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Permit 4 l . CITY OF TIGARD ELECTRICAL PERMIT ,f.'?a COMMUNITY DEVELOPMENT Permit #: ELC2009-00616 T t GAR .D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/13/2009 Parcel: 1 S135DCO3500 Jurisdiction: Tigard Site address: 11680 SW 95TH AVE Subdivision: FIRDALE Lot: 0 Project: Montgomery Project Description: Install (1) branch circuit for hot tub. Owner: FEES MONTGOMERY, DEANA S & CORY L Quantity Description Date Amount 11680 SW 95TH AVE TIGARD, OR 97223 1 crt Branch Circuits 11/13/2009 $56.18 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 11/13/2009 $6.74 Electrical Contractor: GARNER ELECTRIC 2920 SE BROOKWOOD AVE A HILLSBORO, OR 97123 PHONE: 503 - 591 -1320 FAX: 503- 642 -7925 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 rough O, - 9 $01 -0100. You may obtain a copy of the rules or direct questions to 0UNC by calling 503.246.6699 or 1.800.332.2344. Issued By ivo _ _ Permittee Signature: _ �F� i --- 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' Pig r/'.o— ,`J... 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. L Electrical Permit Application - " r =', :176 it '" i 0 NFON ` 'v � ,. 1 , " O' .1 .: 0;1 ,1 .. ate' :at32ii.g.t R .i suc. ,, .^r �mr ' C �� �� City of Tigard EI \ !� � 'ThatefFsr / . 09 �� // PemutNo,; the_A009-00 &ic . 13125 SW Hall Blvd., Tigard, OR 972.1: , Plan Review 1' Internet: www tigurd - ur guv Nutified/Med wd: '' trrn Inspection SO3 Nov 3. 2009 Date/By: dyfRY - . ..,. ' ..... _ a tltcrPcrntir t 11 i e c saCrran la .ti .,- .._. rKS•a►rat1 / Supplement Information /ci I l it r . r, -_• OA - - - - r . . '�' r�� r >r� , ( � q � tl�y, ���.q¢. r r r . ,n• r Ti - t i r .... -. - -- , �11{'1 " ¢ f I i 1� ,1 4��1t ��yI �' fa j *Mt '` i� ti l 9, I + 11" �dI i u 1 . IT i?r40l I.;7Cl!w1i> . gffI . ,aP',r ;Y „ 1,,cn,,7 v l �S' l i M m ..1 ' ,, o t,,I.6� Please hk ll h `t 't' t 'i..k Ui-f ➢ `1„ k �t rr� ? .',!. 0 ' . 't - j W 1r ( y' ; (� ( r LI, • tl 1 'III i • ease cec all that apply submit acts of lens w /item checked below); ❑ New construction �'Addition/altcrati � • ' � pp y ( � p ) ❑ Service or feeder 400 amps or more D Building over tore stones. ❑ Demolition El Other where the avuilob)e tauit uwreot El Marinas and boatyards. 1 ' 1. t' �� y ii . �.' i I> til i d e. ,>! ,, U t a�i,1m {61 „ T: i's w: f 88�'n !4t 2`� i1f;(( exceeds 10,000 amps at 150 volts or ❑ Floating buildings. '""` �"i . t "� ' 1 't r` leas to ground, or exu ads 14 ❑ Commercial -age agricultural al 1- and 2- family dwelling ❑ CotnmerciaJindustrial ❑ Accessory building amps for all other installations, buildings. 1 ❑ Multi family © Master budder 0 Other ❑ Fire pwgp. 0 h,gtalletiuu of 75 KVA of ❑Ark) PR v 11.F " ,. r r r tr t rt rV ❑ Emergency system larger separately derived system, �� I r � p ,., ) tuI �,; . � r �Ps �r lN a � � tl a 0 tl lI'if : 6 ' m, � / Iw } � ition of new rnatur load of [] "A" "I:' "1.2" "1 -3' '�yy �< a .., .� G , d '1 � o..i , Job no.: Job site d ress: /1 lQgU � L�/5 1.: / t V( /p 100 Sex 1-IP or more, nccuponey. - ._._ n i I ❑ et more residential units. ❑ Recreutioual vehicle parks,. C ity Ci /State /ZIP: // "1 Z'7 3 ❑ Health -cure facilities. ❑ H a za rdous locations, 0 Supply voltage for more than _ .. 71I1. 600 volts nominal. Suite/bldg./apt. no.: l Pro act name: ❑ Service or feeder 600 amps ur more f Y � ` i 1 ) P 4 ` • T! 1j ER job Iytacrlptlo nc i Cross street /directions to ob site: beIptIo e li a °" dk s ) n � Qty. 1 Pee. '1'ntol -''' New residential single or multi - family dwelling unit. Includes attached garage. Subdivision: 1 Lot no.: . 1,000 sq. ft. or loss 145.15 4 Tax map/parc el no.: F.a. add'l 500 sq. ft. or portion 33.40 1 r f ti g r " r I I 1 v r {� + p ^'' i I e Limited energy, residential I r .N) '. t s1:, i 665 Y P Cd jpar r jl ( tir ;i Et � t! }!r `r nWiW l ilf °l�Pt t ,r, �;;dtt (with above sq. 11.) 75.00 2 C / . 'C . / T l n t ti al (with abo ve fa q . f ft.) 75.00 2 •1 residenal th abo s. ft Services or feeders Installation, alteration, a nd/or reiocatlou 200 art>ps or less 80.30 2 l jn � I M � ,,... + h � � 'uL1*ai e F"t-� d'�� f�,.���° , ... .g° � ■1 bi ' � �1 fel i; T,�ta e n � 160.60 ,) ��", �t „o 1 +631 9 � �) „ 9 i.� ti ; ig t ' 4 ' A R A ._201 amps to 400 amps -- -- 106.85 2 Name: G 401 amps to 600 amps w TM 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 .. .._- ----- -------- rciucntfon Phone: ( ) 1 Fax: ( ) 200 amps Or leSS 66.85 1 Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 arms 100.30 2 intended fi>r sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133,75 2 Owner signature Date: A. Fee for branch circuits with Branch circuits - new, alteration, ur extension. per panel r , f) T , • ,rn e I E� i 1 ri � ,y l 1 s rf.+ )a I ,t rr'�er I � t 1 }e li � 11 49 „i "l' ^l %R ,.�" �a l * . , i 4 ; 1, fk,5 {t..,,, 3t t6 1 4 9 01# , , nk 1 above service or feeder fee, each branch circuit 6 2 Business name: :....-- .-_,.,.w_..,,_.,.,...,...._._-. I • ^ mmT B. Fee for branch circuits I. .._-.._. ,..- .._,- ........_.,........ -_- -- - -• wirhuuf service or feeder fee, Contact name: •r l t 2 first branch circuit Address: Each add'l brunch circuit 6.65 2 -- -- ,.,, • ......_. ....--- .. _.__..._- -•. Mised s • lancoua crvk'e or feeder not included City/State/ZIP: Each _ - _ _,... _ d' or ...... ry /State /ZIP: Rccon sect lured or modular 90.90 ..._..... 2 ,..-- - - -... dwcllin service and/or feeder Phone: (.. ) Lax.:: ( ) only E -mail: Pump or irrigation circle 53.40 2 6 ;� 1r f7 9r 6 m R•r r U 0 r r ,� t . `;;„,"�tg+ L 4i ;FS�.'�d' agg , M J' ;, "4, ' ?' `1� . i Viar %' k : ".l'. Sign or outline lighting - -- - - -- 53.40- - -- -- 2 Business name: r', 'g_ L - i Signal circuits) or limited energy panel, alteration, or Address: 2q�� 1S " r � w p ¢"� extension. Describe: Page 2 2 li C:i ty ! /State /Z]1' `` ' �' Each additional ins p ection over allowable in any of the above ~� Per inspection 62.50 Phone: (5 5_ 45s.2. f'ax: (5,1 i Lt 2._,-)92:5 Investigation per hour (1 hr min) 62.50 CC13 Lic.: 12 9 Electrical Lic.: CI Su. V. Lie -: -) p`j - Industrial plant per hour 73.75 s r f , s , ': - ...._._ ... _- - -_... Plan review (25% o I . u 1 1 k t�IS'j\ ti, 1r V 14 Suprv. Electrician signature, required: - Subtotal: L ' 5 , m f f permit Ice): - _ Print name: f ..,_ ......_. 142-0 1 1 1/. A S tate surcharge (12% of'p fee): Authorized signature: Tt)TA1., PERMIT FEE: Thii permit application expires if a permit is not obtained within IT+o oa • Print name: Date: days utter 11 hui been accepted as complete. C!/ * Number of inspections allowed per permit. Td Wt190 :60 600E ET ' ^oN SE6LEb9SaS : ON Xt)d O I �11991d eawat�J : W d