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Permit CITY OF TIGARD ELECTRICAL PERMIT Q COMMUNITY DEVELOPMENT Permit #: ELC2010 -00466 T1 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2010 Parcel: 2S102AD03000 Jurisdiction: Tigard Site address: 12800 SW ASH AVE Subdivision: BURNHAM TRACTS Lot: 0 Project: CITY OF TIGARD Project Description: (1) feeder. Owner: FEES TIGARD, CITY OF Quantity Description Date Amount 13125 SW HALL BLVD TIGARD, OR 97223 1 ea Services or Feeders - 200 09/01/2010 $100.70 amps or less PHONE: 1 ea 12% State Surcharge - 09/01/2010 $12.08 Electrical Contractor: MR ELECTRIC OF CLARK COUNTY 14300 NE 20TH AVE. D102 -313 VANCOUVER, WA 98686 PHONE: 360 - 574 -7200 FAX: 360 -546 -2158 Type of Use: COM 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 OAR 952- 001 -0100. You may obtain a cones a rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By Permittee Signature: s 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. Sep. 1. 2010 1:12AM No. 4835 P. 2 Electrical Permit Apulicati EIVE Folt Ot IJSE ONLY N. ., City of Tigard Datul3 ° $ 3 13125 SW Hall Blvd., Tigard, OR 7223 %l ig Plan Review Sly Phone: 503.639.4171 Fax: 503.5 8:1960` t D : OlhuPermrl: I' I t i M I> Inspection Line: 503.639.4175 Date Ready/By: 0 See Pape 2 for Internet: www.tigard•or.gov CITY OF 'WAIT Notified/Metbod: Supplemental information TVA' �O -1%1, °x1/ k() PLAN REVIEW • • ❑ New construction 54 Addition/alteration/replacement Please check all that apply (submit 3 seta of plans wfitems checked below): CI Service or t8eder 400 amps or more ❑ Building over three stories. 0 Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OP. CO STRUCTION ' exceeds 10.000 amps el 130 votes or ❑ Pleating buildings. • less to ground, or exceeds 14,000 ❑ Commercial-use agricultural © 1- and 2- family dwelling 71 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 AM) LOCATION 0 Emergency system. larger separately derived system. • .. ❑ Addition of new motor load of ❑ "A ". "E ". "1.2 ", "1 -3 ", Job no.: 11� Job site address: •� �` A 1 10011 or more. occupancy. 1° - `�UV ! 4'0� �T • • ❑ Six w more residential units. occupancy. Recreational vehicle parka. City /State /ZIP: { s 91a tt-" t D � [' . ❑ Health -care facilities. ❑ Supply voltage for snore than 1 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt, no.: Project name: rvite�,rtrel ❑ Service or feeder 600 amps or more. • Cross street/directions to job site: S W �7l.lN n Description FEE: SCHEDULE. 1 E J • p �Onl. 1 Fee. 1 Torsi 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'I 500 sq. R. or portion 33.92 1 Limited energy, residential . • DESCRIPTION OF WORK (with above so, R.) 67.84 — 2 Limited energy, multi - family 67.84 2 residential (with above sq. R.) Services or feeders iustallationolteratIon, and/or relocation 200 amps or less l 100.70 l()D'•}0 2 XPROPERTY• OWNER I . ❑ TENANT 201 amps to 400 atnps 133.56 2 Name: L 6 " 401 amps to 600 amps 200.34 2 Lim 601 amps to 1,000 amps 301.04 2 Address: l 24100 5w A. e �1 s k • Over 1,000 amps or volts 552.26 _ 2 City/State/ZIP: ' 'j G- b f. C{ -I- Temporary services or feeders Installation, alteration, and/or l .. 3 relocation Phone: (5() l , a )s 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 slaps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, d 01. 401 amps to 599 amps 168.54 2 Owner signature: Date: `.V v }� Branch circuits – new, alteration, or extension, per panel _ A. Fee for branch circuits WA • ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2 l, each branch circuit Business name: iV , j l j {' 1 f , cu IL le nt B. Pee for branch circuits Contact name: 1� �� 4 ( ' _ s '.5 4J without br a crvice or seder fee, 56.18 2 /� first branch eirglit Address: ‘ a � 1' IN a Rot W t GI G ) Each add'1 branch circuit _ 7.42 2 b 1 Miscellaneous (service or feeder not Included) City /State/Z1P: `1 a��Vvie� I j Each manufactured or modular 67.84 2 a r ph. dwelling, service and/or feeder Phone: 6.0 ) a- I u _ �1 s x: : ( ) Reconnect only 67.84 — 2 E -mail: (,,t 51,-A t ° – Jhg Tt l -C– . GWrn Pump or irrigation circle 67.84 2 ONTRACTOR . • Sign or outline lighting 67.84 2 Business name: //�� Signal crt(8) or t �.qtl< e4 i C ~c -li(�'t.t (t2�te energy panel alteration or ed- Address: ` Lr P� cv e , ?\g extension. Describe: Page 2 2 City /State/Z It A t . W a.. • g • .. , Each additional inspection over allowable in any of the above ��' 1 Per inspection 66.25 Phone: 2- � _Qc \ -L-, � - o Fax: (S100) 54/ . a ( S investigation per hour (I hr min) 66.25 ' CCB Lic.: t � 3 tJ 1 Electrical Lic.: 613 (. Suprv. Lic.: 4 S g,5 Industrial plant per hour 78.18 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: ._ Subtotal: , c Date: Plan review (25% of permit fee): Print name: ���// . . - ♦ ..J • 3 ( State surcharge (12 %ofpemritfee): 11/.04 Authorized signatur TOTAL PERMIT FEE: ` i2 . This permit application expires if a permit is not obtained within 1 Print name: Date: days after It has been accepted as complete. • Number of inspections allowed per permit. 1113u110inglPcmailaLC -pc I , hApp.doc 10/01/09 4 40.4615T(11/05/COM/wEa 7111\ •ee) kt -e