Permit (173) CITY OF TIGARD ELECTRICAL PERMIT
I ' COMMUNITY DEVELOPMENTIIII
Permit#: ELC2019-00536
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/13/2019
T I(;r1 II f3 9 Parcel: 2S106DA00400
Jurisdiction: Tigard
Site address: 13341 SW 169TH AVE
Project: Capra Subdivision: RIVER TERRACE EAST Lot: 4
Project Description: Adding(1)branch circuit for hot tub.
Contractor: NW ELECTRICAL SOLUTIONS Owner: CAPRA, DAVID C
PO BOX 805 KEYES,JENNIFER R
MOLALLA, OR 97038 13341 SW 169TH AVE
BEAVERTON, OR 97007
PHONE: 503-759-3952 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/13/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/13/2019 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speci- , Codes and all other applicable law. All work will
be done in accordance with approved plans. This pe •it will expire if work is not started within 180 days ,f iss ance, or if work is su--- 'ed for-more the 180
days. ATTENTION: Ore•on law requir- you to/r•low th- rules adopted by the Oregon Utility Not'cation Center. Those •• - -re set forth in OAR
952-001-0010 through••r 952-001-4094 ou ma,-stain a .,4 of the rules or direct questions to OUNC by callin 503.2 2.1987 or 1.8•,. . 4.
i
t
Issued By: .i'-._./...., LL_���_ Permittee Signature: C v
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.
Electrical Permit Applicatio '.b FOR I)! I1( 1 1 Sl 0v1 1
City of Tigard Received /� `
a 13125 SW Hall Blvd.,Tigard,OR 97223 F;v d " t- i.."'� an Review �i�i� /� i A
= Phone: 503.718.2439 Fax: 503.598.1960 Date : : Related Permit 11:
Inspection Line: 503.639.4175 Ready Date/By: kris- 0 See Page 2 for
i i r, P r r Internet: www.tigard-or.gov Notified/Method: Supplemental Information
________ _ _.. . __ . , E OF WORK _ PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
o Demolition Other:
0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
EI;.,and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
ini Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: 103' I Job site address: 1)341 S t,l Q''''� I t A(�"Z 100HP or more. ❑
//l Q �+[�7 3 ❑Six or more residential units. occupancy.
City/State/ZIP:
7O r t 4 t V 1 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot 1/: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
ARf (wilt above sq.ft.) 75.00 2
/� �� I•--�HG (�Zs Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0 PROPERTY OWNER1 ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: _Day,46 �';k 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
0A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or i.
Address: branch c reeeder fee,first 56.18 5 E.f g 2
uit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
-- -. Duress / � -
u � i�'1¢t r,c a8 I y l�f 5 f we
? n Signal circuit(s)or limited-energy
Address: 1710 ! O 13>r t r P;y panel,alteration,or extension. ❑ Page 2 2
City/State/ZIP: p p�"�� Each additional inspection over allowable in any of the above
Mt)C Ul I(� I b^I 17 3 g Additional inspection(1 hr min) 66.25/hr
Phone:(503)2 4L,3 5 G( I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: ❑12-0t1 L f- a 61 47 I • Co Industrial plant(1 hr min) 78.18/hr
JJ Q Inspections for which no fee is
90.00/hr
CCB Lic.: 2 Z-o-i Z 1 I Electrical Lic.: (I'f 5 9/I sup,:Llc:' specifically listed('I4 hr min)
��3_.S ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: .t -- ``
P _,. Subtotal: g6,/
Print name: l a! L
,...„,,k.4.',.44.,,/-t-'
Date: u \,3, r ❑Plan Review Required(25%of permit fee):
V State surcharge(12%of permit fee): (`p, 7 4
Authorized signature: 4 ;7--......"----°. TOTAL PERMIT FEE: ne(02. U
This permit application expires if a permit a not obtained within 180
Print name:L , — . 6.M4, Date: c't/i 1/17 days atter it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PamiApp_• ERE.doc Rev 06/17/2015 440-4615T01/05/COM/WEB
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
13341 SW 169TH AVE, BEAVERTON, OR, 97007 August 14, 2019 at
9:15:49 AM
Record Type: Record ID:
Residential - Electrical ELC2019-00536
Inspection Type: Inspector:
120 Electrical rough-in Jeremy Burrows
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
13341 SW 169TH AVE, BEAVERTON, OR, 97007 August 14, 2019 at
9:16:08 AM
Record Type: Record ID:
Residential - Electrical ELC2019-00536
Inspection Type: Inspector:
199 Electrical final Jeremy Burrows
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor