Permit l i•
' CITY OF TIGARD ELECTRICAL PERMIT
=. = COMMUNITY DEVELOPMENT Permit #: ELC2009 -00404
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/06/2009
Parcel: 1 S133DA08100
Jurisdiction: Tigard
Site address: 12665 SW SNOWBRUSH CT
Subdivision: Lot: 0
Project: Mattila
Project Description: (1) branch circuit for hot tub
Owner: FEES
MATTILA JIM Quantity Description Date Amount
12665 SW SNOW BRUSH CT 1 crt Branch Circuits 08/06/2009 $46.85
TIGARD, OR 97223 wo /Purchase Service or
PHONE: 503 - 524 -8312 Feeder
1 ea 12% State Surcharge - 08/06/2009 $5.62
Electrical
Contractor:
GRF ELECTRIC
15460 S PARADISE LN
MULINO, OR 97042
PHONE: 503 - 829 -4146
FAX: 503 - 829 -5747
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
Required items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 52- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. - /
Issued By: r� Permittee Signature: IN "97 ( -�70,\
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
•
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4176 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
P, 05 09 07:41a GRFELECTRIC 5038295747 p.1
1. RECEIV _ .. ' . Pi ?lti.11 I le l l �I O \l.1
Electrical Permit Application
City of Tigard AUG 0 5 200 ! • - i - .:b tcim't10o 'o?DO -D i
/ -
13125 SW Hal1131vd., Tigard, OR 97223 Plan Ravi. mbo Paint[
Yhogt: 503,639.4171 prat 503.598.1960 ® Daic/By; FTIGAI ' - RAmi ,W,.: 0 Straw 1far
lnsp 503.6]9.4175 9opptcatat 1( oranmat;aa
11 \Ft' intern= wwa.tigudar$ov
BUILDING DI VLI - '',` "
E OF WORK PLAN RTVVTEW
Flouts chock all tlw why (submit a tau of clams agrees checked below):
❑ NOW cons'suetion ddition/alterationheplacement ❑ Service alcoda400 mess awort ❑Salldiagover Ono storks.
-star the available halt twwwt D Marina sad baobsrdz.
0 Dctnolition ❑ Other: escudo 1n,000 amps at 1 SD vamp ❑ Floating �d Op.
CATEGORY OF CONSTRUCTION escudo
to pound, or meat 14,000 ❑ Caamnci•'1-ore agricalnnal
II. and 2-family dwelling ❑ CommerciaVnduclrial ❑ Accessory building amps for all ader i.rnnarions, baildoga.
❑P;rt: Pa"`0• ❑ l0s*a0atiat 02 Kvw a
❑ Master builder ❑ O[hcr: ❑ irac/gam warm. larger sepuatcly derived ovum.
[] Multi-family
SITE I FORMATION AND LOCATION ❑Maion ciao• mace load 0 ❑ "AI, -E.1
sir ar or mars. D �iooeal ',Thiele �b
Job no.: Iob sire address: J 2 Li to G. 5 e„,) O Sir ar mo rer�emeal emirs ❑ g [or mere than
❑ 1•laaldt•carcfaaaitint 60pvmlbamo1i
Cite /5Sat1e1ZIP: t . �Z23 _ ❑Haxanimuloacone
0 Service a tom 600 amps m mare.
• Suite/bldg./apt no.: S Projetx na t I , Ar . '. _t F8E SCHEDULE DnariMie• l Qh• f F ee r 7e ,at
Cross street/directions eelJOns to job silo: New residential single- or rout 6 - family dwelling twit.
Include, attached garage.
1,000 s4. ft. or least 145.15
Subdivision: ` Lot no.: Ea. add 500 sq. ft. or portion 33.35 l
Limited merry, tesideiltial 75.00
Tax map no.: (wit! ■ be r4 R)
DESCRIPTION OE � W Limited .e energy-. multi-family i ly 7$.00 l 2
t TA /1(' ail A .f in OgK O" +14 4 residential (with above se. a)
Services or feeders tnstauatian,aher.tion, a dior relocation 2
200 amps or less l! 1 80.30
PROPERTY OWNER j CI TENANT 101 arms to 400 amps 1 306.85 2
401 amps to 600 amps 16:1.60 2
Name: J ' !i7 it /IA - {.( A 4/_..) 601 amp m 1.000 amps i ` 240.60 2
77 J S ( I Over 1.000 amps or volts r l 454.65 1
Address: r Z �� < u / Y� 0 Lid � S � - ` Tan wary servitoror (cadent itutallation,al tora lea a gear
City/StatclLTJ? f 1 Vt ) relocation
200 wept to lea: 66.85 1
Owner Phone: 201 wept to 400 amps 16.8
installation: This installs¢ ion is being [Wade on p that I own which is cot 401 amps 599 amps 1;1.75 2
intended for or saalele, lease. rent, or exchange, according b0 ORS 447, 449, 670, and 701. Rraech circuit._ ncW. alteration, or extension. err panel
Owner: signature: Date: p. Fee for branch circuits with
1 ❑ CO NTACT PERSON above service or feeder .fce, 6.65 2
❑APPLICANT each branch circuit ,
Eit0ifCSS name: B. Fcc for branch circuits c
wawa service or feeder f¢, I • 46.85 II 6 � . p 5 2
Contact lama _ first branch circus 1 2
Each add'lbranch circuit 6.65 •
Address: Mlsutlaneous (Amite or feeder not included)
Each manufactured o[modular 90.90 2
Gity/State!11P: ' dwelling. service and /or feeder
Phone: ( ) I Fax:: ( )
Reconnect only 66.85 2 ,
Pump or irrigation circle 53.40 2
E Sign or outline ligliing 53.40 2
CONTRACTOR Signal circuit(s) or limited -
Business name: - a energy panel. alteration or 2
extension. Descabc: Page 2
Address' Dl , 1.
/1� 0 /� 7 Q Each additional Inspection over allowable in an of the above
City/Stars/ZIP: r v ■ r.! r r,rf O' v +' Per impaction 62.50
Phone (1'117) g Zr'f ,A. / U
a Fat:(.' ' - 4- Investigation per hour (I hr min) ` 62.50
Industrial plant per hour I 73.75
CCB Lie.: `? 6, Electrical i.e.: i 3- r ELECTRICAL PEA TEES '
Suprv. Licer(ician sigsutvte, requited: - . .... Subtotal
P1,1 f /� /,, r surcharge review (25% of permit fax):
?Tin' "nle: W r l 1 1 61 . , S bs/1 `r Y ,1 t Date: ' ( f 1 1 �l
State (12Y of permit fee):
( (
TOTAL PERMIT FEES
Authorized signature: `
7hit pawnappGratie. op.resIfs perm 110 f
Print Ilatffe: Date: , daya after it Kai bees accepted as amMem G 'l(]//
• Number of inapeoxa.a Wawa! per permit.
1 aitd ;aaupdualiLC•ParmiWV.da "• 4■446151111ro3 a