Permit A .„ CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00233
ll� DEVELOPMENT SERVICES DATE ISSUED: 5/1/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S102BC -08400
SITE ADDRESS: 12740 SW WATKINS AVE ZONING: R -4.5
SUBDIVISION: MLP2000 - 00007 LOT : 002 JURISDICTION: TIG
Project Description: 1 branch circuit to 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:
STEPHAN BURLESON OWNER
12740 SW WATKINS AVE.
TIGARD, OR 97223
Phone: 503 - 409 -0972 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 5/1/2006 $46.85
[TAX] 8% State Surcharge 5/1/2006 $3.75
Total $50.60 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 questions to OUNC at 503 - 246 -6699 or
1 -800- 332 -2344.
Issued By: ��. Permittee Signature: _��J,
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 Applic'atibn, ° ErvEl
:. Cl of Tigard a Received Pemut No. // i
City g rti1Q 01 2006 Date/B . S / / / „/I DD 33
° 13125 SW Hall Blvd., Tigard, OR 9722 Plan Revte
' C Phone 503.639 4171 Fax: 4 ..5 , .1 9 0 17ate/B Other Permit
I C n It I� Inspection Line: 503.639.417 , j. ur i lutiailk Date Ready/By. HI See Page 2 for
Internet: www.ligard or.gW(� � Tn ri TTtaT(1\ Noufied/Method Supplemental Information
TYPE OF W ORK - PLAN REVIEW
. ❑ New construction ❑ Addition/alteration/replacement 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
❑ 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Other: ❑Building over three stories 0 Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
' JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: f 274 o V,, (...art- t-VihS Clue ❑Health -care facility ❑ ee.
Submit 2 sets of plans with any of the above.
City/ State/ZIP: TO 4 „a U (2-- . C -7 2- / 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: � Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total
Cross street/directions to job site: {�, (. z-bl 0F�= OF New residential single - or multi- family dwelling unit.
C amr+. / Includes attached garage.
S L
' ` - Jcj 1 A ° S VCt• 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft or portion 33.40 l
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
tR uni YI � e �d r 1 c ( + h u b • dwelling, service and/or feeder 90.90 2
J 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: l riff r? M D L 2LQN S'o N 601 amps to 1,000 amps 240.60 2
Address: ( 271—o S. LI. l z S q e Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: 7y9 rdi 97 2- Z 3 Temporary services or feeders installation, alteration, and/or
relocation
Phone: 0°3 lb9 .— 0g7 Fax ( ) 200 amps or less 66.85 I
Owner installation: This ins . ation is bein' made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, re ex h. ge , . •. rdting to ORS 447, 449, 670, and 701.
i 401 amps to 600 amps 133.75 2
Owner signature: _�;I %�.
°� 0 6 Branch circuits — new, alteration, or extension, per panel
Ll Date: S . l r
❑ ' ► -rT 1. I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, r 46.85 �/� .G 2
Address: first branch circuit / 7d D
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
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: ol.AA PI
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: s Investigation per hour (I hr mm) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES'” .
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal: 46 .86
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (8% of permit fee): 3 - -75
TOTAL PERMIT FEE ..co. 400
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: • Fee methodology set by Tn -County Building industry Service Board
•• Number of inspections per permit allowed
I \Building\Permits\ELC- PmnrtApp doe 03/23/06 410.4615T(11/05/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 $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buildmg\Pemits\ELC- PamitApp doc 0323/06
CITY OF TIGARD
R
BUILDING DIVISION ' - ,t PERMIT #: ELC200 &00233
13125 SW Hall Blvd., Tigard, OR 97223 I. DATE ISSUED: 5!112006
Phone: (503) 639 -4171 ��I��+I
Inspection Requests (24 Hrs.): (503) 639 -4175 . "LL.
INSPECTION WORKSHEET FOR DATE: 6123/2006 TIME: 7 : 16 AM PAGE: fit
SITE ADDRESS: 12740 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: MLP2000 -00007 LOT #: Q TYPE OF USE:
PROJECT NAME: BURLESON
DESCRIPTION: 1 branch circuit to hot tub.
OWNER: BIJRLESON, STEPHAN PHONE #: 503-409-0972
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/2312006 Pour Time:
Code # Inspection Description Confirm # Contact #
199 Electrical final • 032208 -01 503- 709 -0972
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Corrections /Comments/ Instructions:
rnii __. --.... _
/201.•
WP
F 1DASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (.fir i Date: 6 Z-3 . Phone #: (503) 718 - g..—C7W