Permit Support Document CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: ELC2014 00038
• ' Date Issued: 01/28/2014
T f 6 A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 t Parcel: 2S110AD09600
��/ir Jurisdiction: Tigard
Site address: 14650 SW 106TH AVE
Project: Condo Pool House Subdivision: LANG HILL Lot: E
Project Description: replace feeder and circuits for pool house. 5/29/14:Reprinted permit for(1)additional branch circuit.
Contractor: A&J ELECTRIC Owner: CALWAY HILL HOMEOWNERS ASSOC
PO BOX 330 BY STAN ADKINS BUILDER, INC
FOREST GROVE, OR 97116 8459 SW BARBUR BLVD
PORTLAND,OR 97223
PHONE: 503-359-5891 PHONE:
FAX: 503-359-1981
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 01/28/2014 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 01/28/2014 $14.84
Type of Use: MF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 01/28/2014 $13.86
Electrical
Type of Const: 1 crt Branch Circuits w/Purchase 05/29/2014 $7.42
Occupancy Grp: Service or Feeder
1 12%State Surcharge- 05/29/2014 $0.89
Electrical
Total $137.71
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a cop of th r.I-s or direct questions to OUNC by calling 503.232.1987 or 1.800.332344.
r /
Issued By: ✓ �-- Permittee Signature: c- 4111
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
May 29 1406:22a A&J Electric CEIVED 5033591981 p.2
RE .
Electrical Permit ADDlicata11VIA%, 2 9 2014 FOR OFFICE USE ONLY
City of Tigard Receives if
Data$v. '[ • Permit To: t 1....))0 i
_ • 13125 SW Hall Btvd.,"Pl od,OR ' r" O F.fIGAAD Plan Review
Phone: 503.718.2439 Fax: a � JateaBv: Olherl'umil:
1 10,,H i i Inspcerion Lirte: 543.639.4:75 t 1 ./T r flh,gIo\I Date R:ady'By: r v' See Page 2 Lr
Internet w•xtv.ti and-a. v f� Notified/Method:tethod; Fes'°
S $o Supplemental]aformation
TYPE OF WORK PLAN REVIEW
❑New construction IN Addition/alteration/replacement Please check all that appy(submit 2 sets of plans wine=choreal below):
['Service or feeder 400 amps or more ❑Building tinier three stories
❑Demolition 0 Other: where the available fault current ❑Martins and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps tie 150 wits or 0 Floating buildings
less to Bound.or eacecds 14.000 Q Camnercsd-girt agricultural
f1:1 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installaimm. buildings.
+ ®Riulti-family ❑Master builder ❑Other: prim pane. 0 htsrellutioa of 150 x VA or
JOB SITE INFORMATION AND LOCATION 13 Emergency
of m. target sepacitety deri.ed s.stcm
❑Addition of new motor bad of ❑`A""E^,'1-2 °l-3
' ICOHP or more. occupancy.
Job no.: Job site address:14650 SW 106th
ll ❑Six or more residential units. Q Raaeatioaal vehicle parks.
CityiState!ZIP: ;+ ❑Hcahh<are£Sell tics_ Q Suppll voltage for more than
N �' i' ❑Hazardous locations 600 vole nominal.
Suite/bldg./apt no.: Project name- 10�I ❑Service or feeder ns amps or more.
- FEE SCHEDULE
Cross street/directions to job site: ttemnation L(Qty. t Pee I Taal [•_
New residential single-or tndti-family dwelling unit.
Includes attached garage. _
1,000 ft.or less --,
Subdivision: 1 Lot no.: 168 54
Fa.add•500 sq.It.or portion 33.92 1
Tax map,pare el no.: energy,1 rgy,residential 75.00
DESCRIPTION OF WORK (wish above sq.ft)
Limited energy,multi-family
2
Add lckt to permit#ELC2014-00038 for AC residential(with above sq.ft.) 75.00
Renewable Energy 1 Q See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY ARTIER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
Address: 1 601 amps to 1,000 amps 301.04 2
Over 1,000 amps orvolu 552.26 [ 2
City/State/ZIP: I Temporary services or feeders Installation,alteration.andior
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not "
701 amps to 400 amps 15.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670.and 701.
401 gimps TO 599 amps 168.54
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch coatis with
—
above service or feeder fee, n
[ Business name: coach branch circuit 7 4- 2
B-Fcc for branch circui 5 arbour
Contact name: service or feeder fee,first
56.18 2
Address: Windt circuit
Each add'/branch crew ] 7.42 7.42 2
t Miscellaneous smite or feeder not included)
City/Stale/ZIP:
Each manufactured or modular
67.84 2
duelling.servisc and/or Ruler
Phone:( ) Fax::( ) s-
1 Recount=only 67.84 2
E-mall: Puma or errieation circle 67.84 2
CONTRACTOR Side or outline lighting 67.84 2
Business name: A&JElectic SiiaI circuit(s)or limited-energy See
panel,alteration.or exurrision. Page 2 2
Address: PO Box 330 Each additional inspection over allowable in any ante above
Forest Grove,OR 97l l6 Additional inspection(I hr min) a 66.25!hr
city/State/ZIP: ,
investigation(1 hr min) 66.251 hr
Phone:(503 )359-5891 Fax:(503 )359-1981 Industrial plant(1 hr min) 78.161 hr
Inspections far which co fee is
CCB Lic:959 j Electrical "e.: 34-1c Suprv.Lie.: S 7 q62.6 specifically listed(n hr min) 90.001 hr
Suprv.Electrician signature,required: \ , ELECTRICAIE PERMIT FEES
.r.. Subtotal: 7 42
Print name: Jesse Peterson Date: 5/29/14 Plan review(25%of permit foe)•
State surcharge(12%of permit Ice): ,PT
Authorized signature: TOTAL PERMIT FEE R.11 i
Print name: Tbis perms application expires if a permit is not oh tamed within 1St)
L Date: days aRev it has been accepted as complete.
• Number of inspections allowed per permit.
I.sa.micg`.PenoiunEt.0 Permitnpp_el.R ERE dre Revor_lrmlt 44C-4C 1511 ILtVCOM.1y5B