notified/Method Supplemental Information
Tl G A R D
Internet: met: www tigard or gov r r
w ^„ ^•r,.. �, 1 vim . . �� ..7 .,. 3.f
G , ! '�'?',`t'i� � , a � eah aS., �:U'.ti..�''�fi�n �3 m.v..e +•9
f 6 s.c ? a „ „( tiO f?^ ,,� fi h - - Please check all that apply (submit sets of glare w/items checked below):
❑ New construction \ • ddlti0n/altt ration /replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
s+ t u t + ]] exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
tFirr CIZENR �._ h � CO:;,' , R$ w i7 : M l i r; L V less to ground, a exceeds 0 volts ❑ Floating b al din agricultural
�` ':�;•!, �:.�,••,�,,,�:- .s�,aEr�,.•.3r..� x buildings
`Q 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. ❑ b �ldi� gi of 75 KVA or
❑ Fire pump.
M aster builder 0 Other ❑ Emerson system. larger separately derived system.
Multi-family ❑ ;._ z:. Y y A.... separately d eri
❑ l .: "r"i l { . r
riff, } 'z Tt S.,�J�+''�FF z °'�' "' D-'' r 0 Q a .. ;,.e =' ;i. ❑ Additionolnewmotorlo adaf ❑"
`: ; •,� ;�"�*" ,.•+.: Fr _ 1001-IP or more. occupancy.
Job J o site addre ���/Q��1'^ / ❑ Recreational vehicle parks.
Job no.: , 4 , • M ] t w es L3 ZpQLi G . �J Six or more residential units. 0 Supply voltage for more than
❑ Health -care facilities. 600 volts nominal
City/State/ZIP: �l 4 7)41_1 ❑ Hazardous locations.
1 � ❑ Service or feeder 600 amps or more
Suite/bldg. /apt no.: Project name: 7;r:1 1i k 4, t z
Description 015•• Fm Toter •
Cross street/directions to job site: New residential single- or multi - fancily dwelling unit.
Includes attached garage.
Subdivision: I Got no.: 1,000 sq, ft. or less 145.15 4 Ea. add'! 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: �y L i m ited energy, residential T5.00 2
" , ^.0f4 Nt(+,k (. \e � ` _•' =:,3 iN � 7.11 x (w it h a bov e
Limited energy ft
s �,.-` ... y, multi- family 75.00 2
J� `� L J tr ,D� •1 ,�Q�� residential vorf (withs ins ll t )
f l) Y.C. ! yI0 Services feeders ova s . tion and/or relocation
200 amps or less 80.30 2
} s gj r'' -hnl ;' 201 amps to 400 amps 106.85 2
,;.''. � � �-�f��;s.�:M . ���:�� . 3.,....,. -� 160.60 2
,� 401 amps to 600 amps
Name: . /) - / A • _ 601 amps to 1,000 amps 240.60 2
n Over 1,000 amps or volts 454.65 2 _
Address: 1.294/Go ,4( R 7 X.,0 Ct ( 0, n GO. Temporary services or feeders installation, alteration, and/or
City /State/Z1P ■ • g , � relocation
Phone: ( ) CS/
F^ S/, ) ., a Fax: ( ) 200 amps or less 66.85 201 amps to 400 Dings 100.30 2
1
-
Owner installation: This installation is being made on property that I own which is not 401 amps to 40 0 amps 1 00 . 30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
s 1 above service or feeder fee 6.65 2
�� qk 1U: ., . ,_ _ .� each branch circuit
Business name: fee c..0 C' f '-((' , B. Fee for branch circuits
without service or feeder fee, ) 6.65 46 85 }�� G 2
Contact name: y` ' f AL first branch circuit t'0 2
Address: ,�� � �' 7t J ' ‘. Y r Q Each add'1 branch circuit i Miscellaneous service or feeder not included
, 1 Each manufactured or modular 90.90 2
CCity/State/ZIP: _. /..� / dwellin_, service and/or feeder 2
Reconnect only 66.85
Phone: ( 1 J -
Pump or irrigation circle 1111 53.40 2
< e 3 * „mot Sign or outline lighting 53.40
n> e
-+aan '°� v :.€ . . ? 0 a sy. .. r .,ti e:....- }.e �.�:.4
Y� sr'" �� * x� � t ..rte � �s.l� i lw s " .,. $ �°° " " Signal circuit(s) or limited-
Business name: ` AT___ A, p et (1 (, energy panel, alteration, or Page 2 2
extension. Describe:
/ i
97 Address: J 5 �( ! � n 3 oil h t'til � Each additional inspection over allowable in an of the above
City/State/ZiP: f�)��,„ p 1l ��� Per inspection 62.50
M r 023,3 h `'5 `fie Investigation per hour (1 hr min) 62.50
Phone: (1 .. ;,),3 3 /.�j�j - � I Fax: ({�• ) 7 � tion p 73.75
l ,, , 9 ll Industrial plant per hour r �
CCB Lie.: / ,, j7�/ I Electrical Lic.: Suprv. Lic.:� 't �. 15 .. in Rl, ' 1' T '�'
r:: Subtotal:
Suprv. Electrician signature, required:
ore /� Plan review (25 %of permit fee):
Print name: 0 Date: A State surcharge (12% of permit fee): (r
TOTAL PERMIT FEE: Ss a
Authorized signature: ,� !r �� This permit eppltcatlon expires Tres if a permit is not obtained within 180
days after It has been accepted as complete.
Print name: Lq )A% `�j !2i C'/ ('-‘,4,,_.; pate: ,314 • Number of inspections allowed per permit.
_.- ._ ..�.�o_.....e..„n,.,•n1 /291OG l 4400.4615T(It105/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200B.00178
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3!28/2000
Phone: (503) 639 -4171 A Nin ��l ��
Inspection Requests (24 Hrs.): (503) 639 -4175 .,„,„W A :_..
INSPECTION WORKSHEET FOR DATE: 7/16/2000 TIME: 7:00AM PAGE: 63
SITE ADDRESS: 12916 SW BLACK WALNUT ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 096 TYPE OF USE:
PROJECT NAME: TUCKER
DESCRIPTION: Ins.aliing (2) branch circuits for hot tub and indoor plug.
OWNER: TUCKER, SAUNDRA PHONE #: 603 - 642 - 5300
CONTRACTOR: ABC ELECTRIC PHONE #: 503 - 233.7151
Inspection Request Scheduled For: Date: 7/1120 Pour Time:
.)' 4)
Code # Inspection Description Confirm # Contact # Message )
189 Electrical final 072690 -0 6233-7651 Y /j
0:
Corrections /Comments /Instructions:
r\i \
PASS 7 PARTI APP n CANCEL _ NO ACCESS
❑ FAIL ❑ C 'I FO' �s. P' CTION up ADDITI AL F ES ASSESSED
/ Inspector: / Date: f Phone #: (503) 718
c.2..i..2,