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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2009 -00566 IiG ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/27/2009 Parcel: 1S 136CA04600 Jurisdiction: Tigard Site address: 10990 SW 79TH AVE Subdivision: FRIENDLY ACRES Lot: 2 Project: Combs Project Description: Repair grounding on 20A circuit and GFCI protection. Owner: FEES COMBS, TYLER Quantity Description Date Amount 10990 SW 79TH TIGARD, OR 97223 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: EDCO ELECTRIC PO BOX 180 GRAND RONDE, OR 97347 PHONE: 503 - 935 -7434 FAX: Type of Use: SF 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 rdance 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. AT NTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 010 through OAR 952 -':1 -■ 1 % You may obtain a copy of the rules or direct questions to OUNC by calling ye246.6699 or 1.800.33 .2344. Issue By: / ` 4 Permittee Signature = �� rdr 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' i jj/J� Date: LICENSE NO. / 5-SG 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. aCT -23 -2009 02:17 PM DR. TANYA E. CARTER 503 6250425 P.02 iectrical Permit Application 2'a 2.MS I_.( 1 n ■i tt 1 /Sl rt►N14) ?'n + 1 iv µ:1, .. OC 13125 8W Hall Blvd., 'Tigard, OR 9'72 kc �nz l fi ', ` ti !r . � Wi, Jy' , City a}` Tigard ^ 1 1 G1 161\1W Dot e BY DPP a ID /0 45 0 Permit loo OW19 .4 � - 2 l b OI Phone', 5036391171 Fax LDI IDyV1S1 0 ii) ti),t� v lcn a a a as other Permit: 00000 xc E: I i,i;':1 *(i, Inspection Line: 503,639.41 7 5 BU fAae lteadyBY ill: 1000 � ' See Page 2 for Internet; www,tigard- or.gov Notified/Mcthod. 0 0000 �r r SuppltmrentalInfbrmatIon TYPE OF' WORK Print name: 0 ❑0 00 l' . U New CA ISttruction (d ditian/alt cation/replacemesit .. ... - . © ( ether: ❑ n ❑ n n PLAN I&E 1't 111' ❑ Demolition P4:.. 1,...t. ,u AI II :, my ■ .,,11� „1 , wI, , .. I „ ,..,:..- d,, .�: 6.x1 ,.11,-.1,.. ■ CATEGORY OF (.'ONSTRIr(.TION ❑Service or feeder 400 amps or more L fui Iding over three r 1- and 2- family dwelling U Commercial /industrial Ll Accessory budding . where the available fault cwrent Annex. stems : 10,000 amps al 1.50 vette or ❑ 0 ivlulti-filnlilt ❑ Master builder ❑ Other: ❑ ❑ ❑ ❑ ❑ Minima end boars-Mt. a. 1csa to ground, or exceeds 14,000 ❑ Floating buildings. JOB SITE iNFORIII: \TiON .kN D LCx':�Tr( amps for all other ittrtallationw. / - _i,, ❑ Commercial. vse C7 C:l Job nn.: [.l l:J l,:l I Job site address: ❑ ❑ 01 C7 El � 71 � �F n'T' a$riQWlural �` f flatulency system buildings. G City /State/ZIP: 00000 l 72z.3 CT /60 ) ❑ Aklition of new motor load of ❑ Itutallation of 75 KVA 1001-1P or more. or Suite/bldg. /apt.no.: FlpFt11 ❑ Projectnarne: nnnnn �. ❑Six cc more residential unite. Larger xeparntely derived system,: Cross street/directions to job site' 110 0 U 0 0 79-6(/ ❑ Health -care facilities. ❑ "A" E. "1.2” "1 -3" occupancy, 50000 Hazard am location.. [� Recreational vehicle - service or feeder 600 parka. Subdivision: nrlf.]❑❑ 1 Lotno.: UOUJ❑ '°Pscmum. ❑ supply voltage for Tax map/parcel no.: 0 ❑ 0 ❑ n more than 600 volts nominal. nieNCRIPTI()N OF WOR1: 011 0110 G .� Q 2/� _ . �%, FEE SCHEDULE 1 r�/iK tg - /./4( . C ✓ n r( 6 rhxctrntitm 1 err. i Fuc. 1 'Cub,! T -7— C1 Li U IJ ❑ Free oY_frt A 1 New re residential ng e. or multi-family dwelling unit. PROPERTY OWNER I ❑ TENANT ❑ ❑°❑❑ 1,000 sq. R, or leas 0 168.5 0 4 Nane: 00071 Ea. add'1 500 sq. ft. or portion n t l 33.92 ❑ ❑ 0 0 1 A n C1 n ❑ ❑ • - • _ - Limited energy, residential 0 000 0 City /StateJZ1P: [::1 f..i1:1 ri C:I _ (1,1ih above au 11 1 n 67 ❑ 2 Limited energy, multi - family 0 0000 Phone: (0 0 0 0 5)171 :1LIII C1 f Fax: (00000)00000 - treiclenrisliA rh - ola y 67,84 2 a 6) ❑ _ • Owner installation: This installation is being made on properl■ Ihat I own Mitch i9 not 4e» -kes oritoeps ihshdltlttM4 :alteration, and /ar relocation intended fur 8 nlc . leave. rent, iN' exchange, according to ORS 447. 449. 670, ant,' 701, 200 amps or less 0 100.70 0000 2 O vncr signature: Pate: ❑ 0000 4 201 amps to 400 amps ❑ 133,56 2 0 AI'PLi('AN 1 ❑ ('ONT.#(T PERN()N ❑ U ❑ ❑ Business name: El 700 1 401 amps l0 600 amps 0 200.34 i t 2 O Contact name: U 00 ❑ U 601 amps to l ,OflO amps 0 ❑ 301.04 � ❑ ❑ O 2 Address: l01n 0 ' I Over 1,000 am ° snips or volts ° 552.26 n ❑ 0 0 I 2 City/State/ZIP: 00000 Temporary services or feeders instaliaf alteration, and /or ` relocation "s Phone: (UU ❑17❑) 0000❑ `Fax:: (00000) t.)nn0n 200 amps or loss n Cl 59,36 1 ° ° ° 0 1 +� E -mail: ❑❑ ❑U❑ , ., 0 V 0000 t. c)NTR #(TOR 201 s to 400 am 0 125.08 ❑ 2 > Pa 13usinesa name: n El per/" 0 0 n 0 E Cft .. 401 amps to 599 amps 0 ❑ 168.54 n n n 0 2 Address: u U 0 0 U 1 OX /870 Breach cfavmts — new, nitrrot iou. or extension, r neural A- Fee tier Ixanch circuits 11.417 ❑ ❑ fJ f7 City /StatetZrP: n l U fl n �- /� above service or feeder fee, 1 7.42 f7 2 !"1 i /'te7 f (7? each branch eitn<iN 0 Phone: ( ❑ ❑ ❑ ❑ ❑)'Ak eOil_' A ... FaX: (UC1L,I0r1)nn77 n B. Fcc for branch circuits n ° °° • without o..ervice or feeder fee, CCB Lie.: �7^fi . ■ Electrical Lie; U 11 , S t,.ic.: }} rte. ❑ 56.18 ❑ 2 %s t1I1rV. `'III file brrneh circuit Suprv. Electrician signature, required: / Each add branch circuit a Q 7.42 ❑ 0 C7 1-.1 2 ' r - , 1 miscellaneous 1servlt+e or feeder not i neluded) Print mole'. CIO 0 [ 1 R �- L(� Date: I ! , . manufactured or modular 0 0000 F2 Q'e4 k / .r;- A J 67.84 2 Authorized Signature: 40„ dwelling. service and to feetkr ❑ ❑ u u Reconnect only ❑ 67.84 17 2 L 1 :11luildinEAPermils1F1 I.0 •PannitApp.doo 10/01/09 440- 41151(11 /0.9/COM/WP..11 7 ,CT -23 -2009 02:18 PM DR. TANYA E. CARTER 503 6250425 P.O3 Pump or irrigation oirotc C1 ❑ 1 : 1 6 7 , S 4 0000 2 fJ Sign or outline lighting 0 0 67,84 1700L1 2 Signal cirouit(s) or limited - energy panel, alteration, or ❑ fJ ❑ ❑ ❑ extension, Describe 0 Page 2 0 2 C'1❑00IJ Each additional inspection over nllntt'nble in any of tl►r ubo.'e Per inspection 0 rt 66,25 0000 Investigation per hour (1 hr min) 0 7 66.25 ❑ C1 ❑ ❑ • Industrial plant per hour ❑ C7 75.18 C] 0 ❑ n ELECTRICAL PERD[lT FEES Subtotal: 0, 0 Plan review (25%ofpermit Re): C1 .,t 1 Stoic surcharge (12% of pcmnt free): ❑ J 010 TOTAL PERIwtIT FEE: Thu permit npplicatiun expires en permit is not obtained tthln Ito dn ruler It hex been accented ss complete, + Number rf inspections allowed per permit. 111 81Wdir4Permits \BLC 1o/01109