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Permit C r � -4- CITY OF TIGARD ELECTRICAL PERMIT '` r a ;, COMMUNITY DEVELOPMENT Permit #: ELC2009 -00560 r ; gat, Date Issued: 10/22/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S 115AA05100 Jurisdiction: Tigard Site address: 10925 SW CHATEAU LN Subdivision: Lot: 0 Project: Lutz Project Description: Alter (1) branch circuit for hot tub. Owner: FEES LUTZ, LARRY D & LIZBETH K Quantity Description Date Amount 10925 SW CHATEAU LANE TIGARD, OR 97224 1 crt Branch Circuits 10/22/2009 $56.18 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 10/22/2009 $6.74 Electrical Contractor: OWNER PHONE: FAX: Type of Use: SF 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. 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 -0100. You may obtain copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1.800.332.2344. Issued By: -- _ , i c_ V 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 eJ Q 0 'P p - Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. `3'F'^ . ",fr Y m , ^ r, , f 3 wf ?,.w v rrrt r; Electrical Permit Application CEIVE 440.4 I y,` h R o -vi ICI,U,;crai , { 1 ,. , F * r S r i °-+' 1 1 .� � . x b. k1r,14- ?tom iNu,'.,. Y.)214;Tagi: :;: x c:: . . _.; riiiirj R eceived City of Tigard Permit No.: c r 4.5 �q, , 13125 SW Hall Blvd., Tigard,OR 97223 ° - T 2 2 2009 Date/By: Review C 4 .. S620 !s . Phone: 503.639.4171 Fax: 503.598.1960 DateBy: �i, r l -c> Other Permit: sr " Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: lulls- El See Page 2 for .ttlisiii s tr4A Internet: www.tigard- or.gov BUILDING DIVISION TL� � Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. 'CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. ' less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 0-1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "13 ", Job no.: Job site address: /0 s $r �',L` -etc. G,v , 100HP or more. occupancy. / ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: . ,„ 47 1 9p 9 74 et ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more. . FEE SCHEDULE Cross street/directions to job site: /Q Description 1 Qty. 1 Fee. Total 1 * r New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 • DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 residential (with above sq. R.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ig-PROPERTY OWNER ❑ TENANT • 201 amps to 400 amps 106.85 2 Name: / � 401 amps to 600 amps 160.60 2 �� G� -6-- 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City /State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( , O$ 9/ , V I Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, r•nt, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 1 Branch circuits - new, alteration, or extension, per panel r Qwner_signature: ` — - . /L' Date: /9 � T A. Fee for branch circuits with APPLICANT 1 ❑ CONTACT PERSO above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, I 46.85 2 first branch circuit Address: 'Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR • Sign or outline lighting 53.40 2 Business name: Signal circuit(s) or limited - energy panel, alteration, or Address: extension. Describe: Page 2 2 City/State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. 1:\ Building ts\ELC- PermitApp.doc 05/23/06 1 g 7 440 oL Electrical Permit Application - City of Tigard • Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: • - • • ' Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* Other: ( / ll7 �"A,�c�i CI rov)9 > 6 - 3/ D/¢ • COMMERCIAL WORKONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: _ *No licenses are required. Licenses are required for all other installations I: \ Building \Permits\ELC- PermitApp.doc 03/23/06 Electrical Permit Application City of Tigard Re7Rvyiew r Permit No.: 13125 SW Hall Blvd., Tigard, PlaOR 97223 ~~I r 2 PlaL ~C~ (QQ Phone: 503.639.4171 Fax: 503.598.1960 DaOther Permit: ion Line: 503.639.4175 i-')TY OF TIGARD Date Ready/By: Juris. ® See Page 2 for Inspect Internet: www.tigard-or.gov ; .p~Art y ~l~',SI oti6ed/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial-use agricultural 1- and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A", "E", "1-2", "1-3", Job no.: I Job site address: /rte / ~V G~ 100111' or more. occupancy. ye- S S' CY l e ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: ~lt! g 7j~2 L/ ❑ Health-care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: 42 Description 2(y. Fee. Total New residential single- or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential DESCRIPTION OF WORK with above s q. ft. 75.00 2 Limited energy, multi-family 75.00 2 residential with above sq. ft. Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name:. ~L 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: 5 /'9 Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, 7nt, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits - new, alteration, or extension, er panel Owner signature: r~ / i Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, ' 46.85 2 first branch circuit Address: Each add'I branch circuit 6.65 2 Miscellaneous service or feeder not included City/State/ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax:: ( ) Reconnect only 66.85 2 E-mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: Signal circuit(s) or limited- energy panel, alteration or Address: extension. Describe: Page 2 2 City/State/ZIP: Each additional inspection over allowable in an of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 lir min) 62.50 CCB Lie.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. ' Number of inspections allowed per permit. 1:\Building,PermitslELC-PermitApp.doc 05123106 ~ 440-4615T(lil051COWWEB r , y- q CITY OF TIGAR® ELECTRICAL PERMIT sz COMMUNITY DEVELOPMENT Permit#: ELC2009-00560 4 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2009 Parcel: 2S 115AA05100 Jurisdiction: Tigard Site address: 10925 SW CHATEAU LN Subdivision: Lot: 0 Project: Lutz Project Description: Alter (1) branch circuit for hot tub. Owner: FEES LUTZ, LARRY D & LIZBETH K Quantity Description Date Amount 10925 SW CHATEAU LANE TIGARD, OR 97224 1 crt Branch Circuits 10/22/2009 $56.18 wo/Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 10/22/2009 $6.74 Electrical Contractor: OWNER PHONE: FAX: Type of Use: SF 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. 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 952-001-0,1r0~0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. 1 ~o Q Permittee Signature: Issued By: _mz~6gg OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE ~1 O Q • Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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.