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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2009 -00503 :TIGARD 13125 SW HaII Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/25/2009 Parcel: 2S 101 AD01300 Jurisdiction: Tigard Site address: 12750 SW 68TH AVE Subdivision: WEST PORTLAND HEIGHTS Lot: 33 Project: Clearchoice Project Description: Add /alter (12) branch circuits for TI. Owner: FEES HAMPTON BUILDING, THE LLC Quantity Description Date Amount 75 -796 HIONA ST HOLUAIOA, HI 96725 12 crt Branch Circuits 09/25/2009 $120.00 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 09/25/2009 $14.40 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 $134.40 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: V it •. . • . ( .l \ Permittee Signature: %-.--Q.J) - 1 t3 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. 24. 2009 2:21PM McCoy N o. 4890 P. 1 � lecini..a, rCrlu„ &tpp D _ ____orrl� l: t * City Tigard Received ig Permit No.: t3' g 2009 Date/By: •.•! . •:. .. - .IIN 13125 SUIT Hall Blvd., Tigard, OR 97223 S E P 2 4 Plan Review I ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: Inspection Line: 503.639 CITY OF TIG Dale Ready/By: RI See Page 2 for 11 c n 1i n Internet: www.tigard- or.gov B r V rI ' , �D NoliIIed/Method: `�' Supplemental • Information 1 .. W' e.1. M= i�>i r •� .. .. _ .. • � . ��_rci.,,uac_.s _—ck ;� ax.�__ ,� ❑ New construction 3 ' ddition/alteration/replacement Please check all that apply (submit 2 sets of plans ■fileo Checked below); 0 Service or feeder 400 amps or more D Building over three stories ❑ Demolition • Other: where the available fault current 0 Marinas and boatyards. � ,r-•s , r ya., . _. i ..x5 gx i , :-" '•. :.. --° p• ❑ �- ,— _- r �;xy6,� r � o i�' 1 7 B d s ���!!_• �- ,.tat . < =_ exceeds 10,000 amps at 150 volts or Floating buildings. } " " w °• `TMm Y�' ' --= less to ground, or exceeds 14.000 0 Commercial -use agricultural ❑ 1- and 2- family dwelling ►� Commercial/industrial ❑ Accessory building amps for all oilier installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: OFire pump. 0 Installation of 75 KVA or F _ ' , }� t y y --- -- =, D new ❑Emergencysystem. larger separately derived system. FY— _ mac ft \ ,.ART:t 0 NNE l' . �.0 -9 ac ...� '?; - Addition of motor load of D "A", "B", "1 -2 ", "1 -3 ", Job no.: 1 Job site address: 1 A, 0_ 100HP or more. occupancy. r �e�T • A -a.... ! D Six or more residential units. D Recreational vehicle parks. City /State/z1P' �•'rd . / ❑ Heatrh.eara facilities. 0 Supply voltage for more than • OHazardous locations. 600 volts nominal. Suitelbldg. /apt.no.. Project name: • C • D Serviceorfeeder 600 ampsormoo. • L : -te '' -,: - ;`.:d' A : -1�{ 4,_1.!�e '"~ ' ; ' Cross street/directions to job site: D ecrip(ioo Qh. Per. Total -- - New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1.000 sq, R. or less 145.15 4 Tax map /parcel no.: Ea. add'l 500 sq. B. or portion 33.40 1 , . n _ _ residential 75 00 2 Limited energy, rest ro tt�� ' S ' �'`_'� ". '' 1 1 ✓ .. , L. ,W1�8b0�� aQ. fl.0 Limited energy, multi-family 75.00 2 Jr ) bc, . r(11� Pan /10845 Q� 5 residential with above sq. fl.) - �.+ Services or (ceders inetallattOn, alteration, and/or relocation - -_ ___ •w.._ .,,�_. : ..,:: - ' r .. ,c. : : '.i ✓E - ��='4" -...r ^ z^.r- 77^7E------7 - — 200 amps or less 80 30 2 t j. ,, c °t - �Eu' #x� s,' if r 2 I r ,_ _ ` :02, 4 ilNJiir, k y ` ,pF ^ . 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps . 160.60 2 . 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 . 2 City/State/ZIP: Temporary services or feeders Installation, alteration, and/or _ relocaton Phone: ( ) Pax: ( ) 200 amps or Tess 66.85 1 Owner inataliationt This installation is being made on property that 1 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 599 amps 133.75 2 Branch circuits- new, alteration, or extension, per panel Owner signature: Date: A Fro for branch circuits Ivirh r.----="--, a _ _ . . M: :. ° ac e rfiu - oS'� • j above service or feeder fee, 6.65 2 • each branch circuit Business namc: McCoy Electric B. Fee for branch circuits Contact name: Kell) tl'rtlrout service or feeder fee, j 46.85 i ll 2 first braact, f;ircuit �+ Address: same Each add') branch circuit 11111111•1111Ulli. 2 Miscellaneous (service or feeder not included) City/State/ZIP: same Each manufactured or modular dwelling, service and/or feeder 9 2 Phone: (503) 234 -7521 I Fax: _(503) 234 -9473 Reconnect only 66.85 2 E- mail: ksloper @mccoyelectrlc,com Pump or irrigation circle 53.40 2 _.. = -�; : '_ : ')2 a�ef "'r�� a E _ _ - 4 - � ` - _- "6, -.,7_ Si or outline li tin 53.40 2 �` ^ . �..... _�i �ayaa� : -tr. �f � —�£u -• 4 Business name: McCoy Electric Signal circuit(s) or limited- energy panel, alteration, or Address: 2014 SE 9 Ave extension Describe: Page 2 2 City/State/ZIP: Portland, Or 97214 Each additional inspection over allowable in any of the above Phone: (503) 234.7521 I Fax: (503) 234.9473 Per inn 62.50 ]nvestigaion per hour (l hr min) 62.50 CCB Lic.: 8277 I Electrical Lic.: 26 -82C I Suprv. lac.: 2175S Industrial plant per hour 0 7175 S - T "' -' F.,� eT =. ` - =�--,; - ■ uprv. Electrician signature, require Subtotal: 0 . " Print name: James R Hall i Date: 1 MIMI Plan review (25% of permit fee): et, tor State surcharge (12 %ofpermit fee): RA v (,` Authorized signature: TOTAL PERMITFEE: g )g t t1( Thlr permit application expires V. permit is not obtained within 180 Print name: I Date: days strait has ban accepted as complete. * Number of inspections allowed per permit, I :1BuildngPnmits\ELC- PamhApp.doc 013/06 440 46157(II/O5/COM/WEB Kk--- 1 (1 1 © r