Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00412
T [ G AR O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/16/2012
Parcel: 2S114BC04300
Jurisdiction: Tigard
Site address: 10468 SW BONANZA WAY
Project: Ellis Subdivision: RIVERVIEW ESTATES NO.2 Lot: 80
Project Description: (1) branch circuit for hot tub
Contractor: SQUARE 1 ELECTRIC INC Owner: ELLIS, KATHERINE A
10117 SE SUNNYSIDE RD., STE. F -216 10468 SW BONANZA WAY
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 -867 -2423 PHONE: 503 - 781 -6123
FAX: 503 - 914 -0432
. FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 07/16/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/16/2012 $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 OA 9 2-001-0090. You may obtain na a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ) J Ail/Loh-Litt Perm ittee Signature: 014 f /�1PeLIcA1/Dki
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.
•
Jul 12 12 03:35p Square 1 ELectric `, 5038553516 p.2
Electrical Permit Applicatio fRECEIVE' x012 OFF• 1CL t F. ON 1.1
City of Tigard !!D� PermitNo L e...4Dla- OD4I a'
•
13125 SW Hall Blvd, Tigard, OR 97223 JUL 1 2 2012 Plan Review
' i¢ ' Phone: 503.718.2439 Fax: 503.598.1960 Oder Permit I
Inspection Line: 503.639.4175
.t - 1 `' "� R D TIGARD Date Ready/By. Jmir:
Internet www.tigard -o CITY OF TIG RI See Page 2 for
r.gov n � IG s' Notifsed/Method: Supplemental formation
• TYPE OF DING DIVISION • I PLAN REVIER!
❑ New construction 1:27 Additlnn/alterdhon/replacelIIent Plane cheek all that apply (submit 2 sets of plans warms checked below):
❑ Demolition ❑Other ❑ Service or feeder 400 amps or mare ❑ Belding over three stories.
where the available fault current ❑ Marinas mid boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
1 and 2-family dwelling less to groped, or exceeds 14,000 0 Commaeial -use agricultural
Y g ❑ Commercial/industrial [] Accessory building
builder ❑ Multi-family for all other hhstallatioos I nsta l
mily ❑ Mast atio
❑ Other: ❑ F� pump. ❑ Installation of 75 KYA m
JOB SITE INFORMATION AND LOCATION Off ° system larger seporatdy derived system
❑ Additionof new motorloadof ❑ "A ,"E^, "1- 2 , -1 -3,
Job no.: ` 001iProahore occupancy.
Job site address:
\ C' 4 6 S w - ;l- c ❑ six
1 or m or e sesiderroai units. O Recreational vehicle parks.
Clty/State/ZINT r /� C 1 2 ' -'4 ' ❑ Health -care facilities. ❑ Supply voltage for more than
l C� r! ❑ Hazardous loradons. 600 volts aominaL
Suite/bldg. /apt. no.: J Project name: ❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Dm near 1 01T. 1 Pee- I Total I •
New residential single. or multi- family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,030 sq. ft or less 168.54 4
Tax map/parcel no.: Ea add'1500 say. R or portion 33.92 1
Limited energy, residential 75.00 - • 2
DESCRIPTION OF WORK (with above sq. ft.)
• ",,U 'v 'j .l' `' E -I- • 4 . LI Limited residential above say S)
75.00 2
Services or feeders installation alteration, and/or relocation
200 amps or less 100.70 2
f4 PROPERTY • OWNER ❑ TENANT 20I amps m 400 amps 13356 2
Name: l 1 l S 401 amps to 600 snips 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 55226 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: (5c . —I g 1 - (G y 2 3 I Pm ( ) 200 amps or less 59.36 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to quo amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 34 2
Branch circuits - new, alteration, or estenslon, per panel
Owner signature: Date: A. Fee for branch circuits wish
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder lee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
branch circuit 1 { 56.18 1 2
Contact name:
Each add branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each malmfactnaedormodular 67.84 2
dwedint:, service and/or feeder
Phone: ( ) 1 Fax:: ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 6724 2
Sign oroudirte lighting 67.84 2
CONTRACTOR • • Signal circuit(s)orlimited�rgy
�^ Each adt6ti ml 1 inspecti
Business name: 5 _. E s, C. 1 — jar G panel, alteration, 1 spect iort Page 2 z
on over allowable in any of the above
Address: p f ('-` ^ &
Al n TS('
.1S( Rd . A �+ ) 1 � T -2Mt Adtilionalinspecem(I hr min) 6625/ hr
!J n . (� Investigation (1 hr min) 6625/ hr
City/State/ZIP: J
('.E Q - J <GZ,mcLS r p rC "1 p industrial plant (1 hr min) 78.18fhr
Phone: (S03) S(o 2-`i 2 3 Fax: ()3) ci I 4 - OL 32 trnpections for which no fee is
Electrical L qq u,.. S rv. Lie.:
specifically listed ( hr min) 90.00/ hr
CB Lic.:
19 5 ( p \ 1 C, O K up 5s^) "] S ELECTRICAL PERMIT FEES -
Suprv. Electrician s � , regained ' `P 10 i 1, Subtotal: IF 51 . t 3
Plan review (25% of permit fee):
Print name: l A R + ?Re I Date: 1 1 1.2 i State surcharge (12% ofpe ntit fee): 4' (� . • . J
Authorized signature: TOTAL PERMIT FEE: y C 2. • ci 3
This permit application expires ifs permit is not obtained within ISO
Print name: days after it laas been accepted as complete_
• Plumber of inspections allowed per permit 12-1/ I Date:
ba • 1
1:1131oU gtPermuslE7L.Pam 07/01/10 440.4615T(11/05/COat/WEB
k'.t MAS 5 Pee-0(
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10468 SW BONANZA WAY, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2012-00412
Jeff Grove
Violation Summary:
Inspector Contractor