Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00344
DEVELOPMENT SERVICES DATE ISSUED: 6/11/2004
`-" 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 104AA -03800
SITE ADDRESS: 12580 SW KAREN ST
SUBDIVISION: BELLWOOD ZONING: R
BLOCK: LOT : 028 JURISDICTION: TIG
Project Description: Installation of (1) branch circuit for 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:
STEVE SUTTON OLIVERS PRECISION ELECTRIC CO
12580 SW KAREN 17035 SW HIGH HILL LN
TIGARD, OR 97223 BEAVERTON, OR 97007
Phone: 503 - 590 -2936 Phone: 503 - 579 -7747
Reg #: LIC 41435
SUP 2539s
FEES ELE 34 -521C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/11/2004 $46.85
[TAX] 8% State Surcharge 6/11/2004 $3.75 Rough -in
[ELPRMT] Investigation 6/11/2004 $46.85 Elect'I Final
Total $97.45
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 foi a '• •_ R 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 1 -800 -332 -2 •4.
Issue» By: ! �! �� _�. _ � _ Permit Signature: )0.- -/!'y\,
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: 244
LICENSE NO: `- 3F S
Call 639 -4175 by 7:00pm for an inspection the next business day
i ..
Electrical Permit Application _ . _ _
Date received: / ly_ Permitno.: E „ -- 4/
$ City of Tigard Project/appl. no.: Expire date:
Address: 13125 SW Hall Blvd, Tigard, OR 97223 w
City of Tigard Date issued:
Phone: (503) 639 -4171 1. �! Receipt no.:
Fax: (503) 598 -1960 Case file no.: 'ayment type:
Land use approval:
TYPE OF PERMIT ,.
111 & 2 family dwelling or accessory 0 Commercial /industrial O Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
- - - JOB SITE INFORMATION
Job address: i y54'0 5 443 4 - Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: 5, I Description and location of work on premises: i} - 4 _ r ,, 4 „
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: J 1 i. / e?'s r)ree. c'j 1C'- @-.,, -i;C Description Qty. (ea.) Total no. insp
jj New residential - single or multi - family per
Address: 1 70 f
5 ) i-� LC X �-i d dwelling unit. Includes attached garage.
City 'E( /( ( State:0 jdZIP: q 7 V .7 . Servicelnchided:
Phone:51) 3 579 7 ?'1 Fax: 5 514 E -mail: OPEZ3 4;/40161., 1000 sq. ft. or less 4
CCB no.: 4/ /3.r I Elec. bus. lic. no: ;3�— S2_/ Each e d e n e r g a1500 sq. ft. or portion theieof
L[ ` Limited energy, residential , 2
City /metro lie. no.: Lt 7 t' Limited energy, non- residential 2
V■ (1)l� Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: 3 s Services or feeders — installation,
alteration or relocation:
P ROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: gam..._ P. Liu+. ^ 601 amps to 10(X) amps 2
City: ' c.p .,,, ` , I Stat >r� ZIP: Over 1000 amps or volts 2
Phone: ,%4 .. - '2 3( I Fax: �E -mail: . Reconnect only 1
Owner installation: The installation is being made on property I own
Temporary services or feeders - ---,
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 'State: ZIP: B. Fee for branch circuits without purchase 1541L,t
of service or feeder fee, first branch circuit: ( 2
Phone: Fax: E -mail: Each additional branch circuit:
• -PLAN REVIEW (Please check all that apply) . misc. (Service or feeder not included):
0 Service over 225 amps- commercial O Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps- rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories 0 Feeders, 400 amps or more 'Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan 0 Other: Perinspection F I 1 I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
y
m
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Dt l N itS ge . ' ” '' & t 1 .. $ 4 k 0 Visa gtKasterCard expires if a permit is not obtained $ Ago.
Credit card number: .fib 4 61 N1- 27 1/ /if within 180 days after it has been State surcharge (8 %) $ .7 7
Expires
'vJ 4 b t '�f *T.t'' accepted as complete. TOTAL $
� Name of Ai - as shown on credit card $ 69. 4"� ? (� 7� ysr
Vr. ar'' 7 j
Cardholder signature Amount F 440 -4615 (6/00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171. MST
BUP
Received Date Requested 6 (42 ,AM PM BUP
FO Location I 0 o d — Suite ' MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) 6,360 7 SWR
BUILDING Tenant/Owner ELC 690 " �
Footing ELC
Foundation Access:
Ftg Drain 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:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL -
MECHANICAL _
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire _ Iarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
IN MOP PART FAIL
SITE El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA . n ` n / Q(
Approach /Sidewalk Date �4 O Inspector 6 1� `�' 1 V V _' Ext
Other:
Final O OT REMOVE this inspection record from the Job site.
PASS PART FAIL