Permit Support Document CITY OF TIGARD ELECTRICAL PERMIT
� COMMUNITY DEVELOPMENT � : Permit#: ELC2019-00748
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24!2019
/2- / i Parcel: 2S108DB05400
Jurisdiction: Tigard
Site address: 15402 SW SEINE CT
Project: Hot tub Subdivision: POLYGON AT BULL MOUNTAIN Lot: 52
Project Description: 1 feeder wire in new hot tub on back deck. 12/16/2019: REPRINT permit to add(1)200 amp service and(4)
branch circuits.
Contractor: SQUIRES ELECTRIC Owner: BABICKY,JASON L&MARY L
2203 NE MARTIN LUTHER KING JR BLVD 15402 SW SEINE CT
PORTLAND, OR 97212 TIGARD, OR 97224
PHONE: 503-252-1609 PHONE:
FAX: 503-253-5831
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 10/24/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/24/2019 $6.74
Type of Use: SF Electrical
Class of Work: ALT 1 ea Services or Feeders-200 12/16/2019 $100.70
amps or less
Type of Const: 4 crt Branch Circuits w/Purchase 12/16/2019 $29.68
Occupancy Grp: Service or Feeder
0 ea 12%State Surcharge- 12/16/2019 $15.65
Electrical
Total $208.95
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 R 01-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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.
Dec 13 2019 05:46PM Squires Electric 5032535831 page 1
Electrical Permit ApplicationR E C E I V E D , „z(>,:1 1C 1,USE ON IA
DEC 16 2019 , ,, Permit# ��
City of Tigard DaetelBy: �16//� 1 f # "-LC / e;0 7v
• 13125 SW Hall Blvd.,Tigard,OR 97223 TIGARD OF
ITY Plan Review
Phone: 503.718.2439 Fax: 503.598.19�A Date/By: Related Penult#:
Inspection Line: 503.639.4175 BUILDING DIVISION Ready Date/By: 1 iu.is ® See Page 2 for i
IIC;AI`'1) Internet: www.tigard-or.gov Notified/Method: Supplemental Information
i' ....;.. _..._. --.__- ._.._;r�{r" r'_,- :....,.. - :...._.._ .. ...: .'P'.AN REPT)W
❑New construction Addition/alteration/replacement Please chock all that apply(submit 2 sets of plans w/items checked):
0 Servtcl or feeder 400 amps or more 0 Building over three stories.
El Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
__ .. ;_;. m �"� k � � � "; Gd M1 I-„K
exceed 10,000 amps at 150 volts or 0 Floating buildings.
1-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.
0 Multi-family ❑Master builder ❑Other: ❑Fire ptjmp. 0 Installation of 150 KVA or
�, ' , '.1 rgial- .a __C,' a t°v tr -.,�..w_ . .. 0 EmergCnc system_ loadof larger separately derived
�D �t' 0 Additi¢n ofnew motor oa system.
Job#: Job site address: l 02. e_. 1't'. 100tiOor more. ❑"A","E","l-2","1-3",
Ci /State/ZIP: /tom , ❑Six or more residential units. occupancy.
ty 1 t � LJRecreational vehicle arks.
�i o� ❑Healthrcare facilities. 0 P
Suite/bldg./apt,#: Project name: / ❑Hazardous locations. Supply voltage for more than
7 0 Servica or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: ., a Ay rs :, P
Descriptio 1 Qty.-I.- Each 1, Total J .
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: lnclade9 attached garage.
1,000 sq.ift,or less 168.54 4
Tax map/parcel# I
Ea.add'1i500 sq.ft,or portion 33.92 1
.._---- _13E ` ^ i : :_.. is Limited einergy,residential .
ii\Cii....Q
41 \ k e'a /r 1DIC/. (with intVg sq.ff) 75.00 2
Vt K] 4 l Vl.i4L/l J Limited residettial(with,multifamily 75.00 2
G .. ., Renewa leiEnergy�ve sq.ft) ❑ See Page 2
.. *'- M`':g-n• F -- : ^; - a Y•aw• a Services!or feeders installation,alteration,and/or relocation
Name: 200 ampor less , 100.70 lop.10 2
Address: 201 amp/to 400 amps 133.56 2
401 amp:to 600 amps 200.34 2
City/State,/ZIP: 601 ampa(to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,040 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocatiin
Owner installation:This installation is being made on property that I own which is not 200 ampa]or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amp1 to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
_ . r Branch fircuite—new,alteration,or extension,per panel
Business. F I,'E f - i y� r.~_; -.t' :.i; Feet branch cirrou
A. er its with
me: J MS �"�t L OE' ubovelservice or feeder fee, 7 42 2
n _ L each branch circuit
Contact name: Al ,(�O B.Fee to}branch circuits without
Address: \t (64 service rfreder fee,first
�y i brarlci�circuit 56.1A 2
City/State/ZIP: pJ i . Q Y19-47-ll
cc c%. Each adds I branch circuit 7.42 2
Phone:ED `L5 Fax: : +� • q Miscellaneous(service or feeder not included)
2 • 1 cp( ) Z5 3 ' �O%1. Each manufactured or modular
— ` , aG[^ dwellin service and/or feeder 67.84 2
Email VN( s VC/ ( / Reconneft only 67.84 2
i
�_ � �e;,"i:-.3 �,e; '�`�.i�,,�. .. ,..�.�' ° ' ' �.�.-, Pump or irrigation circle 67.84 2
Business name: Sy vis '4,c,.t-,C t t,marc - Sign or ojitlinc lighting 67.84 2
Signal citicuit(s)or limited-energy
0 dSee Pa e 2 2
Address: panel,ah tenon,or extension. g
City/State!ZIP: Each aditional inspection over allowable in any of the above
Addition l inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial]plant(I lirmin) 78.18/hr
C Inspections for which no fee is
90.00/hr
CCB Lic.:\%€b$� Electrical Licc.,1V`G Suprv.Lie.: tir6Gspecifrca�lx hsted(/a hrtntn}
Suprv.Electrician signature,required: Subtotal:
Print name: eP- vl,C�t Date: 1211.S 1 '(9 ❑PIaniReview Required(25%of permit fee): �"
State surcharge(12%of permit fee): VS , (OS--
Authorized signature: 1 TOTAL PERMIT FEE:
I This petlmit application expires if a permit is not obtained withhiin 1 0
Print name: e. � Date: 12/131 1 1 days after it has been accepted as complete.
' Number of inspections allowed per permit.
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