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Permit CITY OF TIGARD ELECTRICAL PERMIT •• • COMMUNITY DEVELOPMENT Permit# ELC2012 -00546 Date Issued 09/19/2012 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S111CB01309 Jurisdiction Tigard Site address 14865 SW 104TH AVE Project Ritlop Subdivision DEL MONTE SUBDIVISION NO 2 Lot 18 Project Description (3) branch circuits for Jacuzzi tub and washer /dryer combo Contractor PATTERSON ELECTRIC LLC Owner RITLOP, FRANK 1834 NE ESTATE DR AKIN, ROBIN E HILLSBORO, OR 97124 14865 SW 104TH AVE TIGARD, OR 97224 PHONE 503-703-1241 PHONE 503 - 389 -2636 FAX FEES Quantity Description Date Amount 3 crt Branch Circuits wo /Purchase 09/19/2012 $71 02 Specifics: Service or Feeder 1 ea 12% State Surcharge - 09/19/2012 $8 52 Type of Use SF Electrical Class of Work ALT Type of Const Occupancy Grp Total $79 54 Required Items and Reports (Conditions) This perms • - • ect to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will be do, in accordance wit - .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 ATTENTION Oregon la • r= • Ir.- you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952 101 -0010 through OAR 952 -00 "1090 ay obtain a copy of the rules or direct questions to OUNC by calling 50 1987 or 1 800 332 234 �i Iss • d By I�/�at� 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 4176 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 Electrical Permit Application FOR OFFICE vsi ONLY City of Tigard RDateiv // eceiv Q �� ed am Permit No „ 6LevoZ J A 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review Phone 503 639 4171 Fax 503 598 1960 Date/B Other Permit I I A R D Inspection Line 503 639 4175 Date Ready/By tons ® See Page 2 for Internet www tigard -or gov Notified/Method Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction * Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below) ❑ Service or feeder 400 amps or more ❑ Building over three stories ❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations buildings ❑ Multi- family ❑ Master builder ❑ Other ❑ Fire pump ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no Job site address 4% („..5 S ys. k©LI +1 100HPormore Recreational 0 Six or more residential units ❑ Recreational vehicle parks City/State /ZIP ^t ❑ Health -care facilities ❑ Supply voltage for more than (CC , G�� o Hazardous locations 600 volts nominal Suite/bldg /apt no G Project name ❑ Service or feeder 600 amps or more ` FEE SCHEDULE Cross street/directions to job site V Lvv, O %AK. 4� • Description Qty I Fee I Total I • 6 New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision Lot no 1,000 sq ft or less 168 54 4 Tax map /parcel no Ea add'I 500 sq ft or portion 33 92 1 Limited energy, residential 67 84 2 DESCRIPTION OF WORK (with above sq ft ) �. 1 Limited energy, multi - family 67 84 2 a t A t Q W c_1L (k _ S o ( GC.It.ZZ 1 I V, �- residential (with above sq R) 11 t � Se rvices or feeders installation, alteration, and/or relocation V 5] n.SV■e r Dr e - co V l u d . 200 amps or less 100 70 2 ,Nt PROP RTY O ❑ TENANT 201 amps to 400 amps 133 56 2 Name V - c Cali. ` �`∎-ct —� \ 601 amps to 600 ,000 amps 30104 34 2 2 Address Over 1,000 amps or volts 552 26 2 City/State /ZIP Temporary services or feeders installation, alteration, and/or relocation Phone ( ) Fax ( ) 200 amps 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 OS 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 rCONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name B Fee for branch circuits without service or feeder fee, first 1 56 18 5?„ I© 2 Contact name ‘..-- � U 2C* �� branch circuit Each add'I branch circuit 2 7 42 (-/ g e 2 Address Miscellaneous (service or feeder not included) Each manufactured or modular City/State /ZIP QC eLE dwelling, service and/or feeder 67 84 2 Phone (9 ) 7o3 - 17_4 ) Fax ( ) Reconnect only 67 84 2 Pump or irrigation circle 67 84 2 E - mail Sign or outline lighting 67 84 2 CONTRACTOR Signal circuit(s) or limited -energy ` panel, alteration, or extension Page 2 2 Business name �c5 l.eC�rt� 1,1c_ Each additional inspection over allowable in any of the above Address \ V 3 1 IA. `� F . Fs ��. e Dr- . Additional inspection (1 hr mm) ` 66 25/ hr City/State /ZIP 1a I l. V Oro CA , ( kt 7 \ 2-44 Investigation (1 hr min) 66 25/ hr P '" Industrial plant (I hr mm) 78 18/ hr Phone ( 3 ) 7 12q r Fax ( ) Inspections for which no fee is specifically listed (% hr min) 90 00/ hr CCB Lic /890e I Electrical Lic d7 ♦ Supry Lic 51 5 ELECTRICAL PERMIT FEES /e/4‘7//p, II M ./.5 Subtotal 7 /. OA Supry 1lectrician signature, required , (k Rol /.l-w\ Plan review (25% of permit fee) Print name Q lwe A 0 , Va._ \ �e o Date q ,— f q — / State surchage (12% of permit fee) &. s �" / / L TOTAL PERMIT FEE 7? • SV Authorized signature This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name Date • Number of inspections allowed per permit i \Building\Permits\ELC- PermitApp doe 10/01 /09 440- 4615T(1 I /05 /COM/wEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* El Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other COMMERCIAL WORK ONLY: Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls El Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation El HVAC El Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* El Medical El Nurse Calls El Outdoor Landscape Lighting* El Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I \Bwldmg\Permn&\ELC- PermitApp doc 10/01/09 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 14865 SW 104TH AVE, TIGARD, OR, 97224 Residential - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2012-00546 David Young Violation Summary: Inspector Contractor