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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2006 -00134 DEVELOPMENT SERVICES DATE ISSUED: 2/17/2006 °'� I � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S101 AA -09700 SITE ADDRESS: 12585 SW 68TH AVE ZONING: MUE SUBDIVISION: PP1996 -024 LOT : 001 JURISDICTION: TIG Project Description: (2) branch circuits for light switches. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: DANA, MARK R SQUIRES ELECTRIC 12585 SW 68TH AVE PO BOX 16851 TIGARD, OR 97223 PORTLAND, OR 97292 Phone: Contact #: PRI 503 - 252 -1609 FAX 503 - 253 -5831 FEES Description Date Amount Reg #: LIC 135085 [ELPRMT] ELC Permit 2/17/2006 $53.50 ELE 26 [TAX] 8% State Surcharge 2/17/2006 $4.28 SUP 4882S Total $57.78 REQUIRED ITEMS AND REPORTS This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503 - 246 -6699 or 1 -800- 332 -2344. Issued By: - i11 ti Permittee Signature: C o -e, 9,,v 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'N: 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. 02/16/2006 09:24 5032535831 SQUIRES ELECTRIC PAGE 02/02 Electr ical Permit A-A ,V CD FOR / OI' I' ICE 1.5E ONI.1' • City 0 Tigard Received ^ , /},( / Permit No.6 L i i U' O / ,3� Plan Re 13125 SW Hall Blvd., Tigard, OR 97223 C 16 2Q06 Plan Revuie Review Phone: 503.639.4171 Fax: 503.598.1960 �r , A• " ' ,, : - , Datc/B : Other Permit: Inspection Line: 503.639.4175 N ' ' Date Ready/By: ;uric H See Page 2 for Internet: www ,tr CITY OF T Notified/Method: Supplemental temeaMl 1n r ormAtion r .c s ard.or.us .. ......... ....... .... r :...... ... .. r . .. . ..... 4 ...... , . .:.'.:....:.,I ...,.. • ..A..f ..,I. -, . ❑ New construction 1; Addition/alteration /replacement Please check all that apply: ❑Service over 225 amps, comm'l ['Hazardous location ❑ Demolition [] Other: . ....,,., over 370 amps— rating ElBuildng over 10,000 sq. ft., ,... � ., ::. new residential .....,,,.',.......... , , , , ,. : , . . I:l , ; ::::. ..�;;: • '� ? >; rfr'= �i�. � �!li�i 2- family dwellings 4 or more t s ... ..: ■ . .... ........ . . .. � ',: • ,.,.. ,�..... .. , of 1 -and 2 fan Y � °System over 600 volts nominal units in one structure ❑ 1 - and 2 - family dwelling Commercial/industrial ❑ Accessory building ❑Building over three stories ['Feeders, 400 amps or more ❑ Multi - family ❑ M QOccunant loa over 99 persons ❑ fed structures o 1 Master bu ild aria ' ...' .:.:: ,•..:. •' ::!.' vi r1 es i ... . . ........ ... , .� •'�'IfJ i�. '!ik,it��,'It Egr sd htin lan 8 RV park Li':..r r::l::i'.'... y .....•. , .. .... L..:.... .'IU •... .• . .. :Wealth-care facility 0 O[ll .�. i � $.� � u� l ei t Job no. Job site address: Su bmit? s ets of plans with any of the above. City /StateIZ , , b The above are not applicable to temporary construction service. .,:., ... �. ,,;i;ti.;:!;t,:,i;:r "i! +• i;; �>G1. 'E;;;;�; ':'.. i;: ::: Suite/bldg. /apt no.: Project name: :....,,ii,_::'.. �/,ft/ � f jC'+ Daolplioe I Qom. l r FFoe L I •. Cross street/directions to job site: I New residential single- or multi- family dwelling unit. Includes attached garage. _ 1,000 sq. R or less - 145.15 4 Subdivision: Lot no - : Ea. add'/ 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 — Tax map /parcel no.: - . . Limited energy, non-residential 75.00 2 ...i f ; ;t:i:-:: _ .'.....:..:.. :..': , , &::` le::! r :: ufactured or modular ii 1 :::: :..:....:,'.:..::.:r.;:•;..... , •',:•.. � , ,.. .. � .� • • " , „, , � "!tlV�O ..fir'. _.. ........ ',1.... ..... _ Each man „ : d iog service and/or feeder _ 90.90 2 ' � we11t .90 r) `t c.4._ ex Q) Y4! C� ■ V .. �T OA— I t 1 L; 4. i �1.U!) 5 r_ Services or feeders installation, alteration, and/or relocatio �-- 200 amps or less 80.30 2 ". „ . ... ....:,!.... � �� ... ,'�' " ...,..... ...... .... [ • � 401 ..,;..:.•. .... . 160.60 :. : .:• . amps to 600 amps Name: 601 amps to 1,000 amps 240.60 2 Address: _ Over 1,000 amps or volts _ 454.65 2 Reconnect only 66.85 2 1 City /State /ZIP: Temporary services or feeders Installation, alte and /or relocation Phone: ( ) Fax: ( ) . 200 amps or less _ 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps J 133.75 — 2 Owner signature: Date: Branch circuits— new, alteration, or extension, peryanel • , ::- r.:::.. ;r . ;::. �,,.. �,... _ „ , 1� ...,,, . � '.. i ;, :ii� , . •+ service or f eeder fee, each 6.65 2 Business name: branch circuit 6 ' B, Fee for branch circuits Contact name: without service or feeder tee, 1 46.85 ' $t' 2 each branch circuit Address: Each add'/ branch circuit 1111 6 r�r' 2 City /State/ZIP: Miscellaneous (service or feeder not Included) - Pump or irrigation circle 53.40 2 Phone: ( ) _ Fax: : ( ) Sign or outline lighting 53.40 2 E-mail: al ci - energy panel, alteration, r � ......... .....................,.. , ......,.,,.......:.......;,.. �.`� .' extension. Describe. Page Business name: o 5 1L1 Yt'_ ' AC 6 r 1 !. 04- • E ach additional i nspection over a llowable in any o the above Address: c "Vb i t,Q g,5) Per inspection 62.50 - City / State/ZIP: 'O,4.°N,\ 0..E1, b le 9 7, %]__ investigation per hour (1 hr min) 62.50 � ' 6 © industrial ' an t. t,too'>C Phone: O�J� �,...5 ' I � b 1 Fax: �JT) � , r 1- ",;:�:;:',:.< ...._ .. , .,,. : 'ap1�l�;tt� ? if s: °i�;,,;'�': CCB Lie.: 10� 51) g_..< Electrical Lic.; 1 I D 1 0 Suprv. Lie.: �...5 Subtotal 5 ;� Suprv. Electrician signature, required: Plan review (25% of permit fee) State surcharge (8% of permit fee) 4, �. ic Print name . Dates D 5 /4 , r "` ��''��� 1 l t d V t' S TOTAL PERMIT FEE I rig Authorized signature: This permit application expires if a permit is not obtained within I80 days after it hm been accepted as complete Print name: , Date: * Fee methodology set by Tri- County Building Industry Service Board Number of inspections per permit allowed, i'\ Bu Wing \PamlttAEl.C•PermitA9p.60c 12/03 ea0- a6l5T(10/02/COM/WEb ■ 102/27/2006 13:13 5032535831 ' SQUIRES ELECTRIC PAGE 01/01 02/27/2006 12:04 FAX 5035981960 CITY OF TIGARD f j001 w n Request for P ilding ermit Divisio Action Refund , "/ _ of Tigard TO: CITY OF TIGARD , CO �OQ6 Permit System Administrator , 13125 SW Hall Blvd., 'fiord, OR 97223 0 1C} \ °v Phone: 503.718,2430 Fax: 503.598.1960 www.tigard- ar.gov (* 5 rd. FROM: ❑ Owner ❑ Applicant 0 Contractor (ate one) `/ : ortndividdal> 3 C/ LL4 Ye e r ��p ; e. ►Le, . Mailing Address: — PD DUX 14g51 7 •5c IV City/StatefLip: a `�'7�-9d- 17/2,0/0 (,. Phone No.. PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (i): gi. CANCEL PERMIT APPLICATION. REFUND PERMIT FEES. REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: /.--e-,I1) D tp - 61)63 4 1 - Site Address or Parcel #: 1 a.5 0 6 y fj ( 4 h . No E- . Project Name: Subdivision Name: Lot #: )E PLANATIONTV.Atc � r n- 1 k e.rra4- . Signature: `;,, Date: c,2),7 Print Name: � , t. X916 Y e--6 asememisx 1. g Official may authorize the refund of 5) any tee naddt was eamaslr paid or collected b) dot more than So percent oftbe permit fee for issued permits prior Many in ertfae mew. c) not more than 80 watt o8 pan review 1be vim BA application is cutto:Metbrtrre any plan review effort has been erpeaded 2. Reid rU w be rammed* the arjml Portia is the same method s wit* payment was nxeived. r()/:'WI'I I',I:<i':l_t Rte to S Admin: Dare : Magi [a*l�h_ 4 Ria td :. • A.dnaim: Date 13 ' Reftmd Processed: Date j ' iA Invoice Processed: Date EI Permit Canceled: Date 2/ 0 6 [1 v a ' , - 1T- hided: Date E Receipt #t7 - 776, Date . (/7 66 Method _ - Amount 57. • l AfloiildiagWomasMeePermiWctioa- ,._ dot 01/10105 -- 1