Permit Nt ` CITY CITY.OF TIGARD D ELECTRICAL PERMIT
PERMIT #: ELC2007 -00316
COMMUNITY DEVELOPMENT DATE ISSUED: 5/8/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134AD-04800
SITE ADDRESS: 10765 SW BLACK DIAMOND WAY ZONING: R -4.5
SUBDIVISION: BLACK BULL PARK LOT : 031 JURISDICTION: TIG
PROJECT: MONTY
Project Description: 3 branch circuit: Plugs and 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: 2 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:
CHRIS MONTY OWNER
11705 SW BLACK DIAMOND
TIGARD, OR 97223
Phone: 503 - 939 -9783 Contact #:
FEES
Description Date Amount Reg #:
[ ELPRMT] ELC Permit 5/8/2007 $60.15
[TAX] 8% State Surcharge 5/8/2007 $4.81
[ELPRMT] Investigation F 5/8/2007 $60.15
.REQUIRED ITEMS AND REPORTS
Total $125.11
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 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Thos- rules ar_ set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to eUN• at 503.' 6.6.e' or 1.800 32.2344.
Issued By: � Permittee Signature: ` . >J
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.
• Elec1ri Perm Applicati E V - 1 'OR -0FF OFFICE. USG ON
City of Tigard , 7 Received Q 5.6
o1 Permit No 0 7 —02 /31
2001 Date /By: !/L/
13125 SW Hall Blvd., Tigard, OR 97223 /
0 Plan Review
.." ® ' t Phone: 503.639.4171 Fax: 503.598, 1960. B Date . Other Permit:
T LG�K D Inspection Line: 503.639.4175 VA I Y OF TIGARD Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION 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 ", "1 -2 ", "1 -3 ",
Job no.: Job site address:„ ��.'� ��k+\/� i x or or more. occupancy.
f D 7 �S S Ulf • l� 3 ttivtU�+J❑ Sx or more residential units. ❑ Recreational vehicle parks.
❑ Health-care facilities. ❑ Supply voltage for more than
City / State/ZIP: 1 �J F 44 l 4� �� ' l3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.:. + . Project name: B I frc D ❑ Service or feeder 600 amps or more.
FEE S CHEDULE
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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 I
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 feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER , ❑ TENANT 201 amps to 400 amps 106.85 2
Name: C h 2 /',' M p h r-�' 401 amps to 600 amps 160.60 2
(� 601 amps to 1,000 amps 240.60 2
Address: 1 07 05 5 ; I , /7 t.,G �' 9 1 /Ad Over 1,000 amps or volts 454.65 2
City / State/ZIP: Ti (f �� �!� Temporary services or feeders installation, alteration, and /or
1 ,2-2) Temporary
Phone: (5p '5) 1 5 0 JY) Fax: ( ) 200 amps or less 66.85 l
Owner installation: This installation is .eing made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, I:. %? t, or )(hanv. according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
atur =. �� Branch circuits – new, alteration, or extension, per panel
Owner si
gn al , A Date: S / 07 A. Fee for branch circuits with
❑ APPLICANT
I ❑ CONTACT P R O above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 1 46.85 1 /46 6/ 2
Contact name: first branch circuit r
Address: Each add'I branch circuit �'„ 6.65 2
Miscellaneous (service or feeder not included) • G
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: cc
�' , J ^ id � 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 (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lie.: Industrial plant per hour 73.75
ELECTRICAL' PERMIT FEES r
Suprv. Electrician signature, required: -fl tk Subtotal: / s/
Print name: Date: �� D • � —
State surcharge (8% of permit fee): y. g/
Authorized signature: TOTAL PERMIT FEE:. /01,6 //
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
l:\ Building \Pmmits\ELC- PermitApp.doc 05/23 /06 440- 4615T(l 1 /05 /COM /WEB
Electrical Permit Application - City of Tigard . is'
Page 2 - Supplemental Information .
LIMITED ENERGY PERMIT FEES:
RRESIDE■TIAL=WORK
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. WORK ONLY :
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
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El 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
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00316
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/8/2007
Phone: (503) 639- 4171 �a4��p1 " I � �
Inspection Requests (24 Hrs.): (503) 639 -4175 ' _ !_..
INSPECTION WORKSHEET FOR DATE: 6/3/2008 TIME: 7:00AM, PAGE: 27
SITE ADDRESS: 10765 SW BLACK DIAMOND WAY CLASS OF WORK:
SUBDIVISION: BLACK BULL PARK LOT #: 03 TYPE OF USE:
PROJECT NAME: MONTY
DESCRIPTION: 3 branch circuit: Plugs and hot tub.
OWNER: MONTY, CHRIS PHONE #: 503 -939 -9703
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/3/200: Pour Time:
die'
Code # Inspection Description Confirm # Cl■ntact # Message
199 Electrical final 070701 -01 ' 503-312-0103 Y 4 p kig-
Corrections /Comments /Instructions:
J ' /e...z., 0 .
.ice ..2 - ' All -
M PASS ❑ ' RTIAL APPRO. , ❑ CANCEL ❑ NO ACCESS
FAIL ALL FOR I I •IN P. e i , A FEES ASSESSED
Inspector: / i � Date y (503) 71 2-SO
I
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: ELC2007- 00316
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 518/2007
Phone: (503) 639 -4171 4 1 0 m � i�
Inspection Requests (24 Hrs.): (503) 639 -4175 �'�='I �..
INSPECTION WORKSHEET FOR DATE: 5/30/2008 TIME: 7:01AM PAGE: 28
SITE ADDRESS: 10765 SW BLACK DIAMOND WAY CLASS OF WORK:
SUBDIVISION: BLACK BULL PARK LOT #: 031 TYPE OF USE:
PROJECT NAME: IvIONTY
DESCRIPTION: 3 branch circuit: Plugs and hot tub.
OWNER: MONTY, CHRIS PHONE #: 503- 838.3783
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/30/2008 Pour Time: r
Code # Inspection Description Confirm # Contact # Message ,
120 Electrical 070589-02 503-312-0103 Y �
l9 / c..— o .7042 - n/
Corrections /Comments /Instructions:
A,�,,5 I Aim c� 1�'- )7
,, Q O t t c u'.a �Yt� ' „ � P/X �'-� k ✓/
�� ,ko �
- - ,n tZe me- _ ek ,P�- C re ,..e_
-£4
' i /O a_ -- 3o a, oc '7" e�
a l' L 4 Garheu L. 7
19 e r ge - 11 ----------FL.111 14-. . - -
n PASS ❑ P RTIAL APPROVAL ❑ CANC ❑ NO ACCESS
F FAIL p A L IN ,. • CTION ADDITION FEES ASSESSED ' Lei, _d , Inspector. Date. Phone #: (503) 718
CITY OF TIGARD d�c
l 0.11-11/‘ . ,
BUILDING DIVISION PERMIT #: ELC2007_00316
13125 SW Hall Blvd., Tigard, OR 97223 — , , DATE ISSUED: '3/2'0O7
Phone: (503) 639-4171 yh���iiy����
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/2/2007 TIME: 7:01AM PAGE: 17
SITE ADDRESS: 10765 SW BLACK DIAMOND WAY CLASS OF WORK:
SUBDIVISION: FLACK BULL PARK LOT #: 031 TYPE OF USE:
PROJECT NAME: MONTY
DESCRIPTION: 3 branch circuit: Plugs and hot tub.
OWNER: MONTY, CHRIS PHONE #: 503- 039 -9783
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/212007 Pour Time:'
Code # Inspection Description Confirm # Contact # Message
145 NC or heating unit circuit 058920 -01 503-312 -0103 N
Corrections /Comments /Instructions:
-
1A) 0 it )z
❑ PASS � PARTIAL APPROVAL El CANCEL NO ACCESS
X FAIL /Q�CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 1 v 0 7 Phone #: (503) 718-