Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 00326
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/30/2012
Parcel: 2S115AD03900
Jurisdiction: Tigard
Site address: 10889 SW DOVER CT
Project: Williams Subdivision: DOVER LANDING Lot: 20
Project Description: (1) branch circuit for hot tub
Contractor: PDX ELECTRIC LLC Owner: WILLIAMS, JOE
7933 WHITFURROWS CT 10889 SW DOVER CT
DURHAM, OR 97224 TIGARD, OR 97224
PHONE: 503 - 997 -1989 PHONE: 503 - 639 -9708
FAX: 503 - 200 -1362
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 05/30/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/30/2012 $6.74
Type of Use: SF Electrical
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 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
� O1 & A G4 D
Issued By: � ��'1�C. /,I,il — Permittee Signature: 'Po 71 1,1
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 the next available inspection date.
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.
5/28/2012 5:36 P11 (GM) Fran: PDX Electric LC RECEIVED 503-2N-262 To: 15035981960 Page 2 of t ti
Electrical Permit Application MAY 2 9 2012 .. • FOR ((I l(:I (:Sts (.4V1.] -
City of Tigard V Re.i ed S 3 (1� t4mnt ] ` arx x � 60
CITY OF TIGA I Date Bv. ____ vv++ -^`
C a 13125 SW Mall Blvd.. Tigard. OR 9722 lr` flan Rewew•
' Phone: 503.718,2439 Fax: 503.598. I tl1ILDINCt DIVISI I' Laic /Rnv Other Permit:
T1 GA R U Inspection Line: 503.639.4175 Date Readyilly ® See Page 2 for
Internet: www.tigard or.guv Notified /Method: Supplemental Information
TYPE OF WORK -- PLAN REVIEW
Please cheek all that apply (submit 2 sets of plans w;items checked below):
❑ New construction ® Additiotl /alteration replaecmenl
❑ Service or feeder 400 amps or more ❑ 0udding over three stories.
❑ Demolition E] 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
I - and 2-family dwelling ❑ Comnlcrcialiindustrial ❑ Accessory building amps fur all other installations. buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire ramp. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived systems.
❑ Addition of new name load of ❑ "A" "t" "L �" "1 3"
Joh no.: , Joh site address: 10889 SW Dover Ct I OOICP or more occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /"LIP: Tigard, OR 97224 ❑ Health -care facilities ❑ Supply voltage for more than
-- - - - - ---- ._ .-- _- .. —.--- —_ -- ❑ llazardous locations. 600 volts nominal.
Suite /bldg./apt. no.: Project name: ❑Secs' •e or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to ob site: p L 4.Z_.L..._. ._. I I
1 Description t Feu_ Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
-
1 Lot no.: � 1,000 s - —
Subdivision: - — txlivision: q. ft. or less Irik 34 4
Ea. add'l 5(X/sq. ft. or portion 33 92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. h.) 75.(1[) 2
Limited energy. mull)- family
75.00 2
Hot Tub Circuit residential (with above sq. ft.)
- Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 _ 2
—
-® PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 - 2
Name: Joe Williams 401 amps to 600 amps 200.34 2
-- - -
-- 601 amps to 1.000 amps 301.04 2
Address: 10889 SW Dover Ct Over 1.000 amps or volts 552 26 2
City /StalciZlls: Tigard, OR 97224 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)317-6808 Fax: ( ) 200 amps or less 59.36 I
�._.._ 201 amps to 400 amps 1 25.08 2
Owner installation: 1•his installation is being made on property that I own which is not
intended for sale. lease. rent. or exchange. according to ORS 447. 449. 670. and 701, 401 amps to 599 amps 168.54 2 -
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: ,1 Fee for branch circuits with
:4
:4
APPLICANT above service or feeder fee,
❑ CONTACT PERSON each branch circuit 742 2
Business mune: PDX Electric 11 Fee for branch circuits without —
service or feeder fee. first I 56.18 56 2
Contact name: Marty Palmer branch circuit
Each add'I branch circuit 7.42 2
Address: 7933 SW Whit.furrows CI Miscellaneous (service or feeder not Included)
l:iCy' /$idler /_I I': Portland, OR 97224 Each manufactured or modula 67,84 2
dwelling, service and/or ftx:der
Phone: (503) 639 -9708 I Fax:: f ) R onl 67 8 4
" - Pump or irrigation circle 67.84 2 —
E - mail: info(atpdxelectric.com Sign or outline lighting 67.84
CONTRACTOR Signal circuiu,$) or limited- energy
Business name: PDX Electric panel, alteration, or extension. Page 2 2
- - ---
—
i Each additional inspection over allowable in any of the abov
Address: 7933 SW Whitfurrows Ct Additional inspection (I hr nun) 66 25/ hr
City/Stale/ZIP: Portland, OR 97224 Investigation (1 hr min) 66.25 /hr
- .__..._ i I Industrial plant (I hr mini 78.18/ hr
Phone: (503) 639 -9708 Fax: (503) 200 -1362 I Inspections for which no ide is
9(1.00/ hr
— i specifically listed CAM min)
✓ C.B Lie.: 192731 Electrical Lie.: C696 1 Suprv. Lie.: 56I2S ELECTRICAL PERMIT FEES
Subtotal. 56.18
Suprv. Electrician signature. required:
- -- v - -�,/ Plan review (25% of permit fee):
Print name: Marty Palmer I Date: 5 -28 -2012 State surcharge 112 %of permit fee): 6,74
TOTAL PERMIT FEE: 62.92 ./
Authorized signature: This permit application expires Wit permit is not obtained within 181)
Prim name: after it has been accepted as complete.
— —' Date' • Number of inspections p per permit.
i trhtilding ''.rrrnms.ELC- PcomtApp dot 07:01:10 440 -461 Sri i iit 'wEB
5/28/2012 5:36 PM (GP1T) From: PDX Electric LLC 503 -200 -1362 To: 15035981960 Page 1 of 3
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PDX Electric MAY
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7933 SW Whitfu:rows Cl, Portland, OR 97224
• (503) 639-9/08 BUIL 1T G D C �RD
503 -200 -1362 l �ISIpN
www.pdxelectric.com
info@pdxelectric.com
To: City of Tigard From: Marty Palmer
Fax: (503) 598 -1960 Dale: 5/28/2012 10:25:48 AM
Phone: Re: Electrical Permit Application
Comments
Is it possible to get the permit number faxed or a lied as soon as it is processed.
503 - 2001362
info@pdxelectric.com
facsimile