Permit CITY OF TIGARD ELECTRICAL PERMIT
: COMMUNITY DEVELOPMENT Permit#: ELC2017-00574
Issued: 08/01/2017
Date
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S104AD03504
Jurisdiction: Tigard
Site address: 12800 SW WALNUT ST
Project: CULWELL Subdivision: None Lot: None
Project Description: (3)branch circuits for garage addition and hot tub hook up. Contractor is completing work previously permitted
under ELC2017-00401 for final inspection. ELC2017-00401 has been closed due to new permit.
Contractor: CREATIVE ELECTRIC INC Owner: CULWELL, LESLIE D AND
PO BOX 659 DIANNA L
WOODBURN, OR 97071 12800 SW WALNUT
TIGARD, OR 97223
PHONE: 503-634-2454 PHONE:
FAX: 503-634-5013
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 08/01/2017 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/01/2017 $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 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 copy of es or direct questions to OUNC by calling 503.232.1987 800.332.2344.
Issued By: 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 503.639.4175 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.
i
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
13125 SW Hall Blvd,Tigard.OR 97223 DateB irari� Pemit#.
® Plan Review
Phone: 503.718.2439 Fax: 503.5981 ""a r� b Date/e : Related Permit it: - j 7_ef7l/11
Inspection Line: 503.639.4175 1E Rey Date/By:
p
11(-' \kD Internet: www.tigard-or.gov 241 NotifledlMeUar# Ari 0 See Page 2for
1 ^ ' information
Type of WORK 'j,U�lei, ;ANS
New construction VAddition/alteratioNrepl i;1\ ,r* Please check all that apply(tet 2 sets of pans wMerm
Demolition Ott C`ji �, Service or feeder 400 saps or more Building over thea stories
., where the available fault current Marinas and boatyards.
CATEGORY OF CO exceeds 10,000 appsa at 150 volts Floating bullcngs.
V1-
and 2-fanily dwelling Cornnercial/inc istrial Accessory building less to grand.or exceeds 14,000 Commercial-use agricultural
amps for all other installations. Wirings.
Multi-family Master builder Other.
Fire pump. Installation of 150 KVA or
JOB SfTTE ltWORMATION'.A :LOCATION En 9�Y sY larger separately derived
Job 4t: I Job site address: //g 00 S W. u)Ot/h O T s P« rrx*ar load of A ,."1-2°."1-3°,
City/State/ZIP: Ti Q 0 rd ®R 7),2 3 Six or more ure residential its. � neY
pe
( Health-care facilities. Recreational vehicle parks.
Suite/bldg./apt.t I Project name: Hazardous location. Sippy voltage for nue than
Service a feeder 600 apps a more. 600 volts nonirrd.
Cross street/directions to job site: Pkv SCHEDULE
oe annuls r I Otv. f meet I Tatar I *
New Subdivision:
Lot# al single-or multi-family dwelling unit.
tib
Tax map/parcel# 1,000 sq.ft.a less 168.54 4
Ea add/500 sq.ft a portion 33.92 1
r Dj RIF ION:OFWORK ` _. Limited energy,residential
Trim • l vi/Sh yoirct,9e j7/v� S� S .t�><Che (, t -f�;�, 7�� 2
S Limted �� 2
t S fl�/ °19r/ e /)D'E V b OO }� residential(with above sq.ft.)
IRl�111"IG.Oififlf�t,� L,,,..14
�C'• RatewaWe Enerav See Pane 2
I �' kt4T�;y Services or feeders inetallafionalteration,and/or relocation
Name: 200 arrps or less 100.70 2
Address 201 arrreto400aims 133.56 2
City/State/ZIP: 401 anpsto600arrps 200.34 2
601 anpsto1,000arms 301.04 2
Phone:0 I Fax:0 Over 1,000 amps or vdts 552.26 2
Email: Twnporary services or feeders installation,alteration,and/or
Owner installation:This installation is being made on property that I own which is not 330amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 arrp6to400arrps 12S08 2
Owner signature: Date: 401 amps to 599 anps 168.54 2
CANT "_;' I Branchdreuits—new. or extension,per panel
A.Fee fa branch drains with
Business name: above service or feeder fee, 70,2 2
Contact name: each branch circuit
B.Fee fa branch draits without
Address: servicea feeder fee'first 6randtdrait 5618 5-6.,( 2
City/State/ZIP: Each add'Ibranch arctit7.42 f/f-e 2
Miscellaneous(service or feeder notinduded)
Phone:0 Fax::0 Each rranufachred or modular 6784 2
Email: dwellina service and/or feeder
Recurcect ally 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Coz_F., P--1 r `f a ie,,:47,,-c Sign aoutline lighting 67.84 2
Adckess: 6 \ PB pet peneSigis/circuit(s)it(s)a limted•energ r s�Page 2 2
0, Panel,alteratia,a extensiat
City/State/ZIP 0(3) k 1,..\ fEadh additional inspection over allowable in any of the above
Additiord inspection(1 lir min) 66.25/M
Phone:0 411 1 7,z.olFax:0 Irweat tial(1 M nim) 90.O0Y IT
Email: Industrial pant(1 hr chin) 7818/hr
p�� Inspectiahs for which no fee is
90.03/
CCB Lica Z.531 '1 \ Electrical Li .:kl"..\ -S f, v.Lic.: \-1. % specifically listed(34 tr nim) hr,
St�rv.Electrieian sigtattxe,requiredEL TRICAL MINT F .. .
1/.,/ Subtotal: "1 I. C41,
Print name: D44/ fl 4 Date: 07 Plan Review Required(25%of permit fee):
3 /7 State surcharge(12%of permit fee): r5-) -
Authorized signature: N t://ki TOTAL PERMIT FEE: 71.,��1
' This permit application expires If a permit Is not obtained within 180
Print came: 4,Qnl C I Date: 0 73 I,//` days atter It has been accepted as cusnplets.
* Number of inspections allowed per permit
I:1BriidrglPunitaAELCPerrdtApp ELR_EREdoc015 44O-4615T(11/05tCOM/WE8
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12800 SW WALNUT ST, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2017-00574
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor