Permit II t CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00505
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09!29/2009
TIC'iARD Parcel: 1 S133DD07300
Jurisdiction: Tigard
Site address: 12726 SW DANBUSH CT
Subdivision: Lot: 0
Project: Albaugh
Project Description: Replace 200 amp or less panel, add /alter (1) branch circuit for hot tub.
Owner: FEES
ALBAUGH, JOSEPH BLAINE & DEANN R Quantity Description Date Amount
12726 SW DANBUSH CT
TIGARD, OR 97223 1 ea Services or Feeders - 200 09/29/2009 $80.30
amps or less
PHONE: 1 crt Branch Circuits w /Purchase 09/29/2009 $6.65
Service or Feeder
1 ea 12% State Surcharge - 09/29/2009 $10.43
Contractor: Electrical
WEST SIDE ELECTRIC CO INC
1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 231 -1548
FAX: 503 - 736 -0677
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $97.38
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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 0) Ot_k,A 0 Li 'li_/\p Permittee Signature: -r -rC_ P
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' 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.
... 5 2009 4: 03Pri tdestRECETVEDic 503-736-0656 p . 2
/.••
4
Electrical Permit Application rowou 0 (4 ; USE ONLY • .
SEP 2 5 2009 .
City of Tigard Received ,
Date/By: Pennit No.: E leleri? , (1)SO4
; " 13125 SW Hall 131vd., Tigard, OR 97223 C ITY OF TIGARD Plan Review
• =
'• '' .1 • Phone: 503.639.4171 Fax: 503.598.196
li 1LDING DIVIS101 Date/13Y: Other Permit:
TTGARD Inspection Line: 503.639.4175 Date Ready/By: Jun Fe See Page 2 for
Internet: www.tigard-or.gov Notified/Method: I Supplemental Information
• • •.... •„ . .,....,..: ,
TYPE OF ,i1YORK . *i.; , '•,:•.- ':::':•:f.f.Alsr-,TigNigW- •
. .
.. . ..
p New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 snips or more 0 Building over three stories.
0 Demolition Other:
where the available fault current D Marinas and boatyards.
• .. •• • . ' •
CATEGORY OF ccii■istkittioW - ' " - exceeds 10,000 amps at 150 volts or 0 Floating buildings.
_..,. ,. . . . . ., . - , -., , •
less to ground, or exceeds L4,000
pit 1- and 2 dwelling G CommerciaVindustrial 0 Acc building 0 Commercial-use agricultural
for ail othet installations. buildings.
D Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
D Emergency systeett
JOB SITE INFORMATION ./046 LiiiealfrOisi
. ..:. 0 Addition of new motor load of 0 larger separately derived system.
, " '
_./.
Job no.: ji-/S7kge Job site address: /2724, s-A 0,,,,„l c__
i 100HT or more. occupancy.
i 0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: r
I' 6ed-e,,. ao q 7221 0 Health-care facilities.
_ 0 Hazardous locations. D Supply voltage for more than
600 volts nominal. .
Suite/bldglapt. no.: Project name: /9/ ,,,,,,e z ie w
n. 7. 0, ['Service or feeder 600 amps or more.
- ‘7 i : ' : sa : • :':',. -'• ":::• .:;#.kfl . ' .• . - . a. .
Cross street/directions to job site:
Description i Qty. I Yee. 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. addl 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.)
Pa/Le./ (47,Z I■ * IL' Limited energy, multi-family
residential (with above sq. ft) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less
/ 80.30 c5 2
arPROOERTY OWNER ,
' . - '1. 201 amps to 400 amps 106.85 _ 2
401 amps to 600 amps 160.60 2
Name: hil A
—
601 amps to 1.000 amps 240.60 2
Address:
SIC? /51 Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( 570) , 1 - 3- Z k 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, 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
6 5
. . . . . ,. ..
ni - -- -. .. - - • . 1 .;: lb 0cii.:14 PERS - '::" ,=''' '
• . ,••••_. A PP L ICA NT . .:. • . • . each bra vese n rv ch c. ieeor feeder / eder fee,
6.65 2
Business name:
B. Fee for branch circuits
without service or feeder fee,
Contact name:
first branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included) _
Ci ty/State/ZIP: Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
•
CONTRACTOR ' .- Sign or outline lighting 53.40 2
Signal circuit(s) or
Business name: name: WEST SIDE ELECTRIC CO.'
energy panel, alteration, OT
Address: 1834 SE 8 AVE. extension. Describe: Page 2 2
City/State/ZIP: PORTLAND, OR 97214 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 231-1548 Fax: (503) 736-0677
Investigation per hour (1 hr min) 62.50
CCB Lie.: 13306 I Electrical Lie.: 26-135C Suprv. Lie.: 4654S Industrial plant per hour 73.75
::,: ,• . - ' Ettthltr0AL. ruour FEES
Suprv. Electrician signature, required: 1' Subtotal: q.
Print name: RANDALL ROBERTS Date: Plan review (25% of permit fee):
Oa State surcharge (12% of permit fee): /0
...
Authorized signature: . ifir..,AMPAIIIIAIrrov..% . _
TOTAL PERMIT PEE: 9 3 9'
Print name: t,A,,,yir . Date: 9 zs* This permit application expires if a permit is not obtained 7
am tained within 180
days after it has beet] accepted as complete.
• Number of inspections allowed per permit.
tAllici ding 'erruits1ELC.PerrnitApp.doc 05/23/06 440-4615T(I I /115/COM/WEB