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Permit % � CITY OF TIGARD ELECTRICAL PERMIT � ri . 0: .2 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00079 TfGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/16/2010 Parcel: 2S104DA10400 Jurisdiction: Tigard Site address: 13107 SW MERLIN PL Subdivision: Lot: 0 Project: Hofmann Project Description: (1) branch circuit for split system air conditioner. Owner: FEES HOFMANN, KAAREN L Quantity Description Date Amount 13107 SW MERLIN PL TIGARD, OR 97223 1 crt Branch Circuits 02/16/2010 $56.18 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 02/16/2010 $6.74 Electrical Contractor: PRO CIRCUIT ELECTRIC LLC PO BOX 3948 WILSONVILLE, OR 97070 PHONE: 971 - 563 -8211 FAX: 503 - 266 -1349 Type of Use: SF 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 ordance ' • 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. ATT NTION: Oregon -w re.uires you to follow the rules adopted by the Oregon Utility Notifi - - . enter. Those rules are set forth in OAR 952 -001 -0 10 through OAR 952 -0 -0140. ou may obtain a copy of the rules or direct questions to OUNC by callin 46.6699 or 1.800.332.23 . Issued y: , 1 -li I / _ / Permittee Signature: / , l 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 INSTALL. ON ONLY SIGNATURE OF SUPR. ELEC' /- /J/j��� Date: / 1, �1 LICENSE NO. CaII 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. Edecrricad Permit A dica RECEJVED '� r + tie. F m r fps. f�i a . t ar - , .a� rtiw eft a t t r3 1 NMetnt City of Tigard FEB 16 Received .' fi ;; & , fi 2010 �� } :, M 13125 SW Hall Blvd Blvd., 'Tigard, OR 97223 Plan R = - liana Permit No,: �/� ? P hone: 503. 639.4171 F Plan Review o Edda . ' 0, SO3.59s.t�4 y OF TIGARD Dateg3 . Other Permit 41 .63 0 inspection Lint: 5039 -75 traara ms Internet: unvw.tiga 3.63 Notified/Method. . BUILDING DIVISION Date Ready/By: Jurir. Sec Pale for TYPE OF WORK I Supplemental t Information PLAN REVIEW Please check all that apply t ❑ Demolition Y (submit 2 sets of plans wClcrns checked below): ❑ New construction ] ,Addition/alteration/replacement ❑ Other: ❑Service or feeder 400 amps or more ❑ budding over three stories. CATEGORY where the available fault current OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ marinas and boatyards. ....g, 1 - and 2- family dwelling ❑ Commercial /industrial to ground, or exceeds 14,000 ❑ Commercial Floating buildings. less t ❑ Accessory building griculturai ❑ Multi - family 0 Master builder amps for all other installations. buildings. Other: ['Fire pump' ❑ Installation of75 KVA or JOB SITE INFORMATION AND LOCATION Q Emergency system, larger separately derived sys;er Job no.: Job site address: ` A , ` n Q Addition of new motor toad of 100 0 S1A) mEN f t=1P er more occupancy, ❑Six or more residential units. ❑ Recreational vehicle 0 Health -care facilities. 0 parks. it Supply voltage for more than QH Suite/bldg.lap[ no.: arardousl 600 voltsnominai. Project name: Cross street/directions to Job site: ❑ Service or feeder 600 amps or more. FEE SCHEDULE DeteNew ri' ion residential single- or multi- family dwelling unit. • Subdivision: Includes attached garage. 4 Tax map /parcel no.: Lot no.: I,000 sq. ft. or less 168.54 r Ea. add'! 500 sq. ft. or portion Limited withal/ow 33.92 1 DESCRIPTION OF WORK energy, residential bove s., ft. 67.84 2 g 1 'k Tow ' Li Limited ener y, multi-family _ 5 S STE-r -) iP4 t 0\ .-r residential with above s.. n. 67.84 -© t -3 Services or feeders installation, alteration, and/or relocation /. PROPERTY OWNER 200 amps or less 11111 100.70 _ Ell 2 0 TENANT a Name: A ■ , 0.1,-- 201 amps to 400 amps 13156 2 401 amps to 600 amps 200.34 MS 2 Address: 601 amps to 1,000 amps 301.04 © City /State /ZiP: Over 1,000 amps or volts r 552.26 2 Temporary services or feeders installation, alteration, and/or Phone: ( ) relocation 200 am Owner installation: This installation is being made on property that I own which is not amps o 400 amps r 59 36 0 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 201 am NI 125 08 1111111111131 401 amps to S99 amps 168.54 11111111111 11111111111 Branch circuits - new, alteration, ur extension, er .anel Owner signature: In Date: A. Fee for branch circuits with APPLICANT ❑ CONTACT PERSON above service or feeder Foe, Business name: each branch circuit Contact name: '" 6. Fee for branch circuits II"' tvitorn service ar feeder fcc, Address: first branch circuit Each add'1 branch circuit City/State! %1 P: Miscellaneous service or fccder not included) 2 2 Phone: ( ) F.ach manufactured or modular Fax: ( ) dwcllin_, service and/or fccder � � 2 E-mail: Reconnect only n 67.84 2 CONTRACTOR or irrigation circle Business name : i c_ / 1 r Sign or outline lighting 67.84 2 ` . n l) =( l ^� Signal circuit(s) or limited- Addr 7 p � \ : energy panel, alteration, or V l� I extension. Describe: City/State/ZIP: Pagc2 2 WT.I- oNYillle- 0 { �� p- o7 0 Each additional ins ection over allowable in an of the above Per inspection 1, 3 9 7 ,, f f Fax: ( S�3) 7.1.0 (.° 3c( 9 66.25 �- Phone: CCI3 Lic.: investigation per hour (l In min) _ Electrical Lic.: `(pp(( Suprv. Lic.: {-) 66.25 Suprv. Electrician signature, required: t �' l 07.. $ industrial plant per hour - 78 - 18 Print name: l RJR Subtotal: (v k Subtotal: • / V Date: O _ Plan review (25 %of , cant! fee): 11111111111111111 Authorized signature: State surcharge (12% of perm it fee): • • i rint name: TOTAL PERMIT FEE: rZ Date: This permit application expires if a permit is not obtained within t80 i ,nniulinyNe nitso.r- PcrrvirA tint 10/01/09 days after it has been accepted as camptere. Number of inspections allowed per permit. 4,10- 4615T(1 1 /05;COWWED Z'd 6b�199ZE09 oi.11oalE }ino.yO 0 -id d Z 9 80 06 96 Qad .