Permit CITY OF TIGARD ELECTRICAL PERMIT
p
1111
t , COMMUNITY DEVELOPMENT Permit #: ELC2013 -00038
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2013
Parcel: 2S103BB11600
Jurisdiction: Tigard
Site address: 12180 SW ANN PL
Project: Subdivision: YE -OLDE WINDMILL Lot: 35
Project Description: (1) branch circuit for installation of new hot tub disconnect and connect
Contractor: HUGHES ELECTRICAL CONTRACTORS INC Owner: BOEKELHEIDE, LEE AND
10490 NW JACKSON QUARRY RD BECHARD, MARGARET E
HILLSBORO, OR 97124 12180 SW ANN PLACE
TIGARD, OR 97223
PHONE: 503 -647 -2221 PHONE:
FAX: 503 - 647 -7754
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/17/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/17/2013 $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 952 -00 0090. You ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
01� AP caribA
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.
From: RECEIVED 01/16/2013 12:01 #320 P.002/003
Electrical Permit Application JAN 1 6 201 1012 OFFICE USE ONLY
E L .47/ 3- i?).0 3
. City of Tigard .: '
• 13125 SW Hall Blvd., Tigard, OR 97223 Permit No
CITY OF TI
11,
• Phone: 503.718.2439 Fax: 503.598.19 ElUILDINGDIV GAR IS 1 : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: kris: 0 See Page 2 for
Internet: www.tigard Notified/Method: 69 Supplemental Information
-: ._ -- _ ,. : :,---, ‘ ,- _ - _ 77,.-,,, ;: :. " ,-,,,';- ";•N ;.. ."- - i'e . "... 1- ..- - it'iti,,e;Cti,htiev:/:'-'=:,:-
;,0„,,.„,:-,.-, .. .. .. ,,, , -.—,,... , -. ir--8,-,..,-
1:3 New construction EI Addition/alteration/replacement Please check all that apply (submit I sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available Dolt current 0 Marinas and boatyards.
61.:i'f,'..Z,,-;:',:::?.4.--airA, ' YAW:4P exceeds 10,000 amps at 150 volts or 0 Floating buildings.
....,..: ,--- ,,,,,, . - - ' ,4 , -, A , - . ,...,-,, . ...- . - . , ... .... ,,,, . , .7 A.....!...., ", ■-,,,,,;,----. ,,'-',- -- less to ground, or exceeds 14,000 0 Commercial-use agriculhual
e 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
1, .. - f, „ : 2 : - ' ,. .t , ".., - ;. -, 4 , :::14iiiiii`'4 ,- iiiiiiii4iiiii - „;-/i.iA;iiiii4,,N , ;-. - .4-1 - ..,o.4.4; .,,,,, E Enie sYgtem. larger separately derived system.
2t-'---.-7 'Ii.= , -..4 , - , - , ._- 4-4.7",:r Addition of new motor load of 0 "A",
Job no.: 13A060 Job site address: 12180 SW Ann Place 100 HP or more.
0 Six or more residenti occupancy.
al units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard / Oregon / 97223 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: Hot Tub Connection 0 Service or feeder 600 amps or more.
. r. %C . A 44.1: : 721.5 . 7.1. = - '= 1 .:' 1 4V- -7":
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.: %GOO sq. ft. or less 168.54 4
Ea. addl 500 sq. ft. or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential ,
75.00 2
N-',,;00-1.i.-'okifkj:**,'=',.--_.--N,-,,T=t,;-6-;;6-3,444-E-2-of,v (with above sq. ft)
Limited energy, multi-family
75.00 2
Install new disconnect and connect new hot tub residential (with above sq. ft.)
Services or feeders installation and/or relocation
200 amps or less 100.70 2
. . s....7' 201 amps to 400 amps 13156 2
401 amps to 600 amps 200.34 2 1
Name:
601 amps to 1,000 amps 301.04 2 '
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 '
201 amps to 400 amps 125.08 2
Owner installation: This 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, pr panel
Owner signature: Date: A. Fee for branch circuits with .
i -_ it ;PA4..:;=.4" , _ - ''''.; ,, ,,, - - rii .- --„,;.- ;,;;;;;;;;;,-4, above savice or feeder fee,
742 2
Business name: B. Fee for branch circuits without
service or feeder fee, first I 56.18
56 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP:
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
,,. ,, , Sign or outline lighting 67.84 2
,'2....Z...?"3.--.::.F.:'..tV.1;ff„,-..*,:•7.-;-:--lt-4.-V,:t.-A00-$#.4,00,.k .;.?: Signal circuit(s) or limited-energy .
Business name: Hughes Electrical Contractors panel, alteration, or extension. Page 2 2
Each additional inspection over allowable In any of the above
Address: 10490 NW Jackson Quarry Rd Additional inspection (1 hr min) 66.25/ hr
ation (1 hr min) 66.25/ hr
City/State/ZIP: Hillsboro / Oregon / 97124 Investi :
Industrial plant (1 hr min) 78.18/hr
Phone: (503) 647 Fax: (503) 647 Inspections for which no fee is
90.00/ hr
specifically listed ch hr min)
CCB Lic.: 49 Electrical Lic...)-f- gi a/ suprv. Lic,;.-- 4. 53,5V 5 V...35: 'f
Subtotal: 56.18
Suprv. Electrician signature, required:
Plan review (25% of permit fee):
Print name: David Trapp Date: 1/16/13 State surcharge (12% of permit fee): 6.74
TOTAL PERMIT FEE: 62.92
Authorized signature:
MIAs permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. ..
Print name: Date:
* Number of inspections allowed per permit.
•
•
1: \ Batting \ Permits1ELC-PermitApp.doc 07/01/10 440-46157(11/05/COM/WEB I
From: 01/16/2013 12:01 #320 P.001/003
RECEIVED
JAN 16 2013
CITY OF TIGARD
II BUILDING DIVISION
10490 NW Jackson Quarry Rd Hillsboro, OR 97124
Phone (503) 647 -2221 Fax (503) 647 -7754
hec @hugheselectrical.com
F A X C O V E R S H E E T
TO: CITY OF TIGARD - PERMITS ATTN: PERMITS
FAX: (503) 598 -1960 PHONE: (503) 718 -2439
FROM: STEVE JASNOCH DATE: 01/16/13
RE: ELECTRICAL PERMIT APPLICATION
No. of Pages including cover: 3
Message:
Attached is an electrical permit application for the referenced work, along with the credit authorization
form. Please let me know if you have any questions.
Thanks,
Steve Jasnoch
stevej @hugheselectrical.com