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Permit CITY OF TIGARD ftEVISED ELECTRICAL PERMIT r/zs/ Z. a : COMMUNITY DEVELOPMENT Permit #: ELC2011 -00204 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2011 Parcel: 1 S 136AB05200 Jurisdiction: Tigard Site address: 10340 SW 72ND AVE Project: OULLETTE Subdivision: PP1993 -089 Lot: 1 Project Description: Panel replacement. 9/25/2012: REPRINT permit to add (2) branch circuits for NC and furnace reconnect. Contractor: TDS ELECTRICAL CONTRS. Owner: OULLETTE, JACOB D PO BOX 1521 10340 SW 72ND AVE CLACKAMAS, OR 97015 TIGARD, OR 97223 PHONE: 503 - 710 -0866 PHONE: FAX: 503 - 698 -4519 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 04/20/2011 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 04/20/2011 $12.08 Type of Use: SF Electrical Class of Work: ALT 2 crt Branch Circuits w /Purchase 09/25/2012 $14.84 Service or Feeder Type of Const: 0 ea 12% State Surcharge - 09/25/2012 $1.78 Occupancy Grp: Electrical Total $129.40 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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: 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: % 0 I3ACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' / ' J Date: 7. 2 ST l Z LICENSE NO. S 3 5 / ._ f 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. •i CITY OF TIGARD ELECTRICAL PERMIT ° . COMMUNITY DEVELOPMENT Permit #: ELC2011 -00204 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2011 Parcel: 1 S136AB05200 Jurisdiction: Tigard Site address: 10340 SW 72ND AVE Project: OULLETTE Subdivision: PP1993 -089 Lot: 1 Project Description: Panel replacement. Contractor: TDS ELECTRICAL CONTRS. Owner: OULLETTE, JACOB D PO BOX 1521 10340 SW 72ND AVE CLACKAMAS, OR 97015 TIGARD, OR 97223 PHONE: 503 - 710 -0866 PHONE: FAX: 503 - 698 -4519 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 04/20/2011 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 04/20/2011 $12.08 Type of Use: SF Electrical 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 •..pen. •` for more the 180 days. ATTENTION: Oregon law requires you to follow the rr teted by the Oregon Utility Notification enter. Thos- • e 4 0: 4 r set orth in OAR 952- 001 -0010 through • •:52- 001 -0090. You ma o. •'• = � TT+nrlri •uestions to OUNC by calling 503. .1987 or 1.80. 23;c Issued By: _ — �i 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' 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. Electrical Permit Application Received ltR 01,1.1( I( l I'Nl. ()NI.) City of Tigard Date/13 : L� ` Perm No.. J: _ �pDv zT .1111 : " 13125 SW Hall Blvd., Tiga .6 r 7 Plan Review ��� Phone: 503.718.2439 F .5 960 �4�� Date/By: Other Permit: 1 I �r A h L) Inspection Line: 503.639.41 4% O Date Ready/13y: H See Page 2 for Internet: www.tigard- or.gov PQ� p � -\\ !� ?` \^ Notif k? Supplemental Information TYPE OF W \ ` (° � v PLAN REVIEW CI New construction ® Addition/altc d pi iacement Please check all that apply (submit 2 sets of plans w /items checked below): ti ❑ Demolition ID Other: ❑ Service or feeder 400 amps or more El Building over three stones. where the available fault current ❑ 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. El Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 °, "1 -3 ", od 100HP or more. occupancy. Job no.: Job site address: 10340 SW 72 Ave ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: Tigard Or. 97223 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. Cross street/directions to job site: Mapleleaf nes� uan FEE SCHEDULE Q t y . I � P P I Qty. I Fee. I Total I New residential single- or multi -family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft, or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi- family 75.00 2 New 200amp service, transfer existing circuits to old panel location. residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less X 100.70 100.7 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: Jake Oullette 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: 10340 SW 72" Ave Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State/ZIP: Tigard Or. 97223 relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits — new, alteration, or extension, der panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2 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'l branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City /Statel7.TP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: TDS Electrical Construction INC panel alteration or extension Page 2 2 Each additional inspection over allowable in any of the above Address: PO BOX 1521 Additional inspection (1 hr min) 66.25/ hr City /State/ZIP: Clackamas Or 97015 Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: (503) 710.0866 Fax: (503) 698.7519 Inspections for which no fee is 90,00! hr specifically listed (V4 hr min) CCB Lie.: 170L193 L Electrical Lic.: C -164 4 Su • .. Lie.: 5351S ELECTRICAL PERMIT FEES ,� 5f ��i /UU 7 _ O Suprv. Electrician signature, required: A. , Plan review (25% of permit fee): — Print name: Trevor Schweitzer 4/20/11 State surcharge (12% of permit fee): 10 v r TOTAL PERMIT FEE: t. J / /a, 7 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: * Number of inspections allowed per permit. Electrical Permit Applicati,�EIVE Q FOR OFFICE' USE ONLY ' , City of Tigard t DateBBy: I A -. 7 A .. ,1,11, Permit No.& a(! /J— .00 �O y 13125 SW Hall Blvd., Tigard,OR 97 2 5 2012 Plan Review .11 q l 0 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: T I G R t) Inspection Line: 503.639.4175 CITY OFTIGARD Date Ready/By: iuris: El See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: 77■ Supplemental Information TYPE OF WORK . PLAN REVIEW ❑ New construction rqi 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 ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural c -4_ and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: • loollP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ 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: Description I Qty. I Fee. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential - DESCRIPTION OF WORK. (with above sq. ft..). • 75.00 2 A Limited energy, multi - family 4AL s 7V Ex /S77 7C--- ,O J7 /'1 /T A /& �/ (with sq. ) 75.00 2 residential with above s R. Services or feeders installation, alteration, and/or relocation (A vv. 0‘ C Z ae C. uti\V,,« ` /' 2 ) eige-U i 7i 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: j A ` 601 amps to 1,000 amps 301.04 2 Address: t 0 3 L` 0 7 2 t2 4 /1- A; Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with above service or feeder fee, ❑ AP I ❑ CONTACT PERSON each branch circuit 7.42 2 Business name: B. Fee for branch circuits without r service or feeder fee, first 56.18 2 Contact name: l branch circuit Each add'I branch circuit - 2.---- - - 7.42 2 Address: I Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax:: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 ' CONTRACTOR . , , . Signal circuit(s) or limited- energy Business name: '"\--- S n C. \ ` C 0 J - ) S \ panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: p C ) e (7 \s \ Additional inspection (1 hr min) 66.25/ hr Ci City/State/ZIP: n C Investigation (1 hr min) 66.25/ hr ty C � \ac \(c, J .� C 0 R c i 7 0 k" Industrial plant (1 hr min) 78.18/ hr / Phone: (5 O J) ) / Q , 0 a , (c, Fax: ( ) Inspections for which no fee is specifically listed (%3 hr min) 90.00 / hr CCB Lic.: (¢j v--/ 01 Electrical Lic.: C 1 y Su t rv. Lic.: > 7 S' f _ S ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: 1 Subtotal: �L. Plan review (25% of permit fee): Print name: i ��U S r✓\J\,w Q\ Date: 1,-2 S"-12 State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. I:\Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(11/05 /COM/WEB Electrical Permit Application - "City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: - Fee for all residential systems combined .. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORKONLY , ` ' � Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1: \ Building \Permits\ELC- PermitApp.doc 07/01/10