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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2009 -00628 ',T I GAR L7! 13125 SW HaII Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/24/2009 Parcel: 1S133DA03800 Jurisdiction: Tigard Site address: 12510 SW GLACIER LILY CIR Subdivision: Lot: 0 Project: Montgomery Project Description: (3) branch circuits for a /c, work plug & furnace reconnect. Owner: FEES MONTGOMERY, SHAWN K & BEVERLY G Quantity Description Date Amount 12510 SW GLACIER LILY CIRCLE TIGARD, OR 97223 3 crt Branch Circuits 11/24/2009 $71.02 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 11/24/2009 $8.52 Electrical Contractor: CANBY ELECTRIC INC 790 S IVY ST CANBY, OR 97013 PHONE: 503 - 266 -7878 FAX: 503 - 266 -5543 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $79.54 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 i ordan - h 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. TENTION: Oregon a - •uires you to follow the rules adopted by the Oregon Utility Notification enter. Those rules are set forth in OAR 952 -0 -0010 through OAR 95 01 -01 r0. •u may obtain a copy of the rules or direct questions to OUNC by calling 5 46.6699 or 1.800.332.2344. Issu By: I 4 Permittee Signatu - • an r Gam_ 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 • NLY SIGNATURE OF SUPR. ELEC' 4„: Date: r r 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. A44�� a4HA L 4/ At/ ill ie4({LlV AI �� City of Tigard �ZEC IVEI� EW ! / o 9 Permit No.: U R 97223 Phone: 503.b39.4171 Pax: 503.598 1960 Date/By: • Other Permit; ' 1 , t : \ I :1 , Inspection Line, 503.639.4175 Date Ready/By: km: --1 ® See Page 2 for Internet: www,tigard -0r.gov NQ V 009 Notified/Method; / ( � 1 Supptemeatal Iafermadon n.... TYPE OF w • W , , , ,-,...': , ..:,•,.....,.,.., c,,tt IP11;AN l YIEW d : "tit .lY..,f' '- ` OF T1C Please check all that apply (submit 2 sew of plans hle,ns checked below): • 0 New construction Addition /al[eB i l I 0 Service or feeder 400 amps or more ❑ >1ullding over three stories Q Demolition 0 Other: whore the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION ` • .. exceeds 10,000 amps al 150 volts or ❑ Floating buildings. leas to ground, or exceeds 14,000 0 Commercial use agricultural 91 I - and 2-family dwelling [J Commercial/industrial 0 Accessory building amps for all other installations buildings, ❑ Multi- family ❑ Master builder ❑ Other: ❑Ptrcpump. [a Installation of75 KVAor — JOB SITE INFORMATION AND LOCATION ❑ Emergency m. larger separately droved system, o now © Addition of now motor load of D "A ", "E". "I - "", , "1J ", Job no.: Job site address: / £ f 0 5� Vf Grp j s J - i x or o more. occupancy. ++++ ���ffff 0 ttcereatioaat vehicle parka. QSix or more rcsidentiul onus. City/State/ZIP: 1J t � 4. 1 f� /; —i ' / 7 ❑ ileum.. facilities ❑ Supply voltage for more than ❑Hazardous locations. 600 volts nominal. • Suite/bldg. /apt. no.; Project name: ( © Service Or feeder 600 amps or ior a e �t.7� —_.—. ).- 1 1 . FEE SCHEDULE : 1, a rw.1 , Cross street/directions to job site: noalint 1 Otv. I vee. 1 Total 1 • New residential single- or multi - family dwelling unit. Includes attached garage. ` Subdivision: i - Lot no.: 1,000 sq_ ft. or less r 168,54 4 Tax map/parcel no,: Ea. add'I 500 sq. ft. or portion 33,92 I - _ Limited energy, residential 67.84 2 . DESCRIPTION OF' WORK (with above sq. ft.) _ I Limited energy. multi - family 67.84 2 . .,,.,.,� „,../ 6,01/ (---t, �” 'ii residential (with above sq. n.) , Services or feeders Installation , and/or relocation I 200 amps or less ,_ 100.70 2 • ❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 soaps 133.56 2 401 amps to 600 amps 200.34 2 Name: L7e�1 -Lv'i _ ` Jy E +�,"n� �'3r4 601 amps to 1,000 amps 301.04 2 Address: Over 1.000 amps or volts 552.26 2 City/Statc/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that 1-own which is not - 201 amps to 400 amps 125.08 _ 2 . intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _L__ ___ 168.54 .2 Branch circuits - new, alteration, or extension, pct panrl • Owner, signature: — -___ Date; A. Fee far branch circuits with W ❑ APPLICANT " 0 CON'T'ACT PERSON above service or feeder fez, 7.42 2 ---- -- — each branch circuit Business name: B. Fee for branch circuits without Contact,[uunc; w_ — first branch ct eoitfeeder fee, i 56.18 6(64, I 2 - Address: __ --... Each add'( branch circuit ; ,,- , 7.42 I t/a y t/ 2 _ --- Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular 67.84 2 --- --. -.,_, - - - dwelling, service and/or feeder . Phone: ( ) Fax:: ( ) Reconnect only 67.84 _ 2 E -mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 . Business name: _ / / ' Signal circuit(s) or limited. Or1, S 4-1r1 &. E 1'C_.l ; ,y! j1�) ( . energy panel, alteration, or extension. Describe: Page 2 2 Address: ( City /State /ZIP: ( k rte 976)3 Each additional inspection over allowable in an of the above l �! L . — .. Per inspection _ 66.25 Phone: (7 Z e, Fax: ( 53 ) ZC tam) ' /3 Investigation per hour (I Itam) -- 66.25 Suprv. Lic.: �� per hour 78.18 CCB Lie.; Z�G� I Electrical ctncal l.t . :_ )2 5 Indusvial pla ELECTRICAL i'kIdM1T' F>rl'1 • Suprv. Electrician signature, required: I_ / 1 `I - --_ Subtotal: 1 a 0-7 — — ... .......... -- ..�. • " ^ � Plan review (25% of permit fee): _ ill Print aurae: , ,,r � i� �� Dale, State surchar / permit t . ) ( c 8i r y Authorized sigp ;sure: f 7 ! r This permit applicanoa espircn if a rrmil is nor obtained widths Print mane: Date: days after it he! pert; se :opted ar lumplete. • Number of unspcu�„ns ;dlrnst,.: ,'a ; -ct:nrt 1 ∎Building1Pe,mut I t •1'ennn Jt• . tom i'tn 440-461s t'(t li05fC0M/VIEB 1 I , 1 ' d WdLS :221 GO OE OE ' ^ °N 217SS99E2OS : ON 9NOHd ON I O I X110919 J,BNUO : WOiLId