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Permit ' "',;` ELECTRICAL PERMIT CITY OF TIGARD Iii COMMUNITY DEVELOPMENT Permit #: ELC2010 -00004 r Date Issued: 01/05/2010 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 25111 CA05500 Jurisdiction: Tigard Site address: 9450 SW LAKESIDE DR Subdivision: Lot: 0 Project: Project Description: Change out 200 amp panel only. Owner: FEES PHELPS, KEITH D Quantity Description Date Amount 11205 SW SUMMERFIELD DR #170 TIGARD, OR 97224 1 ea Services or Feeders - 200 01/05/2010 $100.70 amps or less PHONE: 1 ea 12% State Surcharge - 01/05/2010 $12.08 Electrical Contractor: ROBERTS ELECTRIC INC 5759 SW 48TH ST PORTLAND, OR 97221 PHONE: 503 - 244 -7754 FAX: 503 - 244 -0560 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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 0 R 952- 001 -01 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. I ued : Permittee Signature: ( /97 / e,52- / ss B y / 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 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. MPY -8 -2006 06:05P FROM: TO:5035981960 P.2 . i l8Ct1'1CSI Permit a�p�1l1Cat t x A F r 1 � t r C >* TO r , , ' * ,,. RECEIVE o'b' I ` ' ` `-" /v r Re / yy ' ' j d ='. �IIT Oi T1ga rd Clatern _ ©�/Q Y /0 / ' Prowl No.: Z' - 000D' j � - 13125 SW Hall Blvd., Tigard, OR 97223 p y y , -,,, n Phone: 50.630,4171 Fax 503.595.196(1 JAN 0 4 2 0 10 os� : Other Permit ��;; tti in9pcction Line: 503.639.4175 f1.aits Ready/Fly: luiriry 6, Soo Pep 2 ror Internet www.dgard-or.gov Nnb fied/M od: CiTY OF TIGA / Simples tonal Ldormetloe ' . ::: .. - :.. ' . s. ' . ' .. TYPE 'J1 W 1I DING DIVISION • .. ti ,: '. .,•, ; y>ga < 0 ew Constriction r§ Addition /alteration/replacement ' Please cheek all fha4 nhply (submit 3 seta of plena whtems checked bclowl: • Other: ( Service m feeder 4Q0 amps ar more ❑ Bending over three stories. Q Demolition where the available mull currant ❑ Marinas and boatyards. CATEGORY QT CONSTRUCTION • exceeds 10.000 amiss at 150 voles or O Floating baildingr icsa to ground, or exceeds 14,O181 ❑ Commercial - use agrieuhural 1 and 2- family dwelling 0 Commercial/industrial ❑ Accessory building amps ibr all other insf ttmivne. huildinge. 0 Multi- family ❑ Master builder ❑ Other: ❑ Flre pump, ❑ finial/talon of 7s KVA or - 7'!g CI Emergency system. larger scpsratcly derived system. tOB $T INFORMAt1ON AND LOCA'tiOY . °Addition of new meth' load of ❑ "A '9i ", 94', „1.3,.. Job no.: Job site address: 1 o0HP nr more. dtaaytsncy `1`tFS S - w .0 E S(Q� NIP U£ Q 3 & or more residential coin, ❑ Recreational vehicle palm. City /Statc/Z!P: -rt6 i `ti0 0 Wealth - care facilities. ❑Snooty voltage for mom an ❑Hsamdoaa loeariene. re 600 volts nominal. Suite/bldgJapt, no,: I Project name: ❑ Service or feeder 600 amps or more. Cross street/directions irections to job site: S {,t, f ri rte. a p I i : _ RE SCHED9lH.B :: t v ,Sd Re I r. ir wr I • New resideadal single- or rook(- family dwelling unit. Includes attached garage. Subdivision: 1 Lot no.: • 1,000 sq. ft or less 145.15 , 4 Ea. add 500 sq. ft. or portion 33.40 I 1 Tax map /parcel no.: residential )d�$C�t1Pl'ION OF WORi� , Limited (with above 5. 11.) 75.00 2 Limited energy, multi- family 75.00 2 C( >, 6 U u 1 POr ?L e ti l residential (with above :14, n,) Services or feeders iustellatiog and/or relocation , 200 amps or Itus f 80 -30 r 2 ' ' E PROPERTY OW1 R ' T. .' Q 'TENANT . . - • • 201 amps to 400 amps 1 106.85 2 Name: 401 amps to 600 amps _ 160,60 2 Address: 601 amps to 1,000 amp 240.60 2 Over 1,000 turps or volts 454.65 2 City /StatelZiP: Temporary eiMes or feeders lnamllstion, alteration, eod/er relocation Phone: ( ) r'v . ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own Which is not 201 Mips to 400 amps 100.30 2 intended for sale, lease. rent, or exchange, according to ORS 447. 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner si acu Breath circuits- nett alteration or extension, panel - Et^ D at °' - A. for branch circuite with . 0 APPLii`ANT ❑ CONTACT PERSON above service or feeder fix. .••■•■ each branch circuit 5,65 circuit Business name: — 9. Fcc for branch circuits Genteel name: without service or feeder fee, 46.85 2 first branch circuit Address: Each edd'1 branch cireal 6.65 2 City/StateJ7TP; If'nodlaneous (Remit* or feeder not Included) Each manufactured or modular 90.90 2 dweftmp, service and/or feeder Phone: ( Fax: ' ( ) Reconnect only 66.85 2 E-mail: Pump ar Irrigation circle 53.40 2 CONTI<TACTOR . .. Sign or outline lighting 51.40 2 Business n ame: OL� . Ail . c S Signal cincnitts) or limited - energy .—G,' rt i enens'minel, alteration, or Addrrss: .`� ( • .S, t :„ 44,k, Page 2 2 City/State/DP: 4DJ . D L ) 224 Each addidonsl ioapsctlon over Utowsble in any of the above Phtfnc: (5 4L 7)54 Fax: —1)1) ' ,._ - E , ( j Per inspection 62.50 _ hinstfgation per hour p hr min) 62.50 6KCCB Lic.; 1.3 ✓ / I Electrical lie,: �. J 3L Suprv. Lin—: 3 � r Industrial plant per hour 7315 Suprv, Electrician signature. required: , . / 1 IELEC17RICAL R7° 'I WED ;. 1 r� ., ` ... J Subtotal: Y < CO e Pr1%It name: A3 l� i ML pkt I ill Date: / /[ f j 6 Plan review (2596 f permit tbe): 0 0 Authorized si f Slate surcharge (12% of Permit fee): j I �! TOTAL. PERM' FEE: '{ . 0 Print name: l Datc: nisi pe �PPtteauoa whys if 0 peewit b not ahealneed ' 180 daps alien' a tea trans accepted ao eyy late • Number nrhwvecfon cr allowed p permit. (��( + IMuiklitglDnmltitalt.MmhAsodoe e5R3iet, eenarimt etssCOIV tvcs QC. 6047l -563 - 5 - z 3 3d e_ii.) /.102‘i