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Permit Support Document CITY OF TIGARD 9 p � ELECTRICAL PERMIT : s. COMMUNITY DEVELOPMENT �Y Permit#: ELC2020-00535 13125 SW Hall Blvd.,Ti and OR 97223 503.718.2439Date Issued: 10/28/2020 Tf(1ART� Parcel: 2S102CA00922 Jurisdiction: Tigard Site address: 13225 SW VILLAGE GLENN DR Project: 54725 Subdivision: VILLAGE GLENN Lot: 22 Project Description: PANEL UPGRADE. 11/5/2020: Reprint permit to add(25)branch circuits. Contractor: NORTHSIDE ELECTRIC Owner: WILSON,ANDREA K PO BOX 12323 WILSON, LUKE R SALEM, OR 97309 13225 SW VILLAGE GLEN CIR TIGARD, OR 97223 PHONE: PHONE: 503-585-4879 FAX: 503-364-0248 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 10/28/2020 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 10/28/2020 $12.08 Type of Use: SF Electrical Class of Work: ALT 25 crt Branch Circuits w/Purchase 11/06/2020 $185.50 Service or Feeder Type of Const: 0 ea 12%State Surcharge- 11/06/2020 $22.26 Occupancy Grp: Electrical Total $320.54 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. ` '(7�,Issued By: Y v0t 1 �\'CY�. Permittee Signature: CMV \ 111 iyyFFF---"'�" 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. - I1 ) )2c Electrical Permit AnDlic CEI V ED l c,lt Artier USE()\I 1 City o Tigard ReceivedISO: IIII • 13125SWHallBlvd.,Tigard,OR97)V 4 2020 oaa/en �� 5 ' � ELCZC2D-(7DS'j S 2 Phone: 503.718.2439 Fax: 503.598.1960 p�Review Related Permit It CITY OF TIGARD I 1 V AKU Intcrne�tOowGwed�r g�175awy e :// ` l ra,a. , . ....2. ® feePage 2 far 8 LQI+t` DIt f'�I^� V �j� Supplemental rnformet oo PLAN.'REVIEW ❑New construction ix Add i tion/alteration/replacement Plume check all that apply(submit j sets of plans w/items checked)! ❑Service or feeder 400 amps or more 0 Building over Ibm stories. El Demolition ❑Other: where du available fault current ❑Merinos and boatyards. CATEGOIIII;.OF CONSTRUCTION . . . exceeds 10,d/0 amps at 150 volts or ❑Floating buildings. R I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,orexceeds 14,0oo 0 commercial-tine agriculural amps tor❑Multi-family ❑Master builder Fire pump. other installations. buildings. ❑Other: ❑Fire pump. ❑Installation of ISO ICVA or ,_ JOB SiT88,INIIO ATION.AND LOCATION 0 Emergency system larger separately derived Job#: 412,S' Job site address:(322 S V I_�,.,I Gkt hh Or ❑Addition of new moor bad of "tetra. •S S W 1�iC.� 100[1P or mutt. ❑"A","E"."1-2","I-3", Ci tatelZiP' -r ,a,ra JJJJ ❑Six or more residential units. occupancy. ' 1 1 ""'�N _ ❑Hrolthcere facilities. ❑Recreational vehicle parks. Suite/bldgiapt.#: Project name: MI)V11a 0 Hazardous locations. ❑supply voltage for ore than '�1!`a r r ❑Service or feeder 600 amps or more 600`afu romimt Cross street/directions to job site: SC�D�-U-LE Dnonptloa r ia. I Each 1 Tomi I • New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage, Tax map/parcel#: 1,000 eq.ft.or lean 16854 4 Fi add'1500 sq.IL or portion 33.92 1 DESCRIPTION OF,WORK :. -. limited energy,residential (wills about aq.R) 75.00 2 laid 25 CA E I C2o2a-poS? - I;.sited energy,multi-family ((�� fit,,,_- residmlial(with above se It.) 75.00 2 o(/l a1 p( 1 3 t4 ( C!QIr Rem:wa„„ef,„lp, ❑ See Page 2 1 L-i-PROPERTY OWNER -., ❑.TENANT .ices or feeders laWlhtloaial*eradoa,and/or relocation Name: 200 amps or has 100.70 2 Address: 201 amps to 400 amps 13356 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) { Fax:( ) Over 1,000 amps or volts 552.26 2 I Email: Temporary services or feeders installation,alteration,and/or j relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less I 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 IZI APPLICANT I ,w £ONT4G * _`. Branch circuits-new,altered,a,or e..-tenslon,per panel A.Fee fat brands cacaos with Business name: !titmice or feeder fee, �n1F � EY1Cr above d 7.42 2 ( e branch circuit Contact name: i-&,,s i CO.,. b(.hS m.Foe for branch©remits,aarAnne - service or feeder fee,rust Address: RI aK '�323 branch circuit 56.18 2 City/State/Z1P;lice fe i�' Q, ql3� _ Each add'I branch circuit 2 7.42 )15,$()2 ���•rrL Miscellaneous(service or feeder not Included) Phone:(SO )55 —"i g>19 Fax::( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email:M il°erikir-j•111.6dS-ek. .ty-iC-' CCSry _ Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: SfC f- Sign or outline lighting 67.84 2 \2 Z Signalcircutl(e)or limited-energy Address: ���III��U JJ� panel,elkmtita4 or extension. . See age 2 2 City/State/ZIP Each additional 1 etbn over allowable in a of the above r 1 erg. f Additional inspection.(1 hr min) 66.251 hr Phone:(L5b3 6-' 1 l Fax:( ) Investigation(I hr min) 90.00/hr Email; /� ^ , ,," 1,. Industrial plaza(l hr min) 78181 br n (6Lndr a, et€)'i(C •c 90.00/hr f 7] 5 Inspections for whi¢nno nee is CCB Lic.: 8 051 b Electrical •c. Z -(ifL /$f��rv.Lie.:�51141 S specifica Iy listed(x hr min) �3'� ELEG�'RICAI: PFRisust dal: j( Suprv.Electrician signature,required: Subtotal: !$5. Print name: (tv Ja,Ire_ CLV O. Date: Il 1 1.1 I ❑Plan Review Rcyuitcd(25%of permit rtx): F State surcharge(12%of permit he): / Authorized signature: TOTAL PERMIT FEE: 201•710 i� a _(�r This permit appfadua eapirea tin permit is not obtained within 150 way—mit It Print name: 3—telS(Ct. e0Y0''i 5 Date: L(1 1.f( 2A I clays after it ha been accepted as complete. ` • Number of inspections allowed per permit. I:lauildkgVaatinnELC_PuaitApp_5L.R_8¢Edoe aev 06/17R0IS 440.46lST(II!05/COMAVEB