Permit N � ,, CITY OF TIGARD ELECTRICAL PERMIT
._ ` ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00692
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2011
Parcel: 1S133CD11700
Jurisdiction: Tigard
Site address: 11801 SW WILTON AVE
Project: Todd Subdivision: COTSWALD MEADOWS NO.3 Lot: 149
Project Description: (1) branch circuit for hot tub.
Contractor: CASEY'S PLUMBING Owner: TODD, JUNE M
PO BOX 30075 11801 SW WILTON
PORTLAND, OR 97294 TIGARD, OR 97223
P
PHONE: 503 - 524 -8980
PHONE: 503 - 253 -0030
FAX: 503 - 262 -8251
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/07/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/07/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is . - -- • •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done accordance with = •proved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. • TENTION: Oregon la. .-wires you to follow the rules adopted by the Oregon Utility Notific- e jer. Those rules are set forth in OAR
952 -04 - 0010th ough OAR 952 -01i -0090 'o may obtain a copy of the rules or direct questions to OUNC by calling . •. r or 1.800.332.23' • . '.%
Iss -d By: � / Permittee Signatu -• �-+ A ' e ' r
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 INSTALL • TION ONLY
�
SIGNATURE OF SUPR. ELEC' • e � —`—_ Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Dec 06 11 04:35p Casey's Plumbing 5032628251 p.1
_T _
Electrical Permit Application '" FOR OFFICE USE ONLY
e 13125 SW Hall Blvd., Tigard, 0 44 . 4 ) - plan Review
City g of Ti and Recei °ed T�� / ,, � � — 1 'k O'� D �A ff� _Ji Permit No.: �� t^ �[ G�
Phone: 501718.2439 Fax: 503.1960 Other Permit:
T i GAR D Inspection Line: 503.639.4175 � C ��� D a t e /B v: . Date Ready/By: Jurist Bl See Page 2 for
Internet: tvww.tigard or.gov 0 fl� � lAV Notified/Method: Supplemental Information
TYPE OF WO �G ». PLAN REVIEW
❑ New construction Ad dition/alterat p cement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: $ ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
dwelling less to ground, or exceeds 14,000 0 Commercial -use agricultural
42 and 2-family g 0 Commercial /industrial ❑ Accessory building amps for all other installations, buildings.
'❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
0 Emergency system. larger separately derived system_
❑ Addition of new motor load of ❑ "A , "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: L 100HP or more. occupancy.
f S t � ' L� ` 4 ❑ Six or more residential units. ❑ Recreations! vehicle parks.
City /State /ZIP: . & r� C .te ID Health-care facilities. ❑ Supply voltage for more than
i ,c 0- O. - c.._ \a
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt, no.: Project name: 0 Service or feeder 600 amps or more.
FEE SCHEDULE •
Cross street/directions to job site:
Description I Qtr. I Pm I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. It or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. R) 75,00 2
Limited energy, multi - family
1 7/00 2
F �G44% ' { 6‘-i•0 res (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
• ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name 401 amps to 600 amps 200.34 2
`ID c.( 601 amps to 1,000 amps 301.04 2
Address: ` c
`i,'`7G \ ,lt.,.: L'U , V - \ - "Z'V'\ Over 1,000 amps or volts 552.26 2
City /State /ZIP: ! - Temporary services or feeders installation, alteration, and /or
ti C?CL�r I G'i� ° l� l D,.3 relocation
Phone: ( 7} , Ll r 3 v J C Fax: ( ) 200 snips or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
� each branch circuit
t �
Business name: 1' \EkV {,i 5 j � : e �1 i.e ,�✓i B. Fee for branch circuits without �
1 service or feeder fee, first 1 56 18 s ii
Contact name: ? t\ � �
i,CISel \ branch circuit 2
J Each add'I branch circuit 7,42 2
1` D
Address: , L • ' - L • 1 LG -. Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
Gv, *,G\ b l C \ t 6 n C {� �9 Lt dwelling, service and/or feeder 67.84 2
Phone: (3< U Le, -- C6 3s3•- Fax:: ( D Reconnect only 67.84 2
Email c Pump or irrigation circle 67.84 2
%t`- mot-' f� C.CI' �5 F•'U :v1',l'� r;ON •C Cn I t Sign or outline li -
CONTRACTOR `' Pig 67.84 2
_ Signal circuit(s) or limited - energy
Business name: ii\'e..\ L1 _ � E { G _ 4i t panel, alteration, or extension. Page 2 2
1 Each additional inspection over allowable in any of the above
Address: ' 1 ? -LY. ._2:--X=--<;' 1, Additional inspection (1 hr min) ' 66.25/ hr
Ci /$tate/ZIP: �
Investigation 1 hr min
r (= tt , G v- ∎ci I 3� CFI ) Industrial 1 h
lant r min
Co -> �� P (1 ) 78.18/ he
Phone:
( {2) ( t -G .- `� 2 Fax: 4 X ) ,) (1.,D C ,,D- Inspections for which no fee is
CCB Lie.: y \ Electrical Lie.: c? �- Suprv. ye.: /E3(•/_5- listed (V lir min) 90.00/ hr
/EsKl -s ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �� ,.., Subtotal: 5 �p • (g
Plan review (25% of permit fee):
I yy Date: surcharge (12% of permit fee): 1.1v' l �
Print name: k�L' Ci, t_.% i � -t (9 _ it State s a ( P )- IP• 79
Authorized signature:; ^ �% TOTAL PERMIT FEE: �� �Q
J.,i,tr: r �
it
This permit application empires if a permit is not obtained within 180
Print name: )~� k C�.^l_4 j_ i.,(.. E, ct--t k . Date: /, -1_,, • - (,f days after it has been accepted as complete
1 • Number of inspections allowed per permit.
1:1 uildingtermits \ELC- PermilApp.doc 07 /01 /10 440 4615T(II /05 /COMIWEB