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Permit P CITY OF TIGARD ELECTRICAL PERMIT 1111 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00182 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/07/2011 Parcel: 2S 111 ACO2300 Jurisdiction: Tigard Site address: 9170 SW PINEBROOK ST Project: NEWCOMB Subdivision: PINEBROOK TERRACE Lot: 64 Project Description: Panel replacement. Contractor: CHERRY CITY ELECTRIC Owner: NEWCOMB, WAYNE E 1596 22ND ST SE 9170 SW PINEBROOK DR SALEM, OR 97302 TIGARD, OR 97224 PHONE: 503 - 566 -5600 PHONE: FAX: 503 - 540 -8147 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 04/07/2011 $100.70 Specifics: amps or less 15 crt Branch Circuits w /Purchase 04/07/2011 $111.30 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 04/07/2011 $25.44 Electrical Type of Const: Occupancy Grp: Total $237.44 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OA 2- 001 -0090. You may o of the . -s or di t questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / 1 Issued By: _ , Permittee Signature: I / OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. G1 V 3D Electrical Permit Application RECEIVED FOR WTI( l(. L USE ONLI III City of Tigard P; ° +' Received a �� �� . a -- S")% Permit Tr o.: ":"--71--C_ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.59$.1 Date)B . Other Permit: Ins ection L ine: 503, 639,4175 TY OF TIGARD >5ate Ready/13y. /,3 luris: ®see e 2 for llicAlcn p y y ¢ Internet: www.tigard - or.gov 131111,[)JNG DIVJSJW: Notified/Method: _ , Supplemental Information TYPE OF WORK I PLAN ))�Y1 W ❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): © Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or Q Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all ocher installations. buildings. Multi family ❑Master builder ❑Other; ❑Fire pump. ❑ Installation of 75 KVAor JOB SITE INFORMATION AND LOCATION ❑ Emergency system, larger separately derived system. ❑ Addition of new motor load of ❑ "A" "E" "1 - l" "1 Job no.: Job site address: r t 100HP or more. occupancy. • v—c) I b I 13 Six or more residential units. ❑ Recreational vehicle packs. City /State/ZIP: l 0 a facilities. ❑ Supply voltage for more than �Q 1� 1 f ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt, no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE . Cross street/directions to job site: veseriptioe I Qty. I Pee I ratan I New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less . _ 168 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map/parcel no.: Limited energy, residential 75,00 2 DESCRIrPTION OF WORK (with above sq. ft.) 5 C� / Limited energy, multi - family Q Alt . { �„` . a/_ .11±, ` �J �-+l Ir residential ( with above s ft. 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less I 100.70 I Q() 710 2 ❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 4 133.56 2 Flatus: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City /State /ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) 1 Fax; ( ) 200 amps or less 59.36 ! Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel A, Fee for branch circuits with Li APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 "42 l 1 t I n 2 each branch circuit t , 0 Business name: e F leufr, t c. B. Fee for branch circuits without ( ` A 1 service or feeder fee, first 56.18 2 Contact name; 1 c i fy ,?'1 b S l r e + y branch circuit . -- - - . y 1 -_ ll l ► , , 7t Each add'l branch circuit 7.42 2 Address: • rLr YiSt Miscellaneous (set-vice or feeder not included) _ 1 Each manufactured nr modular City /State/ZIP: SI) • AI q "7 • dwellii . service and/or feeder 67.84 2 Phone: 5 ,.-5(400 Fax' : 5)rlatJ "AILI7 Reconnect only 67.84 2 E-mail: t~ • Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 — CONTRA : li ., Signal circuit(s) or limited- energy Business name , , - • ; . E - panel, alteration, or extension. Page 2 2 Each additional ins 'action over allowable in an ' of the above Address: 5 •• Additional inspection (1 hr min) 66.25/ lu City /State /ZIP: . ,e • i C� —1 • Investigation (1 hr min) 66.25/ h . • Ildustrial plant (1 hr min) 78.18/ hr Phone: 63) _ -.40 Fax: (5o3 ) 5 ! ,_ : ( 7 Inspections fo whi no fee is v CCB I iC.' s e cifica y listed ('h hr min) 90.40 / hr :Electri c. 1c.: .,_91 S * •/ b - —. . • . *LEC1<RICAL PERMIT.,FEES .. • • p signature, �� 11/4 Subtotal: BI Z �a Su rv, Electrician si ature r ante r —.✓ • _ Plan review (25% of permit fee): Print name: " 1 • Date: State surcharge (12% of permit fee): ..s ' L 111 i Authorized Signature � - �� ��++►► _ ' �71.. Z !� TOTAL PERMIT PEE: X37 it! �' r. This permit application expires if a permit is not obtained within I days after it bes been accepted as complete. Print name: Date: . Number of inspections allowed per permit. 1 uilding \Permits1ELC.Permle4pp,dac 07/01/10 440-0615T(r /c0m/wze.