Permit CITY OF TIGARD
ELECTRICAL PERMIT
n
` COMMUNITY DEVELOPMENT Permit #: ELC2010 -00298
Date Issued: 06/17/2010
T E GARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S1 01 AA06400
Jurisdiction: Tigard
Site address: 12323 SW 66TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: 24
Project: Spec Space
Project Description: (2) branch circuits for water restoration.
Owner: FEES
TING, ELON & SYLVIA Quantity Description Date Amount
BY WILLIAM R SOUTHARD, 20400 NE 122ND
ST 2 crt Branch Circuits 06/17/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/17/2010 $7.63
Electrical
Contractor:
MCCOY ELECTRIC CO INC
2014 SE 9TH AVE
PORTLAND, OR 97214
PHONE: 503 - 234 -7521
FAX: 503- 234 -9473
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 952- 001 -010'. • • of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By • ' L _s - 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.
Jun. 15. 2010 2:51PM I1cCo \E- leeLc No.9613 P. 1 -
Electrical _Permit Application 1 "� , ' ; FOR orrtrr use ONLY
City of Tigard Received bataBy: G 1`5'110 13rr permltNo.: t- Lim it) —m
N.. u 13125 SW 11011 Blvd„ J
Tigard, OR 97223 UN 1 5 2 0 h , plan Review
C • Phono: 503.639.4171 .Fax: 503.598.1960 Dal/By: ether Permit: tp901.0 (?'
I' 1 G A u Inspection Lino: 503.639.4175 ' ; , i , Date Ready/13y: Jul t4 gee !Page a tor
Internet: www,tigard or.gov a ‘ % Suppl emental Notified/M '1�
Information
Ye�`,.`.f�z '`p +� xr. •s r.�- w Fs . �SK � ��i s5 - ? L ti !�� . �r•��� C ' ', i . .ar. ��t T . ,�,k [.: . .� r; -:. ete - „�.
ti .n,..'' . ..' « ?4 .:: 1..,,,i ✓, 4 � rc -4 ` . • ; ':. ' +�)- ;x-tsv,. •v t - v •••:,41. ' t - ' r n - e . } c. 1t i a -: -
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11111 New conslnction % Addition/alteration /replacement Please check all that apply (submit j gets of plans w /items checked below);
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition • Other: where the available fault current
0 Marinas and boatyards.
.KJ. ?'- _.. i. i . ` . , . - y.. �,� rrY-•r,. - exceeds 10,000 am a
'•�-` � .,` V rrQ,13a :: oil ffib ” :i. ; �. - h .•i" : : _✓�g , amps t150 volts or ❑ Floating buildings.
ices to ground, or exceeds 14,000 ❑ Commercial-use agricultural
b 1- and 2- family dwelling jCommercial/industrial ❑ Accessory building amp for all other installations. buildings,
❑ Multi -family ❑ Master builder ❑ Other (1 Fire pump. ❑ Installation of75 KVA or
r; y° :, < r r ; . r , s ❑ Bmcr s larger separately derived system.
' tgii �E ,O . ; feI4 ?E O1iI Ik
I .. � z , " ,, ❑nddigonpfnewmotor load of Q"A "'$" "12" "1 -3"
Yob no.: Sob site address. (� / „� p. n` 10oHP or more.
occupancy -
Ja V 7� 7 l�`V C� V ❑Six or more residential units, ❑ Recreational vehicle parks.
City /State/ZIP: t`1r71 c )l ❑ Health -care facilities. LI Supply voltage for more than
C�JI�✓ ' ❑ Hazardous locations, 600 volts nominal.
Suite/bldg. /apt.no.: Project name: Far- -J - `y - fin ❑ Service or feeder 600amps
-, �`' ? ',, ,. ; . '\IN 47X ' 1� ; 11L ' ' r ' ; ---f
Cross street /directions to job site: Description _ � Y o ry. 1 Rec. I : Total 1
New residential single- or multi - fancily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 168.54 4
Tax map /parcel no Ea. add'1500 sq. R. or portion 33.92 1
Limited energy, residential 67.84 2
-. .1 ?,' ` x , ? t E1'lgT 1Q . {S F' * PM:'‘ < } (w above sq. ft.)
k.). W I Limited energy multi- Enmity
Sr R-1?4� 1 (' ) \ residential (with above sq. n.) 67.84 2
{3 tQ c 1 (� fi'�•„ .. . Services a or feeders installation, alteration, and/or relocation
1� i � T 'n 200 amps or less 100,70 2
0 PRQ kRTl V t
,,....., .r... .. � .. ,.. t)'S,]Y�?� :.:; ..r, : i , . .,.. �, ®*fi,ANT..,. ,:.. amps
, ,. 201 to 400 amps 133.56 2
Name: 401 amps to 600 aiu 200-34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/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 l 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, per panel
Owner signature: Date: A. Fee for branch circuits 1 yith
} , Q ,APiP1 X6 t I ., 0 .. Q OOPr>? $,Orgy . .? above service or feeder fee, 7.42 2
each branch circuit
Business name;
B. Pea for branch circuits /
Contact name without service or feeder fee, 1 56.18 • �(C . U 2
fast branch circuit
Address: - Each add'I branch circuit I 1 1 7.42 1'- .L47., 2
Miscellaneous (service or feeder not Included)
City /State/ZIP: Each manufactured or modular J '' —
dwelling, service and/or feeder 67.84 2
Phono: ( ) Fax :: (' ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
':: s .... a....,. (.OtYTRr),GTOR .(4 ,� r Sign or outline lighting 67.84 2
Business name: McCoy Electric Signal circuits) or limited-
energy panel, alteration, or
Address: 2014 SE 0 ave extension. Describe: Page 2 2
City /State/ZIP: Portland, Or 97214 Each additional inspection over allowable In a __of the above
Per inspection 66.25
Phone: (503) 234 -7521 Fax: (503) 234 -9473 - Investigation per hour (1 fir min) 66.25
t/�CC Lie.: 8277 I Electrical Lie.: 26-82C ' Industrial plant per hour 78.18
VV° C Suprv. Lic.: 2175S P P
i',:Vi- M � .. r; g01 � F tI ` : ; ? ,'
Suprv. Electrician signature, required:
tiA.A...
subtotal: (��
Print name: James R. Hall Date: Plan review (25% of pennit fee): ~-�
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEB: i r o) 3
This permit application expires i permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete
4 Number of inspections allowed per permit.
Ll aulldIng lPermllaLC.PernhlApp.doc 10/01109 440.4615T(11/05/CDASIWa
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