Permit -- CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00446
DEVELOPMENT SERVICES DATE ISSUED: 6/24/2005
�=--• 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 114 BA -12700
SITE ADDRESS: 16385 SW COPPER CREEK DR ZONING: R -7
SUBDIVISION: COPPER CREEK STAGE 3 LOT : 092 JURISDICTION: TIG
Project Description: Installation of (1) branch circuit for new 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: 0 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:
FREEMAN, BRIAN C + KACI L WELLCO ELECTRIC INC
16385 SW COPPER CREEK DR 2655 N MAPLE CT
TIGARD, OR 97224 CANBY, OR 97013
Phone: 503 - 260 -3419 Phone: 503 - 997 -8922
FEES Reg #: LIC 127540
SUP 4400S
Description Date Amount ELE 24 - 388C
[ELPRMT] ELC Permit 6/24/2005 $46.85 •
[TAX] 8% State Surcharge 6/24/2005 $3.75 REQUIRED ITEMS AND REPORTS •
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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%mo • n 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are t forth in OA' •52 40 -00 0 through OAR 952 - 001 -0100 You may obtain copies of these rules or di - et -ques • •. to OUNC at
503 -24 -6699 or 1- 800 - 332 -! 44.
Issu d By: k. �� e , . Permittee 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:
CONT. ACTOR ATION ONLY
SIGNATURE OF SUPR. ELEC'N: - DATE: P :;'fi
LICENSE NO: " � eo
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 'orrICG,IJSE o i Ll'' '
City of Tigard
Received f _ 0, 06
(� Penmt No
Date /By w ` /
13125 SW Hall Blvd., Tigard, OR 97223 P lan Review
Phone: 503.639.4171 Fax: 503.598.1960 // otP8'4p�i� h1;.t Date/B Ot Permit:
Inspection Line: 503.639.4175 .t .._l Date Ready/By: ® See Page 2 for
Internet: www ci.tigard.or.us Notified/Method. MI Supplemental Information
TYPE OF WORK PLAN REVIEW `
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
LJ I - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑ Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
• _ - JOB SITE INFORMATION AND LOCATION- ❑Egress/lighting plan RV park
Job no.: Job site address: %(1/348 ❑Health -care facility ❑Other:
S W C>, 1:4 1 C� Ck Submit 2 sets of plans with any of the above
City /State /ZIP: t GNI "CYZ.Z.\ The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name:
Description I Qty. I Fee. I Total I "
. 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. add'I 500 sq ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
- DESCRIPTION OF' WORK Each manufactured or modular
• dwelling, service and/or feeder 90.90 2
T'v ' il 1. ^ cTP&L. . Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPERTY OWNER ❑TEN ANT 201 amps to 400 amps 106.85 2
n O �
Name: � ,� l.-( 401 amps to 600 amps 140 60 2
+� 601 amps to 1,000 amps 240.60 2
• Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City / State/ZIP: Temporary services or feeders installation, alteration, and /or
(..Phone: Q3 2 / _ O - 3 �� ( ) relocation
�( f� 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, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature' Date: Branch circuits - new, alteration, or extension, per panel
' (APPLICANT ' ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Et �o Z.L.�r -�A._ 1 r4c_. , - branch circuit
B. Fee for branch circuits
C
Contact name: 1Ql.-N-- ``� J 0 without service or feeder fee, ) y $S
each branch circuit 46.85 2
• Address: Z ac S N NOP.O LE__ Cam- , Each add'I branch circuit 6.65 2
City /State/ZIP: ��t...1 ®Q . /X, 0 ■'-' Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (' ) ESV0 - T: Fax: : (o )7 C6o' 2 _ Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR ' energy panel, alteration, or
extension. Describe. Page 2 2
Business name:
Address: ` -AaCc iv M ap 1 CV . Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: v (' Q02. • , �� 0 \-- I nves ti ga ti on p er hour (1 hr min) 62 50
Industrial plant per hour 73.75
Phone: (GI) �OeTh .. V1\--Z-Z.... Fax: �A�) 2��— �,qZ-Z *
ELECTRICAL PERMIT FEES*
CCB Lic.: 1 Z1 S V. 0 Electrical Lic.: Z4 -3 Suprv. Lic.: y�C c 5 Subtotal t....}4 ' '
Suprv. Electrician signature, required: M Plan review (25% of permit fee)
r
Print name: 't W e N QU A Date: Z� — 0 State surcharge (8% of permit fee) , 7
` TOTAL PERMIT FEE 5 G be)
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: + Fee methodology set by Tn- County Building Industry Service Board
•• Number of inspections per permit allowed
i \Builduig\Per its\ELC PemiitApp doc 12/03 440-4615T(l0/02/COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I RESIDENTIAL WORK ONLY: _ _ 1
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
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
n 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\Pennns\ELC- PennitApp doc 04/03
OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006-00i146
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: C/24/2005
Phone: (503) 639 -4171 /�'mnrrB4�iilp���lll
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/15/200a TIME: 7 :06AM PAGE: 40
SITE ADDRESS: 16385 SW COPPER CREEK DR CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 3 LOT #: 092 TYPE OF USE:
PROJECT NAME: FREEMAN
DESCRIPTION: Installation of (1) branch circuit for new hot tub.
OWNER: FREEMAN, BRIAN C + KACI L, PHONE #: 503-260-3419
CONTRACTOR: WELLCO ELECTRIC INC PHONE #: 503 - 887 -8922
Inspection Request Scheduled For: Date: 8115/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 013546-02 503 -997 -8922 Y
Corrections /Comments /Instructions:
x..03 - 7cr3 - 53 -64
ba_ w <NI L iyal w E.R Cr - Nun ix k■D
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•
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A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G tkei L Date: Si y L " ' Phone #: (503) 718-