Permit CITY OF TIGARD ELECTRICAL PERMIT
111 DEVELOPMENT SERVICES DATE ISSUED: E2 ;2 -00726
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: Install 1 hot tub circuit.
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:
GOLDWYN, DAVID OLIVERS PRECISION ELECTRIC CO
12354 SW WINTERLAKE DR 17035 SW HIGH HILL LN
TIGARD, OR 97223 BEAVERTON, OR 97007
Phone: 503 - 590 -2533 Phone: 503 - 579 -7747
Reg #: LIC 41435
SUP 2539s
FEES ELE 34 -521C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/18/03 $46.85
[TAX] 8% State Surcharge 12/18/03 $3.75 Rough -
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By: 4 Permit Signature: t ' 2 fa?
d ,
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: 3�
Call 639 -4175 by 7:00pm for an inspection the next business day
12/17/2003 08:44 2035795907 REVILO SAINTS PAGE 01
fr
Electrical PermitAp 1 licatio l ik, - t E \V Datereceived: , g / Permit no.: C, b -DO' (p
L' - .1 City of Tigard Project/ap no.: • Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigald,E0 9722 20 0 3 Date issued: By$ jg J Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598.1960 Case File no.: Payment type:
CITY OF TIGARD
Land use approval: BUILDING DIVISION ) _
•
Al & 2 family dwelling or accessory O Commercial/industrial O Multi- family 0 Tenant improvement
0 New construction ❑ Addition/aiter'ationlreplacement O Other _ 0 Partial
Job address: 2-3 !4/ r. Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: j Block: Subdivision: � — L
Project name: G 9 id w 1 I Description and location of work on premises; , . �- / -
Estimated date of corn . letionHnspectiton:
(()V I it %f" ANTI( AI ION VIA. Still MIT
Job uo: 1Fee Mal Desulptloa
Business name: 0 l ix 01 f • / / � {Y , :e. New reddeatdd -rte per (era) Total no. bop
Address: 1 7Q 3 3. 6 �,L1 i i _ a er&Ina r oae. redgar
Ci : t il
. a a State:DR_ ZIP. R p 7 • Sa.leewcbldett
Phone :s03 S 9 7 Fax: S - 0 , E-mail: D 'ELiV.' , 6 0I e „421 . 2_00 a ft_ or less 4
Each
CCB no.: 4 / 3 5 Elec. bus. ic. no: 34 - 5-1.1 addittomrai S oo an,. ft or portion thereof ,
Limited eeergy, residential 2
City /metro lie. no.: lin G Limited iel 2
.. t iPL • L . /ff Each manufactured 11001e or modular dwelling
Signature of supervising electrician i -, aired) r Service and/or fader . . 2
Sup. elect. nstue (print): , u - Limes no: 5 Sankt. or fenders —installation,
attendee orrdocsdow
I'It4)1'I It I 1 ()1■ .1I.I( 200. ,. or less 2
�� l to 400 W
Name (print): _L)aN1C` J - � 201 ompa aps 2
p ,. to 400 a 2
Mailing address: aan� 4,,..- _ 601 amps w 1 000 amp 2
City: [State: "ZIP: Over 1000 amps or volts V 2
Phone: �Cj p —a-5 Fax: 113 -mail: Reconnect only 1
Owner installation: The i.ustallation is being made on property I own neoporneyeerdeeect beedets -
kratallstlati, rebind=
which is not intended for sale, lease, rent, or exchange according to ' a0a ' Or
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owne(s s' ature: Date; 401 to 600 2
&tech circuits - new, alteration,
Names or Mention � Pub
A. Fee for branch rncwts with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Pee for brendt circuits without wane
Phone: Fax: E-mail: of service or feeder foe, first branch circuit J 7 L� . 7(x,7" 2
Eeth additional circuit
19 \\ Its \ II 11 119v:R& dick I, all trial :i1 1. ] Abe. (Service or feeder not taduded):
0 Service over 223 amps-commercial O Mealdreare facility Each pump or Irrigation circle 2
O Service over 320 amps-raring of 18a O Hazardous location Each sign or outline lighting _ 2
family dwellings 0 nuitding over 10.000 square feet four or Signal circuits) or a limited energy panel,
O System over 600 volts nominal more residential units In one atnrmue alteration, or extension* 2
O Building over three stories o Peak" 400 amps or more ^ *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Fact additional Impotent over the allowable In any of the above
O E$mess/tighting O Onset: Ptrinspection f I I _ L
Submit _ seta of plans with any (tithe above. Investigation tee
The above are pot applicable to temporary eoss4'octloo service. _ Other
=Jurisdictions aroma - . ', ardh. please cal for were m� Notice: This permit application Permit fee $ Lf( , �i
'Noes alla l Jur
O Visa o MaaterCard expires if* permit is not obtained Plan mview (at „ %) $
credit card comber: _ I I within 180 days after it has been State surcharge (8%) .... $ 3, 7 5 •
°° accepted as complete. TOTAL $ . • /s f1
$
cardwider signature Amount 440.4615 (60:1000M)
/O /. 0o
Building Division
Applicant Request to Cancel Permit
City of Tigard BEGEALEID
AN 11 2004
TO: CITY OF TIGARD, BUILDING OFFICIAL OF TIGARD
13125 SW Hall Blvd., Tigard, OR 97223 CITY DI VISIO N
Phone: 503.639.4171 Fax: 503.598.1960 BUILDIN
FROM: Applicant Name: c X& Aeas
Mailing Address: ('3S Sic) MIA /,. // L41.i-
City /State /Zip: t3G4'e,2ra•J Ore/.
Phone No.: ,$n3 -S
V 0 1 0 Fax No.: 573 5 75 —S'►a t
PLEASE CANCEL PERMIT APPLICATION AND REFUND PERMIT FEES, IF ANY,
FOR THE FOLLOWING:
7/v ��. 2_no3 �7 '
Permit No.:
Type of Permit:
Site Address: st•4..) LAN-v.\ ' a�e.. 4
Subdivision:
Lot No.:
EXPLANATION: l . ` D. -
Signature: • MO - Date: 1 1 (ozio
o
Print Name: yam, ern \q
FOR OFFICE USE ONLY
Route to Admin.: Date: . By: k li
Permit Canceled: Date: �/i y d / By: ,:
Refund Processed: Date: 4 iy /o y By: - ;
o /eaj -S ,27 /a /P d3
/ emkn//� 4 ' 7, y?
i \ Building \Forms\RegCancelPermrt.doc 04/03