Permit *. #}, CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00344
' ! COMMUNITY DEVELOPMENT DATE ISSUED: 5/18/2007
,00 iT3GA�RD•' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 104 CC -05300
SITE ADDRESS: 13609 SW ESSEX DR ZONING: R -7
SUBDIVISION: HILLSHIRE ESTATES NO. 3 LOT : 161 JURISDICTION: TIG
PROJECT: ANTHONY
Project Description: Installation of (1) branch circuit for hot tub.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
DOLAN ANTHONY NORTH BY NORTHWEST
13609 SW ESSEX DR. 326 S 15TH ST.
TIGARD, OR 97223 ST. HELENS, OR 97051
Phone: 503 - 590 -5430 Contact #: PRI 503- 348 -0505
FEES
Description Date Amount Reg #: ELE 5 -50C
[ELPRMT] ELC Permit 5/18 /2007 $46.85 LIC 142140
[TAX] 8% State Surcharge 5/18/2007 $3.75 SUP 4512S
Total $50.60 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 da s. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - : - 0010 thro • • O • 95- • .1-0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issu • By: ! ■4.1 Permittee Signature: k' % /
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'N: C ,` DATE: 5 " / S c9 7
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.
Electrical Permit Application -
pplication I'. . f ='' t I* , a 1 ' o FFI •E V" -.4t,',.
w n .
r ` h. ,,`r., EONL 5 . ' '^„ ,.. ' a
e ' �• Received /
��, ( Ity of Tigard Date/By: � ph I Permit No.: & 7 z23
,, *r n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
V p .; • • � Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Ins ection Line: 503.639.4175 Date Read /B Jn ., ® See Page 2 for
Ta G'A P Ready /By: � B
IuY Internet: www.tigard - or.gov Notified/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 ", "I 2 ", "I - ",
Job no.: Job site address: j 7 o 9 5 <- .t 55 e X O.' 1 occupancy.
❑ Six x o or r more r rest esidential units. ❑ Recreational vehicle parks.
City/State /ZIP: / 3, O 9 5 &l ,E 55 e. x Ur, 71'5 Atvc ®e, ❑ 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: Description 1 Qty. 1 Fee. 1 Total 1 •
. New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 1 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. ft.)
Services or !.'eeders installation, alteration, e ;'.%.v:r re'e Won 1
200 amps cr less I ou.30 2
1 PROPERTY•.OWNER \ ❑. 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,
relocation
Phone: ( ) 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 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 .2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch•circuits with
a APPLICANT , D 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 4.gs" 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
e,,'- 4 (� - )0 ed Signal panel, or limited -
Business name:
y energy panel, alteration, or
Address: 3 2 6 5 i g r y 5 T extension. Describe: Page 2 2
City/State /ZIP: 5 r *eta ,tl S Or 17e 5 1 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (97/) ' d 9 5 7 9'y Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: f y I 1 i 6 Electrical Lic.: 6 5 O d_ Suprv. Lic.: L/ VI_ Industrial plant per hour 73.75
N�n „d ' 7/i (O� /D f li 7 ELECTRICAL:: " FEES - 0 ej i Suprv. Electrician S Waled required: /' .....--a---4-1.—, ,� Subtotal: '� jp . g`c
,/ Plan review (25% of permit fee):
V
Print name: e _ r (.. o e k 5 Date: `j — / — v 7
State surcharge (8% of permit fee): o ff ? • 7
Authorized signature: f--e"”` ,rte TOTAL PERMIT FEE: 50 . &U
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.
l:\ Building Termits\ELC- PermitApp.doc 05/23/06 440-46 15T( l l /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
R "WORK ONLY: °
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL:WORK;.ONLYc ;r
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n 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