Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00197
• DEVELOPMENT SE"Y2VICES DATE ISSUED: 4/13/2006
•i I� 13125 SW Hall Blvd., Tigard, OR 97223 503 639 - 4171
PARCEL: 2 S 114 B B - 05300
SITE ADDRESS: 10075 SW PICK'S CT ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.1 LOT : 015 JURISDICTION: TIG
Project Description: (2) branch circuits to 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: 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:
SIMMONS, RODNEY L AND OWNER
JUDY A
10075 SW PICK'S COURT
TIGARD, OR 97224
Phone: 503 - 624 -0504 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 4/13/2006 $53.50
[TAX] 8% State Surcharge 4/13/2006 $4.28
Total $57,78 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. You may obtain copies of these rules or direct qu- - '. to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344
Issued By: 4r ,_ , t ,(,G 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'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.
Electrical Permit A rt►►z OFFICE Ic1: LSI: O\I.1
e' ,V�®
City of Tigard DateB� ® h op P> Permit No.' ee9 -0l9'
13125 SW Hall Blvd., Tigard, OR 97223 ® 1 c� 2006 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 ;APR J / / ,,, dl,, M1 . - ' : i I N Date/B : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Igial RI See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information
ittoiC415W IO PLAN REVIEW
❑ New construction 2+ Oddition/alteration/replaccment Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'I ❑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
•..and 2 family dwelling ❑ Commercialindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family 0 Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: I Job site address: 7 _ n 01 facility Daher: -
��� �� G/ Submit 2 sets of plans with any of the above.
City/ State /ZIP: 7 (?a The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: /) ,( e,is Or. 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
/3 /-(, / � / �� S ry _/ �j(� / • dwelling, service and/or feeder 90.90 2
(%(� C ] Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
/ - 401 amps to 600 amps 160.60 2
€'
Name: Q ' 4 5 . 4 . 0 7 mom 601 amps to 1,000 amps 240.60 2
Address: /0 7 S �p , yo CT Over 1,000 amps or volts 454.65 2 -
Reconnect only 66.85 2
City/State/ZIP: 747 , e 1 . , 6 - , Temporary services or feeders installation, alteration, and/or
Phone: (�y�p / , / Fax: ( ) relocation
v.! (�0�7 C60 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, le, ; t, r exchange ording to ORS 447, 449, 670, apd70D panel
amps to 600 amps 133.75 2
t
Owner signature: YfJ / / CC Date: !2 �� Branch circuits— new, alteration, or extension, per anel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: "j branch circuit
Contact name -�� B. Fee for branch circuits
without service or feeder fee, 46.85 44, 2
Address: first branch circuit
Each add'I branch circuit 6.65 6 bs 2
City / State/Z1P: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) 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: l
Address: (J Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: I Suprv. Lic.: Subtotal 643 .
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 4. a
TOTAL PERMIT FEE 57 7g
Authorized signature: This permit application expires if a permit is not obtained within t80
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
is\ Building \Pennits\ELC- PmmitApp.doc 12103 440.4615T(10 /02/COM/WEB
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CITY OF TIGARD
BUILDING DIVISION i, . PERMIT #: ELC2006- 011197
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2006
Phone: (503) 639-4171 µ lii
Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 5/17/2008 TIME: 7:06AM PAGE: 9
SITE ADDRESS: 10075 SW PICK'S CT CLASS OF WORK:
SUBDIVISION: PICKS LANDING NO.1 LOT #: 015 TYPE OF USE:
PROJECT NAME: SIMMONS
DESCRIPTION: (2) branch circuits to tub.
OWNER: SIMMONS, RODNEY L AND, PHONE #: 503 -624 -0504
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 030041 -01 503.6240504 N
Corrections /Comments /Instructions:
, til w
i■ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: clop Date: ' / 1 ' C6 Phone #: (503) 718- Z 911
CITY OF TIGARD ,r_
BUILDING DIVISION PERMIT #: ELC2006 00197
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2006
Phone: (503) 639 -4171 , I I
Inspection Requests (24 Hrs.): (503) 639 -4175 . - IL.
INSPECTION WORKSHEET FOR DATE: 4/18/2006 TIME: 7:05AM PAGE: 8
SITE ADDRESS: 10075 SW PICKS CT CLASS OF WORK:
SUBDIVISION: PICKS LANDING NO.1 LOT #: 015 TYPE OF USE:
PROJECT NAME: SIMMONS
DESCRIPTION: (2) branch circuits to tub.
OWNER: SIMMONS, RODNEY L AND, PHONE #: 503 -624 -05:14
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/18/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
150 Hot tub /spa/pool 028252 -01 503 -784 8494 N
Corrections/Comments/Instructions:
/� .'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �/ Date: X113 6, Phone #: (503) 718- /'Cgy