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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 -00088 ,1;; Date Issued: 02/23/2010 T t G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S134AA01800 Jurisdiction: Tigard Site address: 10180 SW NIMBUS AVE J1A Subdivision: SCHOLLS BUSINESS CENTER Lot: 0 Project: City Edge Comunity Church Project Description: Add /alter (4) branch circuits for receptacles. Owner: FEES ROBINSON, CONSTANCE A & Quantity Description Date Amount ROBINSON, LYNN ET AL, BY KG INVESTMENT MGMT, 10240 SW NIMBUS AVE #L3 4 crt Branch Circuits 02/23/2010 $78.44 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 02/23/2010 $9.41 Electrical Contractor: 3D ELECTRICAL SERVICES INC PO BOX 173 OREGON CITY, OR 97045 PHONE: 503 - 657 -9173 FAX: 503 - 655 -7140 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $87.85 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 OAR 952- 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: — I _ i _ J �/ Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on properly I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' b- ``Jn „ ��� �_ Date: LICENSE NO. ' Cali 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. F E B - 2 3 - 2 0 1 0 ( T U E ) 1 0 : 0 2 3 0 E " (FRX)5036557140 P 002/002 Electrical cal Pet trait Application F C L� ' 1 ` .� � 4 ' i Ire ='- �] i ill 1 1 . �'. 1 , t4i/' a . i� I �. •� 2 20 10 , ... U . .. 8b._ }. ; . .. ,+ . .'v_ r _ „ :. -NF l ., -' S '' City of . FEB .. l� Permitrla:9- 000f Inspection Line: 503.639.4175 3 gee Page S for v 13125 3 01 1iai1 8tud -, Ti gaed, OR 97223 p g �i� ® s� Phone: 103- 639.4171 Fax: 503.598.1960 C I'�Y �r- j 1G�RC - 1 Y: OtherPotrr>it: y1 i . ! O, I y� `' c me R d,methy : r�tvitie•,,,S Internet: www.tiga&d -or.gpv B�IC��'' vlv�`3I���at0!ed/Method: Q f Supplementellntbnnatlon . TYPE OF WORK • ` PLAN REVIEW CI New construction 'Addition/alteration/replacement Please check all that apply (submit a sots of plans warms checked below): 13 service or feeder 400 amps or more Q Building over three stories. ❑ Demolition [} Other: whom mr avaitebte tkrde curroet ❑ Marines and boatyards, CATEGORY OF CONSTRUCT/ON comas 10.000 amps at 150 volts or 0 floating building& less to ground, or mooed, 14,000 0 Commercial -use agricultural ❑ 1- and 2- family dwelling cial/industrial ❑ Accessary buridmg mope for all odtQ installation,. buildings. ❑Multi- family ❑ Master builder El Other: ❑ Firo pwnp. ❑ Inalallstion of 75 KVA or . sy Prnrrg®cy system larger separately derive . d stem JOB 'SITE INFOR�MATION LOCArtori . Q Addition of new motor l of ❑ "A', S ". `1.2 ". `1 -3 ". o.: Job ante ad dr e ss : r f 0011P or more, escupaney. Jab n 2 L ( 5 a q 1 01! 80 S W#J i lr.dt,, s A u. "4 S 2 Q Six ac more resideettial units, ['Recreational vehicle parks. City/State/ZIP: l 1 ,.. Q q 2 ❑ Health-cato facilities. 0 Supply voltage fbr more than ❑ 11axardous locations. 600 volts nominal. Suite/bldg. /apt. Project nine: • •1111,1/. 0 Service or feeder 600 amps or morn. FRI8C`SED13LE Cross street/directions to job site: 0 Desalpaso 10br. I Yea 1 root 1 L 1/. .... New residential single- or mulq-ftundly dwelling unit. 0 J U£re, Includes attached prep. Subdivision: I L no.: 1,000 sq. ft. or leas 168.54 1 4 Tax no.: Es. add'1500 eq. A or portion 33.92 - 1 Limited eaorgg, nsidontial sq. 67.84 2 DE>3CDESCRIPTION DESCRIPTION OP.. WQR1C ( with above q• R. ) Limited energy, multi- family 67.84 2 • r side:die/ (with above so. ft) "` Services or ICeders 1nstafisdon and/or relocation 200 aatpt or less 100.70 2 ❑ PROPERTY OWNER I 0 TENANT ' 201 amps to 400 amps 133.56_ 2 401 amps to 600 amps 20034 2 Nom 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 ereps arvoits 55226 2 Temporary City/State/DP: on servlees or feeders Instafatton, alteration, and/or Phone: ( ) Fax ( ) 200 amps or leas 59.36 1 Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 - 2 1 intended for sal; lease, rent, or exchange, according to ORS 44 b' 7 7, 449, 0, and '701. 401 trips to 599 str 168.54 z I Branch circuits — new, alteration, or en on, per panel Owner signature: Data - A. Fee for branch circuits with — m • elee elee er feeder fee, ❑ :APPLICANT ` ©CONTACT P3SRSON 7.42 2 each branch circuit Business name: . a Fee ibr branch circuits without feeder fro, first service or Contact name: 56.18 5- (4 i t E 2 Each add•( branch circuit 1111112131gE131 2 Address: Miscellaneous `service or ftadernot included) City/State/ZIP: g dwelling, sery andIor feeder 67.84 2 Phone: ( ) Fax: : ( ) Reeenneot only _ 67.84 2 : • Pwup or irrigation circle 67.84 2 i E -mail: 14 t4 k ti! :g 4. Lo 4 ,4p ca C . C.0 w. Sips or outline righting , 2 p CONTRACTOR _ Sipe!. circuit(s) or limited - energy Business name: Z 1 7 CC panel, alteration, or es0snsiot► Page 2 2 L,l f l ..a L .] P r U 1 4G !v L Each additiorml lltspeeUon over allowable In any of the above Address: pc, , o x 1-73 z.o. c.'� f-il w `f .2. l 3 Additional inspection (1 hr min) - 66.25/ In City /Stnte/Z1P: b re a ,,� ` p r Ind pi (1 hr min) f 66.25/ hr 9 4 s � Industrial planet 1 hr m�) 78.1e/ hr Phone: (Sp 3) ( 7- ci 1 1 3 I Fax: (s.1a 3) ( 5 5- '71 t{ O Inspections for which no foe is 90.00 / hr epocifically listed (Si hr min) CCB Lic.: 4 3 S 23 y . Electrical Lic.: 3 - bb - Suprv. Lic.: 3 "7,41 3 S ELECTRSCAL PERMIT FEES . Suprv. Electrician signature, required: .�,,,_. Subtotal: 7 W, ' Plan review (25% of permit fee): Print name: 3 , 1 \ '.D m ✓` Date: � 2 (O State surcharge (12% of permit fee): [{ Authorized signature: TOTAL PERMIT FEE: 1 r This permit email expires ira permit Is not abta nod within 1 days ater It has been accepted as complete. Print name: g t (( )1.1.. ,.... j Date: 2..27— (a • Number of inspections allowed per permit. 1 :11luilding1PeitaLGlhnuitApp.doa 10101109 410.461.11 0