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Permit -, CITY OF TIGARD ELECTRICAL PERMIT • t Permit #: ELC2010 -00096 1 S . COMMUNITY DEVELOPMENT Date Issued: 02/26/2010 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARDi Parcel: 2S101AD02800 Jurisdiction: Tigard Site address: 12665 SW 69TH AVE 100 Subdivision: WEST PORTLAND HEIGHTS Lot: 31 Project: Amedisys Project Description: (8) branch circuits for TI Owner: FEES CEDAR ENTERPRISES LLC Quantity Description Date Amount 12665 SW 69TH AVE STE 200 TIGARD, OR 97223 8 crt Branch Circuits 02/26/2010 $108.12 wo /Purchase Service or PHONE: 503 - 636 -6657 Feeder 1 ea 12% State Surcharge - 02/26/2010 $12.97 Electrical Contractor: KEC ELECTRIC INC 761 SW BAILEY AVE HILLSBORO, OR 97123 PHONE: 503 -439 -0904 FAX: 503 - 640 -3838 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $121.09 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 AR 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. ^ / Issued By: � �i1� PerrnitteeSignature: �N �� /� " 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' Q /✓ .9-7 Ei}- 7O /\' 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. Feb 26 2010 14:54 KECELECTRIC 5036403838 p.1 Electrical Permit Application FOR oFrICC USG ONLY City of Tigard Received / DatetSy. • - . i 4 .;:iv Permit No6Z 9/© le 9 rep 13125 SW Hall Blvd., Tigard, OR 97223 plan Review iN / e Phone: 503.639 4171 Fax: 503.598 1960 Other Perini ��r • Dae /fly a�P�V /D ®�� T 1 t, A K D Inspection Line: 503 639.4175 Internet www tigard or gov Notified M JCS r mental information 4'T:A1 Supple a for RfsF{It4Y , ❑N ew construction ® A d d it i on / a l teration /replacement Please check Al that apply (submit 2 sets of plans wit ems checked below ) ❑ Demolition Other: ❑ Service or feeder 400 amps or more ID Building over three stones . v r re t available fault current 0 Marinas and boatyards ' lit � o1= G('CBUCVRI -` . ; s, ea ds 10,000 amps at1 i0 volts or ❑ Floating buddnng5 ❑ 1 - and 2 - fami I tw lest to ground, or exceeds 14,000 In Commercial-use agricultural g ® Commeruial/in ❑Accessory buildin a , for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: Lint p ump. ' :. Installation a ton f 7 stall r o 5 KVA or T(1@ ❑ ,n rgency system. larger separately derived system. `'. " 44.,R< Chili - AN0 � at ,f oN ❑ Ad itien of new motor toad of Job na.. ..1 Job s it e address: 12665 SW 69 th Av 100 P or more. occupancy. O Six .r mote residential units. Q Recrealonal vehicle parks City /State/ZIP: Tigard, Or 97223 i ❑ Ilea th -care facilities. ❑ Supply voltage for inure than _ ___I ❑ Hazardous locations. 600 volts noininal. Suitc/bldg!apt. no.: 100 Project name: Amedisys ❑ Ser ice or feeder 600 amps or more . "t Cross street/directions to job site: E ` D� Den cap km 1 yty. Fur I Total `' New r sidential single or multi- family dwelling unit. inclu • es attached garage. 4 Subdivision: Lot no.: 1,000 'q. ft. or less j 168.54 Tax map /panel no.; Ea. adc '1 500 sq. ft. or portion I 33 92 1 1 Limped energy, residential i , , pg_KRIPT10,1_43t WOR71k t (wit i above ergy sq. ft.) lt/- 67.84 2 Remodel Tenant improvement Lim en mafamily residential (with above sq. It.) 67'84 Servicles or feeders installation, alteration, and/or relocation 200 arYPS or less 100 70 2 .. s + 4 ' 17 " Al i ef : 4 01 a psto1 a 600 a 00 amps 133.56 1 2 2 • Name: 40lt s to 200.34 ` 601 am s to 1.000 amps I ; 30:.04 2 Address: Over I, 00 amps or volts I I 552.26 City /State/zip- I Temp rary services or feeders installation. alteration, and /or - I reha a�+nn r _ Phone: ( ) Fax: ( ) 200 am as or less I 1 59.36 1 Owner installation: This installation is being made on progeny 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 amts to 599 amps 1 168.54 2 7 Brand circuits— new, alteration, or extension, per panel Owner signature Date • . .Fee or branch c rcuits , 11/Ii ' 0 k:PPLLCalt ' ` ?: a service or feeder fee, 7.42 2 : C QNT"ACT PERB each branch circuit Business name: B Fee ,,or branch circuits ivirhovn servi ar feed fee. first 1 56.18 Contact name: b ran • h ctrouit 56.18 Address: Each ad "1 branch circuit 7 1 7.42 11.94 2 Miscel aneous (service or fee der not included) City/State/ZIP: Each m nufactured or modular l dwellin . service and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) I Reconnfct only 67 84 2 E Pump o irrigation circle 67.84 2 Sign M 67.84 , G(Jhci�RCC'IbR . . e, . Signal e rc t ui t(s ) o r , li m limited- energy Business name: KEC Electric, Inc, genet. a teratior,, or extension pi 2 2 Each a4Iditional inspection over allowable in anv of the abov .Address: 7 4.- J Additio al inspection (1 Iir min) 66 25/ hr City /St ate /ZIP:I/ SW Bailey Av Or 97123 lnvestig non (1 hr min) 56 25/ hr Industrial plant (I hr min) I 78 13/ hr Phone: (503)439 -0904 1 Fax: (503) 640 -3838 Inspect rs for which no fee is ,((�] /�CB Lic,: 99267 1 �/ L speaficalh listed (V: hr min) 90 00/ ^� UU �P E lectrical 1 ic.: • 3 •26C Su.rv. Lic.: 44895 _ I i. ELEO*tCAL:,PpOff'I FETES Suprv. Electrician signature, required: � Subtotal: 108.12 Plan review (.25% of permit fee) Print Warne: Kenneth E. Conway t Dale /� I State surcharge (12 °U of permit fee) 12.97 Authorized signature: �' Y j TOTAL PERMIT FED: 124.(Itt i. This permit application expires if a permit is nor obtained within 180 Print Warne: i days after it has been accepted as complete. Date' • Numb r of inspections allowed per pertr.it. 1 ;Bui /dine ?ermit+lELr.PermaApp.d l0/01:9 440 4615T(U /COMWE$