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Permit J r • CITY OF TIGARD ELECTRICAL PERMIT _. ,. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00567 .TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/27/2009 Parcel: 2S101AC00700 Jurisdiction: Tigard Site address: 12700 SW 72ND AVE Subdivision: BEVELAND NO. 2 Lot: 13 Project: Pauley & Rogers Project Description: (2) branch circuits for lunch room addition. Owner: FEES ROGERS, ROY R Quantity Description Date Amount 13690 SW TWELVE OAKS CT TIGARD, OR 97224 2 crt Branch Circuits 10/27/2009 $63.60 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 10/27/2009 $7.63 Electrical Contractor: MOUNTAIN F ENTERPRISES INC 25973 S MOEHNKE LN BEAVERCREEK, OR 97004 PHONE: 503 - 313 -0761 FAX: 503- 632 -5521 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through 0 R 952 - 001 -01 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: B!✓ 6 eel-77 ■i' OWNER INSTALLATION ONLY The installation is being made on property 1 own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 603.639.4176 by 7:00 a.m. for an Inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. • 10/26/2009 09:29 503 - 632 - CEI ]ED ALAN FITCH ELECTRIC PAGE 03/03 • Electrical Permit Application 1 V 1J MI: 1; ( ) l l l ( I I `,t. < ►. i .1 • City of Tigard (if. : T 2 6 1 ! 9 Received h' g Date/13 . !d .2.7 p `i Permit No ' cc ® y -21056 . -- A Phone: 63981171 Tigard, 503.598.960 CITY OF '.. ':: , : � y ew other Penmi Inspection Line: 503.6394175 BUILDIN ''L,'. � eady/ a" u/� � -J . L . h Internet; www.ra.tigard.or.us Notified/Method: suPa Supplemental tal Inlnf oemadou , '' ? ,R sy ';H b tr ,t iLFl • ',Af., F:� r �� '.17f"�jM Y'A 9','fc. LK��V/ (� fi :'m `t a , , � 'I . ' E) O-i1L ,mob Yi. 1 [. N r � ,p. '��,,!y'.� N .J t <'f ` 1 (ri . . ' f fSyU 2 ' � •. t '1. • ft lfif�. . t� , �,� .��f' ..A?I r .' �Lf�1FR��� p. J �, f �I\ �'Y ,�) 7 � Y'���C > Q 'I � \"�' � l .1 _{ • ^ ���':��:�,� �"r.0.�.f:� i.. t`$r ;c fts,- titi+trrn,.fk:�w�f�•;con,N �, ��1w u ❑ New construction E Addition/ alteration /replacement Please check all that apply: ❑ Demolition CI Other: ❑Service over 225 amps, comm'l ❑Hazardous Location , rsysttetyt•, . �, , �t ❑Service over 320 amps - rating ❑Bunting over 10,000 sq. ft., a6r. Q' , �` rr:� thmrtzti'ksak vo ''.,' . ti ` .. • `.' � w ,14i. { "� of I- and 2- family dwellings 4 or more new residential ❑ 1 - and 2 family dwelling V: Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure !]Building over three stories ❑Feeders, 400 amps a< more ❑ Multi family ❑ Master builder ❑ Ofd MyY, :' , , '' . � ti 1 ,, • R , r - t , an r .� l]Occupant load over 99 persons ❑Mann lured structures or , ' 4v . i' a if. ) f e a rr l!. r , er :` .. ,,, �: ,; . r ... :.. �.. • .11 � x+oa'fi, a 1 �1nmPnidcGa�(a, �'fl ! �r : ��d'?� �, • � ❑ Egreas/lightnng plan RV D �p SW 1 Av l- ❑F mit, care, of lay p abo Job no.: Job site address: 1', Submit,/ sets of pl with any of the abovee . City /State/ZIP: Tt eakip pf.... 44213 The above are not licable to temporary en�or y cotrstrudion service. Suite/bldg /apt. no.: Project name: ': '" '.,:, t ' r .. `11 .•,i. ,. `�c ,,' ?': : Pert fpdoo Qtr. Pre. Taal Cross street/directions to job site: g i.. e �l /1 em New residential single- or multi - family dwelling unit. ,Qd, ,d �J ,, �� F Includes attnehed garage. / •7 r^-L y /O 6 1,000 sq. ft. or less 145.15 4 Subdivision: l Lot no.: Ea. add'I 500 sq. ft or portion 33.40 1 ax map/parcel no.: Limited energy, residential 75.00 2 »:`'� a �yy� y wt t��`0 "� tE"" x /x, ,, ��,: Limited energy, non - residential 75.00 2 ', ,tire ki 1t�Ag0 t e. , 7 . RI' ffn `'• err.. 4. r ' &•1 M' •:4, :1 � {,�t� : �l Each manufactured or modular 1 dw dlinp, s vice and/ feed 90.90 2 � _ Services or feeders 1u statlation , alteration, and/or relocation L fsl.�L`r , 2e c, ( 200 nis or less 80.30 2 q �� i Ti a l'i . aw n n . ..x �° , g: , . , , , u e,, $, g a y n it 201 amps to 400 amps 106.85 2 N 401 arms to 600 amps 160,60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Ova 1,000 amps or volts 454.65 2 City/State/ZIP: Reconnect only 66.85 2 Temporary services or feeders installation, alteration, and/or Phone: ( ) Fax ( 200 amps or less 66.85 t 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 133.75 2 Owner signature: , Date: Breach circuits - new, alteration, or eateosloa, per panel v ' ,,,° , s , to vif , .. ,:valq;" ;p; i a` It,��Q� `'pf�s�7 � - m `ai` , Fee for branch circuits wnh . • , 1 � � ,aemnssN RtK' i9a�v,c l ' StTiw1� A Business name: service or feeder foe each branch circuit 6.65 2 B. Fee for branch circuits �� r ge Contact name: without service or feeder fee ,I Address: each i branch circuit / 46.85 2 _ Each add'1 branch circuit / _ 6.65 (t ,( 2 City/State/ZIP: Miscellaneous (service or feeder not incinded) 7 ,2. Phone: ( or irrigation circle 53.40 2 ( ) Fax:: ( ) Sign or outline lighting 53.40 2 E -mail Signal circuit(s) or limited - ,,, 1 \ t 1 < + qar F t ^" "^4 w ar r + r, , " r. energy ti, 1��,i•' : +.frl,1. ;. •I �+�U .t�: t � �} � •,:lit V , a a ;, a e i�;4n1;�� �' ' at � : ��M1p' u� � t 1M s Panel, alteration, or extension, Describe: Page 2 2 Busine3sntutic U87'TP V .1.1j LNG. Vt Al-1R&) f 1Ti-14 c, . _ Address: ' S� - 3 c - , n o �� Each additional inspection over allowable in any of the above t✓ Per inspection 62.50 City /Staie/ZIP: 'Ze G ipe-- • ' i e Investigation per hour (1 hr min) 62.50 Phone: 6 31.5 . Fax: (� ) 3Z 4 ' Industrial plant . hour y 73.73 ■ � � „ �ol�,. ,.i` ^ a.nntC.: Fl�,= ,«Y��a��'.,�RS� 1•i:�i iY >, CCU Lic.: �' j1 062_ Electrical L'c 3.3 g }C Suprv. Lic.: 39-L Subtotal Suprv. Electrici; signature, required:, A- l Plan review (25% of permit fee) 6 3 . ( Print name: 1 1-4"1 t.0 u Date: 10 - 2 o 1 State surcharge f$96rafvermit fee) � ` �Ex Authtuized signature: �_ e: 'TOTAL P n' Fkl ir Ibis permit application erpites if a permit is not o ed within 180 g days after It has been accepted as complete Print name: Date: ' Fee methodology set by Tri- County Building Industry Ser, o rd • • Number of tespectiions moonlit allowed 1a13uilainRTer ,ffiu\eLl}Fazaiv\py.doo tuns ..o-istst+(taroa/coD,vwES 4k9r CITY OF TIGARD BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 ` +N'�'f1411 Inspection Requests (24 Hrs.): (503) 639 -4175 .''ll� INSPECTION WORKSHEET FOR DATE: TIME - . PAGE: SITE ADDRESS: ) � ©D 6-1N / C e i & • CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: £ cLf& D n r© (�� PHONE #: 56 CONTRACTOR: Pcw I 1 Ro t° rs Ct. e Ornp�y PHONE #: 56 3— j-_ O Jri - ®n 0Ornmun J �I ;ed --; X80 Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message Corrections /Comments /Instructions: ,, { V -- Late __ - - 7 t� L 6o(. S 5 3 16 ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: Phone #: (503) 718-