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Permit CITY OF TIGARD ELECTRICAL PERMIT s , gar , � ` t r'a 1, COMMUNITY DEVELOPMENT Permit #: ELC2010 -00197 Date Issued: 04/23/2010 T f G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S134CA00102 Jurisdiction: Tigard Site address: 11665 SW NORTH DAKOTA ST Subdivision: Lot: 0 Project: Kaneta Project Description: (3) branch circuits for heat pump and furnace Owner: FEES KANETA, KEVIN H Quantity Description Date Amount 11665 SW NORTH DAKOTA TIGARD, OR 97223 1 ea 12% State Surcharge - 04/23/2010 $6.74 Electrical PHONE: 503- 312 -4436 3 crt Branch Circuits 04/23/2010 $71.02 wo /Purchase Service or Feeder Contractor: 0 ea 12% State Surcharge - 04/23/2010 $1.78 CONDUIT ELECTRIC Electrical 19461 SW 89TH AVE TUALATIN, OR 97062 PHONE: 503 - 692 -1428 FAX: 503- 692 -3652 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 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 • • R 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1. 0. l� _ 322 Issued By: � � r"gm ti Permittee Signature: 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. Electrical Permit ApplicR p i \/ � ->.. 1 : FOR OFFICE USE ONLY City g Date/By: Tigard DatReceived By: � 3 /0 Permit No.'r o2 0/0 — e 13125 SW Hall Blvd., Tigard, ORM3 3 2010 Plan Review 11 Phone: 503.639.4171 Fax: 503.598.1960 f� © Date /By: Other Permit: T I G A R D Inspection Line: 503.639.4175 CITY I OF TIGARD Date Ready /By: Juris: ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: ' 6- Supplemental Information BUILDING. DIVISIQir,' TYPE OF WORK PLAN REVIEW ❑ New construction I Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground. or exceeds 14,000 ❑ Commercial -use agricultural R I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2', "1 - ?', Job no.: Job site address: I i W C o s e - Sl ki.i . t■..),11,cr- ()A Ic-N n 100HP or more. occupancy. 12 Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: 7 .-)8_ f c2 9 7-L2_ ❑ Health -care facilities. ❑ Supply voltage for more than a ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions t0 job site: Description 1 Qtv. 1 Fee. 1 Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1 Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 67.84 2 500 N ek t' - i--te INS L L / R t A-Q -e Limited eid ntial ( th above sq 67.84 2 E'�►O t residential (with above sq. fi.) 1f Services or feeders installation, alteration, and/or relocation S I L 11.0 -e �U�� • 200 amps or less 100.70 2 Ip. PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: K F iJ.lt NI l< Aim 401 amps to 600 amps 200.34 2 / - 5 S 601 amps to 1,000 amps 301.04 2 Address: 1 1 Co sP 5- �. Not 1+ `�A ( ' A Over 1,000 amps or volts 552.26 2 City /State /ZIP: `r c Q{2 11-22.3 Temporary services or feeders installation, alteration, and /or relocation Phone: ( 5U 3) 311 - ye" 3 So 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 168.54 2 Branch circuits - new, alteration, or extension, • er panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT , ❑ CONTACT PERSON above service or feeder fee, each branch circuit 7'42 2 Business name: B. Fee for branch circuits / I Contact name: without service or feeder fee, first branch circuit 56.18 2 Address: Each add'l branch circuit 7i' 7.42 f f.- y 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular dwelling, service and/or feeder 67.84 2 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 - Conduit Electric energy panel, alteration, or Address: extension. Describe: Page 2 2 19461 SW 89th Ave Each additional inspection over allowable in any of the above City/State/ZIP: Tua 1 a t i n , OR 97062 Per inspection 66.25 Phone: (503 692-1428 Fax: (5 0 3) 692-3652 Investigation per hour (1 hr min) 66.25 CCB Lic.: 109669 Electrical Lic.: 26 Suprv. Lic.: 4501 S Industrial plant per hour 78.18 _ ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: t Print name: r 1 Pa Date: / Z 2---A Plan review (25% of permit fee): ----- Cha e G a State surcharge (12% of permit fee) `b . 5 Authorized signature: .i TOTAL PERMIT FEE: T ?. 5f This permit application expires if a permit is not obtained within 180 / Print name:��.� Date: VA Z. days after it has been accepted as complete. V " Number of inspections allowed per permit. t \ Budding \Permits \[LC- PermitApp.doc 10'01 440- 4615T(1l /05,COM1'WEB