Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: IttA,v0 DEVELOPMENT SERVICES DATE ISSUED: 12/23/03
�,L ,. I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134CC-04100
SITE ADDRESS: 12354 SW WINTERLAKE DR
SUBDIVISION: CAPSTONE ZONING: R-4.5
BLOCK: LOT : 008 JURISDICTION: TIG
Project Description: Installation of (1) feeder and (2) branch circuit for hot tub wiring.
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: 1 W /SERVICE OR FEEDER: 2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
TIFFANY DUFF NORTHWEST PUMP + EQUIPMENT
12354 SW WINTERLAKE DR 2800 NW 31ST
TIGARD, OR 97223 PORTLAND, OR 97210
Phone: 503- 5r 9- 6)050 Phone: 227 -7867
Reg #: ELE 26 -852C
LIC 64567
FEES SUP 4884S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/23/03 $93.60
[TAX] 8% State Surcharge 12/23/03 $7,49 Rough -
Elect'l Service
Total $101.09 Elect'l Final
This Permit is issued subjed 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 hot started within 180 days of issuance, or if work is suspended
for more t 80 -days ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notifi t .n Center. Those rules are set
forth ' AR 952 - 001- 001O.through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions . I UNC at (5e • ' 246-6 9 or
1- 0- 332 -2344.
I sued By: 1 I , )Wa - / 1_l 1, Permit Signature:
- -- OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, 4, r rent.
OWNER'S SIGNATURE: DATE:
CONTICTOR ST.= ATIO ONLY
SIGNATURE OF SUPR. ELEC'N: ( A .✓ DATE:
LICENSE NO: ���{S
Call 639 - 4175 by 7:00pm for an inspection the next business day
E ' ctrical Permit Application FOR OFFICE USE ONLY
Received z Electrical //
Date/Ely: /� � J l ' Tj Permit No.: 6/t; (� -'007V0
O
City of Tigard Planning Approval Sign
City Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 torut Post - Review Land Use
µ ;r� j ^ J t\ Date/By: Case No.:
Internet: www.ci.tigard.or.us ■ y,, F•� Contact Jtld El See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 - Name/Method: -/ ! (6 Supplemental Information.
' - •, TYPE OF WORK _ .PLAN REVIEW (Please check•alfthat apply)':: ,'' . ',,,-
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Er Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
' • . ' CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
1 & 2- Family dwelling ❑ Commercial/Industrial ❑System over 600 volts nominal one structure
Dg
Accesso Building
Multi-Family El
over three stories ❑ Feeders, 400 amps or more
ry g ❑ Y ❑Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
. JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 1235N $ - & M * (4 ,, 'ti R g FEE* SCHEDULE ' •. ' - • A - .':.
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: (-for me Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential- single or multi - family per
l dwelling unit. Includes attached garage.
X14a� Pc "7 to igo Fp« Service Included:
1000 sq. ft. or less 145.15 4
S °V 7 - . # 1 4b cm °* Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
- DESCRIPTION OF WORK % . service and/or feeder 90.90 2
Services or feeders - installation,
W IRC I.M HCT' 7•4•0 alteration or relocation:
200 amps or less I 80.30 Sa So 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
' la PROPERTY, I ❑ TENANT 601 amps to 1000 amps 240.60 2
�, Over 1000 amps or volts 454.65 2
Name: / il c ( =p,..'' 1)V �• 1= — Plc/i () 6.6 wyiy Reconnect only 66.85 2
Address: ) 1- 3 s ' / 5. W . a //oTCn 6.4- /4 C Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 7 2 QK • 200 amps or less 66.85 I
201 amps to 400 amps 100.30 2
Phone:�'b3- y2/ -3ayo Fax: 401 to 600 amps 133.75 2
❑ APPLICANT ' , ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit a 6.65 /I 30 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
���► qq alteration, or extension Page 2 2
Business Name:
Ivcnlrf ,at t04 Egt, me,,A.4 Description:
Address Nil ) I / lllJ11
/State /Zi Each additional inspection over the allowable in any of the above:
Cit
y p: t a C • C) Per inspection per hour (min. 1 hour) 62.50
Phone:65$-€,1 -(oC7 b F ax: Investigation fee:
CCB Lic. #: ( Lic #: (9 ( , (� C Other:
C? Electrical Permit Fees* - I , •
Supervising electrician \",..;� Subtotal $ 33.40
signature required: ( t, � - Plan Review (25% of Permit Fee) $ 7 y9
Print Name: A `j p U4 --f I Lic. #: 11S89S6 State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $ JO I. O4
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information P -
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $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 ▪ ' A
COMMERCIAL WORK ONLY:
Fee for each system $75.00 _ •�' C.
(SEE OAR 918- 260 -260) • �' '
•-•
Check Type of Work Involved:
❑ Audio and Stereo Systems
Boiler Controls
�C• ��""'''' s �� 3• . , N. . •.'.i
Clock Systems �
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
Landscape Irrigation Control
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting
Protective Signaling
F7 Other
Number of Systems •
* No licenses are required. Licenses are required for all
� ,
. gther installations -
1 ). a .
i:'Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION / DIVISION Business Line:- _(5 3) 639 -4171 MST
'7 BUP
Received Date Requested . A PM BUP
Location Suite MEC
Contact Person .d/ ( ) Sao — a-S -3 3 PLM
Contractor • h ( ) SWR
BUILDING Tenant/Owner - ELC �3 �Z� 7
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 4 SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear CO `NO -- ZA
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall I I + 6 Aikkt
Fire Sprinkler
Fire Alarm `
Susp'd Ceiling lk
Roof 4
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
CTRIC
Se
Rough -In
UG/Slab
Low Voltage
- larm
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• ,'ASSN 'ART
SITE Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date Z — � Inspector e c 1\16 c3 Ext
Other:
Final DO NOT REMOVE this Inspection rd from the job site.
PASS PART FAIL