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Permit 11/10/2010 10:31 3608875584 J.C. ELECTRIC, INC. PAGE 01/02 ■ Electrical Permit Application 71" i ..fi , r i FOR OhhIcL LSE ONLY ,. ; �.. F g . / / /b /a � " • eaeivea • City of Tigard D ate/By: / f / / 4 , e ` ✓ Permit No. Leo /D —00 y3_ d ■ 1 3125 S h all Blvd,, Tigar: °R/e224) R 722 NO V 1 0 Plan Review 7 1 2 Q 0 remit: Phone: 503.718.2439 Pax: 503.598.1960 Date/$v: Other Pe Inspection line: 503.639.4175 Date Radyy: /B JUIj e 2 for Se rag TI GAR ly CITY OF TIGA blotifedMlethod: — ' 1 1 I Supplemental Inforwation Internet: www,tigard-or.gov f y u 4r t lrfr xl r i ¢r r n m v, v ` ; I n i t{� : r , I F (' ! V t� } I n j 1 tl ; , 4 6 i i ! �f . ', `B l ? l Bair 1 . , t1thil; .a Hit ll : „ :. �� . 1 � , �I i�I .." is 1 libif l i " ❑ New construction ® Addition/alteration/replacement Please check all that apply (submit Z set$ of plus w /items checked below): ❑ Service or feeder 400 amps or more El Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. Milt 1 i r alur7mNir ,i nls Mille +. g t n+r ai + , 'm r gr i f` � }f exceeds 10 000 ams at ]00 volts or , p ❑ Floata buildings g . ' ;;l fR f 1 ( srrh ritIlf' Litt ih�!rm} 'lie t�i tflr�ll ii}Fti:r f Li J!'t W � l ess t o groun or exceeds 1 ❑ Commercial -use agricultural ❑ I- and 2- family dwelling g. Commercial/industrial 0 Accessory building amp for all other installations. buildings. ❑ Multifamily ❑ Master builder ❑ Other: © Fire pump. ❑ Installation of 75 KVA or f ii+31 i r TV °'nm i1 J `' r ' ■ l `. fl 161 n i l l ; I i t Q 1 9 [ 1 ■ l , r {, "' ❑Emergency system. larger separately derived system. (¢� i , 3 1 ! , l i lug; � r r l ii i m l i i 4 1 i h i L i s r f u l , I tl #136 hL•.', # l ltiem�r it ii ! , _I' 1 , i 1 E 1 l ' 1 ❑ Addition of new mot r load of EJ " A E , "1 -2" "1 -3 ". 100HP or more. Recreation. Job no.: Job site address: 11634 PACIFIC HWY ❑ Sir or more residential units. ❑ Recreational vehicle parks. City /Statc /ZIP: TICARD OR 97223 l: Health - care facilities. ❑ Supply voltage for more than ❑ 1tazardous locations. 600 vita nominal. Suite/bldg. /apt. no.: Project name_ SUBWAY 0 Service or feeder 600 amps or more. ` ��E. " " iligl Olt 1 , l un rn lUtt tlMEN1 B ' Cross street/directions to job site: NEAR 72 & HWY 99W nwcri Aim � To et " New residential sing or multi - family dwelling unit. • • Includes attached garage, Subdivision: Lot no.: 1,000 sq. ft. or less 168. 4 Ea. add'} 500 sq, 8. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential �i ;'i�l IBl i2,11: f� jIB TEE i` , p '>t' rya` � ' '}fit ) lL }.. 11 . ft. 75.00 2 { ; �@ with above . 16'liilf , I'! � 1( }1 ; EE r,Eu�rt 117 ro' +tntu 22 3470ti itti_�tn�1 14(!8 i, t i4i11141. tall 111 IP li l; II�fA Limited energy, Inuit - family 75 00 2 ADD CRJSTMMIAS LIGHT OUTLET residential (with above . • . ft. H w - Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 �( ',0' Y'i , , sly n u t j 1, �( �#I•} ( j' 201 antes to 400 amps 133.56 2 Ulf i,(:`i ¢ i l lrlTIMEE IIIIM t'U ENIV J srr>�t lE # 1 tit' lltatllli i 401 amps to 600 amps ill 203.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 ' Temporary services or feeders installation, alteration, and/or City/ State/ZIP: relocaliou __, Ph one: ( ) Fax: ( ) 200 amps or less 59 1 201 antes to 400 snips 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 2 intended for sale lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Bianchi circuits -new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with 1 r11�}pppt • ' pr, 1 i �r �llyytj�: 'n. p : aa l ; . ° n ' j )k ij;�J1 }1 li} }yr 1 • {( y�p� �Hp -4,s , , , "(T tiiil ;y{ above service Or feeder fee, • . 1 } f F lUth � , y iF�.tlig afi 1l1 {F� k t .fai111 111[ ll. t lSk a tFt i liffll l `; above rvi circuit 7.42 2 )3usincss name: B. Fee for branch circuits without service or feeder fee, first 1 56.18 5618 2 Contact name: branch circuit , , — — Each add'I branch circuit 7.42 2 Address: ' Miscellaneous (service or feeder not included) Each manufactured or modular �— City /State/ZIP: , dwelling, service and/or feeder • _ 67.84 2 Phone: ( ) Fat;:: ( ) 5 eormec:t only 67.84 2 Pump or irrigation circle 67.84 '2 E-mail: lj$f 1tytnlmY2f fn�IiJFgrtIUJ �I (4111 l6 3ttyprtinrt1 fFinf ttyN,�I�{(ggt1 Sig nor outline lighting 67.84 2 ! 1 1111 tit} Iji ,' 1 t i }tie.alUN flHrJttNlr„':lii'� � �t. tieF i 1111111 ' i. 1 8' li III 'r .' }illtbrtltlil lililiEl aFtillig Signal circuit(s) or limital-energy - Business name! JC ELECTRIC, INC. pane alteration, or ex -tension. Page 2 2 M Each additional inspecfion over allowable in any of the above Address: 118 NW 184 ST Additional inspection (1 hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City/State /ZIP: RIDGEFIELD, WA 98642 - industrial plait (1 hr min) 78.18/ hr • Phone: (360) 887.7889 Fax: (360) 887.5584 inspections for which no fee is 90.001 hr s • cificall listed hi lir min t � , CC13 Lic.: 118452 Electrical Li 37 -724C Supi ' S t l b ' Ns 7i+ , llr n." `�r�i I� I o y/ r— Subtotal: 56.18 Suprv. Electrician signature, required: . µ Plan review (25% of permit fee : Print name: JON COULIMOR8 ! , . 11.10.10 State surcharge (12% Of permit fee): 6.74 / r TOTAL PERMIT FEE: 62.92 Authorized signature: - Thin permit application expires if a permit Is not obtained within 180 days after it has been accepted as complete. Print name: JON CO L LIMORE Date: 11.10.10 t = hl„ tit of inspections allowed per permit. r :t9oi,,,„0.crmita.c_Nrmi,ApIdde nil/ 0 4 --i 1 LL . 10 1 D .40- 4015T(ivo5 /COhf/wEE