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Permit 1 ° /10 al-Jcif2-4 C 1 e :7 - C ITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 -00517 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/28/2010 Parcel: 1 S135CD00101 Jurisdiction: Tigard Site address: 11555 SW 95TH AVE Subdivision: BOETCHERS ADDITION Lot: 5 Project: Kelso Project Description: (1) branch circuit for kitchen. 10/01/2010 added (5) branch circuits B.T. Owner: FEES PRICE, JENNIFER D Quantity Description Date Amount 11555 SW 95TH AVE TIGARD, OR 97223 1 crt Branch Circuits 09/21/2010 $56.18 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 09/21/2010 $6.74 Electrical Contractor: 37 da Electrical Permit 10/01/2010 $37.10 PRO STAT SERVICES LLC 4 da 12% State Surcharge - 10/01/2010 $4.45 2904 E 24TH STREET Electrical VANCOUVER, WA 98661 PHONE: 503 -539 -7772 FAX: 360- 718 -7092 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $104.47 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. .6699 or 1.800.332.2344. Issued By: Permittee Signature: OtAANAAJi 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. CITY OF TIGARD ELECTRICAL PERMIT I: COMMUNITY DEVELOPMENT Permit#: ELC2010 -00517 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/28/2010 Parcel: 1 S135CD00101 Jurisdiction: Tigard Site address: 11555 SW 95TH AVE Subdivision: BOETCHERS ADDITION Lot: 5 Project: Kelso Project Description: (1) branch circuit for kitchen Owner: FEES PRICE, JENNIFER D Quantity Description Date Amount 11555 SW 95TH AVE TIGARD, OR 97223 1 crt Branch Circuits 09/21/2010 $56.18 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 09/21/2010 $6.74 Electrical Contractor: PRO STAT SERVICES LLC 2904 E 24TH STREET VANCOUVER, WA 98661 PHONE: 503 - 539 -7772 FAX: 360 - 718 -7092 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 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 = •o•ted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0100. Yo - • o• -in a - ctquestions to OUNC by calling 503i6.6699 or 1.800.332.234• Issued By: -411 Permittee . _ i - A. J� ►�� — _ /' � 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 803.639.4176 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. Electrical Permit Application 1.(,i< ()I.' " ' . l '' '' \' Line: City of Tigard may G J 2 1 v Kermit No.: i 5 13125 SW Hall Blvd., Tigard, OR 97223 \\\ rss Plan Riew Other Pmt: Phone: 503.639.4171 Fax: 503.59 1, DaDate/B t „ r s : ® See page Z for T Ins ection 503.639.4175 k` A, �Q Date Ready/By: : 1(„ n it I ? p -'' �,� Notified/Method: 77C4.0 77C4.0 SaSupplemental meotat Informatioi Internet: www.tigard -ocgov �\ • TYPE OF WORI�jcQ . 1 �taPC o PLAN REVIEW ` , � �� Please check all that apply (submit J sets of plans w /items checked belov [3 New construction [�Addition/alteration/�l �t>� \V ❑ Service re feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: � c , .� ■ �� \� where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRO�CION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agriculture 13 and 2- family dwelling ❑ Cornmercial/industrial ❑ Accessory building amps for all other installations. ❑ buildings. ❑ Multi- family 0 Master builder ❑Other: ❑ Fire of 75 KVA or pump. ❑ Emergency larger separately derived sy JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A" "E" `1 -2" °t -3" 100HP or more. occupancy. Job no.: I Job site address: It tJiS S o g94,1 po.e ❑ Six or more residential units. ❑ Recreational vehicle parks. ❑ Health-care facilities. ❑ Supply voltage for more th City/State /ZIP: 'r(IJOA Ok 1 CA C7'3). 3 ❑ Hazardous locations. 600 volts nominal. ❑ Service or feeder 600 amps or more. Suite/bldg./apt. no.: I Project name: FEE SCHEDULE Cross street/directions to job site: Desertptton 1 Qty. 1 Fee. 1 Total � 61761-0t New residential single - or multi - family dwelling unit. �'� p Includes attached garage. Subdivision: I Lot no.: 1 sq. ft or less 168.54 Ea. add'I 500 sq. ft. or portion 33.92 Tax map /parcel no.: Limited energy, residential 75.00 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 i J i N v 1 residential (with above sq. ft.) ( (� (/�� vV V Services or feeders installation, alteration, and/or relocatio 200 amps or less 100.70 1 2 01 amps to 400 amps 133.56 !PROPERTY OWNER ❑TENANT 401 amps to 600 amps 200.34 Name: 1411.X t--C I4 I ` ° 0 QQ , p, � 601 amps to 1,000 amps 301.04 Address: � , Q ) o �j W � bk./ P_e,01.1.32 Over 1,000 amps or volts 552.26 Temporary services or feeders installation, alteration, and City/State /ZIP: t �� 3 relocation r 200 amps or less 59.36 Phone: ( C��1 Q 3 0 I Fax' ( ) 201 amps to 400 amps 125.08 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with above service or feeder fee, 7.42 (ir APPLICANT 1 ❑CONTACT PERSON each branch circuit B. Fee for branch circuits without Business name: service or feeder fee, first I 56.18 branch circuit Contact name: L.0,1,‘. t'r, 1 E ach add'I branch circuit 7 Address: q 1, O'I ' j Ui-) P...�v --� Miscellaneous (service or feeder not included) _ , '' DD Each manufactured or modular 67 84 City/State /ZIP: t 6 i as 3 dwelling, service and/or feeder Phone: ( Reconnect only 67.84 ?j0� �O� �jfl�j3 I Fax: : ( ) 67.84 j pump oe irriga circle E - mail: t - 1 - vt. 0 ) C,..•U rsk.,(- - ' A-C t Sign or outline lighting 67.84 CONTRACTOR Signal circuit(s) or limited - energy panel, alteration, or extension. - - Page 2 Business name: p„,, 9 Sir V 1 C-eS Each additional inspection over allowable in any of the at -} Additional inspection (1 hr min) 66.25/ hr Address: Zgt7 y 7,..4 1 Investigation (1 hr min) 66.25/ hr City/State /ZIP: V kn GO Leaue" W ' l V w, , Industrial plant (1 hr min) 78.18/ lu S 1 $ 1 I F (3t, ,) ` 1 1 —2 O Z Inspections for which no fee is 90.00 / hr Phone: 0 ipp Z specifically listed ('Vz hr min) - e Su rv. Lic.: 23.5 EL ECTRICAL PERMIT FEES CCB Lic.: 0 /.. E lectrical Lic.: (' 5 -� I P S� Subtotal: -32 e Suprv. Electrician signature, required: Plan review (25% of permit fee): q State surcharge (12% of permit fee): Print name: � 9 13 I e x, le___ Date: L I'l4/ l TOTAL PERMIT FEE: it) c permit is not ob withi Authorized signature: This permit application expires if a pe days after it has been accepted as complete. Print name: b S p 4p c...' ` l D ate: 9 /-_- ,, `Q • Num ber of inspections allowed per permit. ra;41. katt V 6.62-i.ck c I zt I t o