Permit (WI/ oteR 5/40,4 E ECTRICAL PERMIT
IN CITY OF TI ARD
s COMMUNITY DEVELOPMENT Permit #: ELC2008 -00634
TI G AR O 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 11/14/2008
Parcel: 2S110BA05300
Jurisdiction: TIG
Site address: 11815 SW WILDWOOD ST
Subdivision: Lot:
Project: JOHNSON
Project Description: Installing (1) branch circuit for hot tub and (1) low voltage system for landscape lighting.
Owner: FEES
GARY JOHNSON Quantity Description Date Amount
11815 SW WILDWOOD ST 1 [ELPRMT] ELC Permit 11/14/2008 $121 85
TIGARD, OR 97224 1 [TAX] 12% State Surcharge 11/14/2008 $14.62
PHONE: 503-603-1814 1 ea Services or Feeders - 200 06/11/2009 $80.30
amps or less
Contractor: 2 crt Branch Circuits w /Purchase 06/11/2009 $13 30
Service or Feeder
OWNER 11 da 12% State Surcharge - 06/11/2009 $11 23
Electrical (manual)
PHONE:
FAX:
Type of Use: SF
Class of Work: Type of Const:
Occupancy Grp:
Total $241.30
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 ATTENT e . : - eon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -00 % through OAR • f2 -0' 0100 A• u may obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800 332 2344
Issue. By: f Permittee Signature:
OWNER INSTALLATION ONLY tAgze_eLy__
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 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.
CITY OF TIGARD ELECTRICAL PERMIT
t ° y PERMIT #: ELC2008 -00634
°. COMMUNITY DEVELOPMENT
DATE ISSUED: 11/14/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S110BA - 05300
SITE ADDRESS: 11815 SW WILDWOOD ST ZONING: R -
SUBDIVISION: SHADOW HILLS LOT : 012 JURISDICTION: TIG
PROJECT: , JOHNSON
Project Description: Installing (1) branch circuit for hot tub and (1) low voltage system for landscape lighting.
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: SIGNAUPANEL: 1
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:
GARY JOHNSON OWNER
11815 SW WILDWOOD ST
TIGARD, OR 97224
Phone: 503 - 603 -1814 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 1 1/14/2001 $121.85
[TAX] 12% State Surchar 11/14/2001 $14.62
Total $136.47 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 day's of issuance, or if work is suspended for
more than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 throueh OAR 952 - 001 -0100. Y. •• - • • -in copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By J ` - _ Permittee Signature: It
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: 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.
Electrical Permit A t t lication r �
® FOR OFFICE USE ONLY
w `J Tigard of Ti d - � Received P No (!U
, Jt
13125 SW Hall Blvd , T1gari• : 7 ,‘ ' �� Plan Review /S t
: Phone 503 639.4171 . "'t • `" :'I960�� { �SC w ` Date By Date/By' I' N 0 i Other Permit ete cen /V6-- t�J(CU
T I G A R D Inspection Line 503 639 ' w\ �" � ®`�` D ate R ea d y B y runs M See Page 2 for
Internet: www.tigard -or.go - \°� O � �® ��e Notified/Method �� Supplemental Information
TYPE OF rr-- 4.- PLAN REVIEW
❑ New construction ❑ Addition /alt'�d �t;placement Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: Q3 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 ", "1 -3 ",
\\ IOOHP or more. occupancy
Job no.: Job site address:
1 `g / 5 SW ) 1 . ( t W c d 5T, ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: - r/ J 4i d 0 R 9 7 4 ❑ 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 I Qty I Fee. I Total I •
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'I 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
X4, C f -CC4 ,f -1— A Ofl r S residential (with above sq ft )
' ' �( Services or feeders installation, alteration, and/or relocation
�/ c.SL/- S]�Cr! vT /i ,7 /17S 'J 200 amps or less 80 30 2
❑ PROPERTY OWNER ❑ TENANT J 201 amps to 400 amps 106 85 2
401 amps to 600 amps 160 60 2
Name: Gov ✓ F , �U h S o 601 amps to 1,000 amps 240 60 2
Address: (((6 L tj S ) 1 ,i 1 - () w oc , cr - Over 1,000 amps or volts 454 65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
Ti S a r a o R 7 Z 4 relocation
Phone: (50'3 3 41 - o Z 2.. (, 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, rent, ore hange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2
- �v� q-
Branch circuits - new, alteration, or extension, Qer panel
Owner signature: _, II- /4 - � 8 A Fee e for r branch circuits with
APPI I ❑ 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 I
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 circurt(s) or limited -
t�to vka (, energy panel, alteration, or
Address: lI g l 5 51 toi 1 wdo A 57 .
extension Describe Page 2 2
City/State /ZIP: - F, 34 ,,., ) R q 7 Z 2 4 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' /.l_
Print name: Date: Plan review (25% of permit fee)
State surcharge (12% of permit fee) / Lj 6T
Authorized signature: TOTAL PERMIT FEE. Ip
D ate: p
This permit application expires if a permit is not obtainad iGithin ta
Print name:
6 4 1/ i E. TO In N ow I I — /4 g days after it has been accepted as complete.
/ • Number of inspections allowed per permit
I \Budding\Permns\ELC- PennitApp doe 05/23/06 440- 4615T(I 1 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
I
LIMITED ENERGY PERMIT FEES:
'RESIDENTIAIWORK.ONLY�: `, �?•;:•, j
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:
.COMMERCIAL_VVOR&ONLY:
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- PernutApp doc 03/23/06
CITY OF TIGARD •
BUILDING DIVISION
A PERMIT #: ELC1.00a,006.4
3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11114/2008
Phone: (503) 639-4171 Z;iT('
Inspection Requests (24 Hrs.): (503) 639-4175 - ,,, ---.
INSPECTION WORKSHEET FOR DATE: 10712009 TIME: 7:00AM PAGE: V.51
SITE ADDRESS: 11815 SW ‘AilLDWOOD SI. CLASS OF WORK:
SUBDIVISION: SHADOW HILLS LOT #: 012 TYPE OF USE:
PROJECT NAME: joHmsoN
DESCRIPTION: Installing (1) branch circuit for hot tub and (1) lo voltage system for lan(kcape. fighting.
OWNER: JOHNSON, GARY PHONE #: /303_603...1131,1
CONTRACTOR: OWNER - PHONE #:
Inspection Request Scheduled For: Pour Time:
D7---1/27/2009
Code # Inspection Description Confrnt Contact #. Message
Electrical final O13004::01 503-341-0226 '■ Y
Corrections/Comments/Instructions:
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.0, PASS --..Aul...- Eztaz 0 *' - ''"' --eAtICEL 7 NO ACCESS
Ik FAlt . CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector: Crl Ntg L' Date: 1 - )-1 --4 Phone #: (503) 718- PM-
.
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)]
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Please check the appropriate box and complete the following statement:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
will be performing work on property I own, a residence that I reside in or a residence that I will
reside in. if I hire subcontractors, 1 will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Property Owners about Construction
Responsibilities contained on these two pages and I hereby certify that the information checked and
completed above is correct and accurate.
(ma E . SoVl riso .JV
Print name of permit applicant Signat of p 't applicant
//.. /4 - og
Date
Permit #: L-C OW8 ( 3Lf
This form is supplied to building
permit offices by the Oregon ** Address: /e / 6eir H
Construction Contractors Board, r
as required by ORS 701.055 (6) l � / �� 1-34 I ri
Issued by: - T Date: (// / i/X)e-
This copy to issuing permit office