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Permit " CITY OF TIGARD ELECTRICAL PERMIT `° - a COMMUNITY DEVELOPMENT Permit #: ELC2010 -00575 TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/19/2010 Parcel: 1S136CB00226 Jurisdiction: Tigard Site address: 8120 SW THORN ST Subdivision: SHANNONDOW Lot: 25 Project: Schultz Project Description: (1) 200 amp service panel change Owner: FEES SCHULZ, LINDA Quantity Description Date Amount 19105 NE HWY240 NEWBERG, OR 97132 1 ea Services or Feeders - 200 10/19/2010 $100.70 amps or less PHONE: 1 ea 12% State Surcharge - 10/19/2010 $12.08 Electrical Contractor: WEST SIDE ELECTRIC CO INC 1834 SE 8TH AVE PORTLAND, OR 97214 PHONE: 503 -231 -1548 FAX: 503 - 736 -0677 Type of Use: SF 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 copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: /�� / Permittee Signature: V % L ,Z—/ (f77a 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 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. Oct 15 2010 1 1 : 20AM West S i d/ it i c 503- 736 -0656 p.2 c(CC '4:\Z■ -4 Electrical Permit Applicatio 0 0 ' ti - S) l a n : , )t i it I , ,, W City of Tig � `� � � rj k ° / Other Permit: lI/1 /a , . • Nu: O1/ — 1 ho : 503.639.4171 F 503598196 S 50 Hall Blvd, Tigard OR 97223 ^ 1 A , �j\ p) R 0 • • • _ t+ Phone: ..t� ©��V Date/B . Y inspection Line: 503.639.4175 t��� Date Ready/By: Jan� /7 �/ 0 S. page 3 for Internet: www.tigard- or.gov Notified/Method: " / 1 I (.2 Sapplemmtal Information ' ;-'-',L.m2 � . -,� ;: »:..�xu Xyir.lc:tY y?=tx•?�5?e! Alrfil 'i;4�.;:li .s5; - µ • x : ,,4..::. " F '1 :'S'k "�r.IEFri w nips?, 1.. .i _•{,;, •(.. me. .� .. ._... 4' rp t+!d �' ,r - .m .:>+' " Yc`•r'.i i;. :3 ..... .;..& • t, .x•c .':k.:. ys .:,. •.l,f {.I:• w• cur_. !"9, �? : � .s. Y� i.:t,.'- ❑ New construction IX Addition/alteration /replacement please check all thatapply (submit Lae ts of plans wfitems checked below ): ' ❑ fe Service or eder 400 amps or more 0 Building over three stories ❑ Demolition 0 Other Floating the available fault current 0 Marinas and boatyards. ? i v: - ,er..r., ?' ;;;. f - i?�ti' '�' xr �'v?`ti: exceeds 10. temp at volts or [] oat buildings .. .. = ._. M _ �" ?; y% �") w:;:,rM%f } ?: i t 000 amps 150 l m8 gf l- and 2-famil dwellin lass to ground, or exceeds 14,000 I:Com:neacid - use agricultural y g ❑Commercial/industrial ❑ amps for [di other installations. buildings. • ' ❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump 0 installation of 75 KVA or • >.+ fF , .a..:,: ^ ,j:�F4 tl vy ' ° = ' a n t'; :: = -:' 0 Emergency system. larger separately derived system. • w•,g' ..so...:4i.»'� t -'` y ci s r �t■ a 6 . `,^ly;l° x r s av,.., 'ij , i , � ❑ Add of new motor load of ❑ "A ", "E "1.2" "1 - 3" � Job no.: J'5 73 Job site address: Z U .Sea T6t 0rs7 71: 100HP or more. ,, /j /, ❑ occupancy. Six or more residential units. 0 Recreational vehicle parks ty / , ''fir dt 7 ??2_3 ❑ Hea care facilities. facilities. os ❑ Supply voltage for more than • Ci /State/ZIP: r - , lil, v //G � O Hasardous locations. 600 volts nominal. no.: Project name: ..80/142 L /! � l ` _ ._ 't / ❑ Service or feeder 600 amps or mare. aay,r��e,qq. ' ' r"is ' , ' 1,!. „ ,,'0.4. S� :u� pry" F` `? Cross street/directions to job site: .l nni; ET::1:x`1g.1 ai= `I �a nes Total New residential single or multi- fatntily dwelling unit Includes sttaebed garage. • Subdivision: I Lot no.: 1,000 sq. ft or Ices .- 168.54 4 Tax map/pax el no.: Ea add'I 500 sq. R or portion 33.92 1 F _ _ , ct,. Limited energy, residential 4 aTxt ;;7 1?t1M �1; ,1<. _ '?:ifti: % 'r k; :,.; :. f M,]:.^: :g::,r;j?'• 75.00 2 c `!4 = �a TrNtiCi[?iift,t r ; ,;t `,,' (with above R .�:... ; . � : , -es v- :mr t is 1 . ):"' . .. : ^YC'7.rw • . �' ) Lim ited energy, multi -family • Alta / e / residential (with above sq. ft) 75.00 2 Services or reedsn installation, alteration, and/or relocation 200 amps or less / 100.70 /( )!u 2 • s ` .,r' :t +%. . :• ;', �.•F .i.k:. : « :I . '7 ..-:. .Z... s�. � �+ ;'. Y.r. * :rr,.....: +�m ': ,'. � • . > �� 201 amps to 400 amps 13356 2 ..G- / � / w, ;' .,, . Name: S C ff e l- 7 Z , L V 'J - 401 amps to 600 amps 00.34 2 201 601 amps to 1,000 amps 3 A4 2 Address: /9 /()S �E /�� � / Z Ya Over 1.000 amps or volts 552.26 2 / Temporary services or feeders installation, alteration, and/or City/State2lP: Af ELt) & r 66 7/3,2, relocation ( Phone: ( ) Fax: t ) 200 amps or Less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property th 1 ow n which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701_ 40! amps to 599 amps 168.54 2 • Branch circuits - new, alteredon, or extension, per panel Owner signature: Date: A. Fee for branch circuits wfh F P > r l t `mss :;• rt DV 5 •r= _� above service or feeder fee, 7.42 7 . :. each branch circuit Business name: B. Fee for branch circuits without service or feeder fee. first 56.18 2 Contact name: branch circuit Each add' I branch circuit 1 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: /State2IP: Each manufactured or modular 67.84 2 lY dwelling, service elling svice and/or feeder Phone: ( ) I Fax: : ( ) Reconnect only 67.114 2 Pump or irrigation circle 67.84 2 Email: .y.: ,:.X_t,,.,,::�w>tc,. Signoroutlitreligh lighting _ 67.84 2 F +1e r J:. s . ry ; .x.i; : r.� M g ; :,: _, } . .. Nut ;o cr ' •'':" �!s:;.: •a•` ail: t 5 i'y_ _,.:;a,ae . � _ • _• • •r,: _ ;)' ._.� _t ..r'� ... ,.,r . ,._'�.:�.•,.. `�. �I: ,.......... , �:::�:, ;.��== ;:: ;c, 'n;;,.c.. Signal circuit(s) or 6mited- energy Business name: West Side Electric CO. , Inc. panel, afuration,orextension. Page 2 Each additional inspection over allowable in a of the above Address: 1834 SE Sth Ave. Additional inspection (1 hr min) 66.25/hr City/StaterZIP: Portland /OR/97214 Invest gatiott(I hr min) 191 hr Industrial plats 78 (1 hr min) T8.18r hr ■ • (5 0 3) 2 31 - 154 8 I Fax: (5 0 3) 736 Inspections for which no fee is 90.00/ hr specifically listed (% br min) CB Lic.: 13306 Electrical Lic. 26 Suprv. Lie.: 4654-S ' `' *„' ::. K "'t , ., ,';'f- •r ._ T r• •' 1 . 1 Suprv. Electrician signature, required: �. /� Plan review (2596 ofpermb : I�f= Print name: Randal l F Roberts Date: /4//51/0 State surcharge (12% of permit fee): /g �f' TOTAL PERMIT FEE: J/ Authorized signature: The , 7 ' permit application expires On permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. Number of inspections allowed per permit. ✓ • 1l9wlanotTeraut FLC- PennitApp.doc 07/01tlo 440-4615ryII/CS/COM/WF.B