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Permit CITY OF TIGARD ELECTRICAL PERMIT g COMMUNITY DEVELOPMENT Permit #: ELC2009 -00194 Date Issued: 05/05/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S110DD11000 Jurisdiction: Tigard Site address: 15510 SW 109TH AVE Subdivision: SUMMERFIELD NO.13 Lot: 680 Project: Fessler Project Description: Replace 200 amp panel. Owner: FEES FESSLER, MELVIN L & MARGARET J Quantity Description Date Amount 15510 SW 109TH AVE 1 ea Services or Feeders - 200 05/05/2009 $80.30 TIGARD, OR 97224 amps or less PHONE: 3 crt Branch Circuits w /Purchase 05/05/2009 $19.95 Service or Feeder Contractor: 1 ea 12% State Surcharge - 05/05/2009 $12.03 C MILLER ELECTRIC INC Electrical 26670 S HWY 170 CANBY, OR 97013 PHONE: 503 - 651 -1616 FAX: 503 - 651 -2064 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $112.28 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 952:401-0100. 01100.. You y ob copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: x QQ .L ' `- � Q Permittee Signature: 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'N Date: LICENSE NO. 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. s. FRONTEiR MANAGMENT Fax 5034431919 A.r 29 2009 12 :22.m P002 002 • E ecti ieal Permit Application FOR OFFICE I, sL O L's IL City of Tigard aeeeivea APR 3 0 2009 r3ateis Li, 30 .c Permit No.: , lei. -Gale 13125 SW Hal! Blvd., Tigard, OR 97223 Plat Review Phone 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: I. I U_1 F.D Inspection 1-inc: 503.639.4175 CITY OF TI G AR L. Date Ready /By: t Et See Page a for --- Internet: www.tigard -or.gov BUILDING DIVISiC • NoifiedfMethod: � � , Suvvlew�tallettrrmavon 1 J PLAN REVIEW TYPE OF WOIlIC ❑ New construction ddition/alteration/replacement Please cb -ck all that apply (submit sets of plans w /iteme checked below): ❑ Demolition ❑ Other: t D Service or feeder 400 amps or mac 9 Building over three stories. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other Installations. buildings. 4Muiti-family ❑ Master builder © Other: r 0 Fire pump. 0 instanetion of 75 KVA or 0 Emergency system. largo( separately derived system. JOB SITE INpORI4i�TIOlst AND LOCATION ., 0 Addition of new motor load of Job no.: Job `. 1 1 `v.'''/4:‘,/-c, ! OOHP or more. occupancy, ob site address: , -' -' t 0 `_ nJ \ C , ,. -� 0 Six or more residential units. in Recreational vehicle parks. City /State /ZIP: i 0, l>. t rC 4 r tc�2. _ ' - 7 2_,-; ' 01ealth -care facilities. ❑ Supply voltage for more than El Harardo>:s 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: _ fiste:;ptese I 4N• Fez 'rom . New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: i 1,000 sq. ft. or less 145.15 Ea. add'I 500 sq. ft. or portion 33.40 Tax, map/parcel no._ Limited energy, residential DESCRIPTION OF WORK m with above sq. ft. 1111 7500 2 },/ - q f , t �, ra -c Limited energy, multi -family \ residential (with above sq. 19 1 75.00 2 `� Services or feeders installation alteration and/or relocation 200 amps or less Mill 80.30 8M. 30 0 PROPERTY OWNER ---- U. TENANT 201 amps to 400 amps 106,85 IN Name: 401 amps to 600 amps 160.60 601 amps to 1,000 amps 240.60 Address Over 1,000 amps or volts j 454.65 City /State/ZIP: Temporary services or feeders installation, alteration, and /or _.-,. ---- relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 NNW I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I00.30 II intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 — Owner signature: Date: Branch circuits new, alteration, or extension, .cr panel e� APPLICANT A, Fee for branch circuits with , • -- I ❑ COIF CONTACT PERSON • above service or feeder fee, I 6.65 n cis 2 Business name: -'"" each branch circuit B, Fee for branch circuits Contact name: without service or feeder fee, , first branch circuit Address: Each add °I branch circuit II. 6 Ewan Miscellaneous service or feeder not included City /State /ZIP: Each manufactured or modular 90.90 iliii Phone: ( ) Fax :: ( ) dwellin :, service and /or feeder � � Reconnect only 66.85 E-mail: . Pump or irrigation circle l 53.40 . _ CONTRACTOR ,,., Sign or outline lighting 53.40 Business name: C IV, , t ' _-, Signal circuits) or limited- �- 'y � — r I n��' energy panel, alteration, or Address: 9 C , j`_ S a, }, t s_1.. ',7 V extension. Describe: { Page 2 III 2 City/State/ZIP: , ` �,� 7 _ _ . !�� r _ 0 j Each additional inspection over allowable in any of the above Phone: r ! ° r , Per inspection 1 62.50 (bC5) t .. 1 ,p . (, Fax: (�:,,i:1�5) ca,S t � 2 C,G\ -J Investigation per hour (1 hr min) 62.50 CCB Lie.: 101 515 Electrical Lie.: j, l ', Suprv. Lic- d Industrial plant per hour 73.75 St Els trie signatu required: • • - 1 r EL ECTRICAL PERMIT FEES —: ��- �' ..,,� Subtotal:', Z C� Print name: Q,, Date: Plan review (25 °/a of permit fee): • 1 � a � State surcharge (12% of permit fee): ° z .03 Authorized signature: TOTAL PERMIT FEE: f l - -'fig r Print name: Date: This permit application expires if a permit is not obtained within 180 --a___________,- days after it has been accepted as complete. Number of inspections allowed per permit. 1:' uilding \PenninVEL6- PcrnitA.pp.doc 05/23/06 440- 4615T( 1l/OSJCQ54/WEB