Permit 1 T CITY OF TIGARD ELECTRICAL PERMIT
4 COMMUNITY DEVELOPMENT Permit #: ELC2011 00724
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/28/2011
Parcel: 2S111AC00300
•
Jurisdiction: Tigard
Site address: 14630 SW 91ST AVE
Project: TEICHROEB Subdivision: PINEBROOK TERRACE Lot: 44
Project Description: (1) branch circuit for hot tub.
Contractor: PDX ELECTRIC LLC Owner: TEICHROEB, EUGENE M
7933 WHITFURROWS CT 14630 SW 91ST AVE
DURHAM, OR 97224 PORTLAND, OR 97224
PHONE: 503 - 997 -1989 PHONE:
FAX: 503 - 200 -1362
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/28/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/28/2011 $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 issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through -001-0090. You may obtain a co y of .e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.234
J
Issued By: 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' 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.
12/27/2011 11:14 PM (GMT) From: PDX Electric LLC 503-200-1362 To: 15035981960 Page 2 of 3
Electrical Permit Application V S '41 V)1 . . .
roa ofilc...:E (...ist ONLY
.. S)Ar Ilan Tigard, OR Review
City of Tiga ..1v Received •
1 cp i \ I\ _ natemy, /J , , Permit No.: gi cdsati _
, ..> 13 125 Blvd., 97-223 1 L ,90. Plan
Phone: 503.718.2439 1-ax: 503.598.196 - C
IN
v - t Other Penni'. Daten3y:
I ic; AR n Inspection Line: 503.639.4175 ' • - Nv*-- Date Ready
, .‘C) l - Judo' v 1 El See Page 2 for
'- Internet: www.tigard-orp,ov
01 NN:I. Notihed/Method: M-Ip I Supplemental Information
- aCNt .1%.‘6‘) - —
TYPE OF WO! , .0 . PLAN REVIEW
11] New construction IZI Add itionialteratOalacement Please check all that apply (submit 2, sets of plans wittems checked below):
0 Service at feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps 01150 volts or 0 Floating buildings
less to ground, or exceeds 14,000 0 Commercial-use agricultural
ED I- and 2-family dwelling 1.] Commercial/industrial D Accessory building amps for all other installations. buildings.
0 Mu I ti-fam i ly 0 Master builder 0 Other: 0 Fire PUP. 0 Installation of 75 KVA or
0 Emergency system. larger separately derived system.
JOB srry, INFORMATION AND LIX:ATION
0 Addinon or new motor load of
Job no.: Job site address: 14630 SW 91st Ave 1001 Sr more occupancy.
(3 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard/OR/97224 0 Health-care facilities. 0 Supply voltage For more than
0 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 L22Itr-..iIll,,!1_2_.
_ ----- .......
New residential single- or multi-family dwelling unit.
Includes attached garage.
. .......
Subdivision: Lot no.: 1,(X)0 sq. R. or less 168 54 4
Ea. add') 501) sq. ft or portion 33 92 1
Tax map/parcel no.:
Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above s9,11.)
-
Limited energy, multi
Install (1) 50 amp circuit for hot tub residential with above slit.) 75,00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
IZI PROPERTY OWNER 0 'TENANT 201 amps to 400 amps 133.56 2
__....... _............
..-- ---
- _........_..—
401 amps to 600 amps 200.34 2
Name: Gene Teichroeb
601 amps In 1,000 amps 301.04 2
Address: 14630 SW 91st Ave Over 1.000 amps or volts 352,26 2
City/State/ZIP Tigard/OR/97224 ocatio Temporar services or feeders installation, alteration, and/or
:
reln
Phone: (503)332-3653 Fax: ( ) 200 amps or less 59 36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not —
intended for sale, lease, rem, or exchange, according to ORS 447 401 amps to 599 amps 168.54 2 , 449, 670. and 701.
Branch circuits -. new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits midi
above service or feede tee,
.4 APPLICANT . 0 CONTACT PERSON fd 7.42 2
each branch circuit
Business name: PDX Electric LLC 13. Fee for branch circuits wallow
service or feeder fee, first 1 56.18
56 18 2
Contact name: Marty Palmer branch circuit
Each add'I branch circuit 742 2
Address: 7933 SW Whitfurrows Ct MisceRansous (service or feeder not included)
- Each manufactured or modular
City/State/ZIP: Portland/OR/97224 67.84 2
duvet ling„ service and/or feeder
Phone: (503) 997-1989 1 Fax: : (503-) 200-1362 Reconnect only 67.84 2
Pump or irrigation circle 67 84 2
E-mail: marty@pdxelectric.com
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: PDX Electric LLC _panel, alteration, or extension. Page 2 2
____ .. .,........... Each additional iwia.c over allowable in any of the above
Address: 7933 SW Whitfurrows Ct Additional inspection (I hr min) 66.25/ hr
,
Investigation (I hr min) 66.251 hr
C i ty.iSt ate/ZIP: Portland/OR/97224
,_ _ Industrial plant (I hr min) 78 I a/ hr'
Phone: (503) 997-1989 Fax: (503) 200-1362 Inspections for which no fee is
90.00/ hr
specifically listed (i4 hr nin)
CCB Lie,: 192731 Electrical Lic.: C696 1, iii Suprv. - v. Lic.: 5612S ELECTRICAL PERMIT FEES
_
..._
Subtotal:
_ - 56.18
Suprv. Electrician signature, required: -
Plan review (25% of permit fee):
_
Print name: Marty Palmer ! Date: 12/27/11 State surcharge (12% of pennit fee): 6.74
_
TOTAL PERMIT PEE: 62.92
Authorized signature: ,,.. „.(14/ ,...r i , > / e / i 2
_A ,.. This permit application expires if a permit is not obtained HO
tained within
/ days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
i \13uildinOermits \ LII.,C -Permit App.doc 07/51/ru 540-45 15 r( H "05/C:OMAVEH
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