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Permit • n CITY OF TIGARD ELECTRICAL PERMIT al COMMUNITY DEVELOPMENT Permit #: ELC2009-00435 Date Issued: 08/21/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: 1S134CCO3200 Jurisdiction: Tigard Site address: 12000 SW 122ND CT Subdivision: YE OLDE WINDMILL Lot: 18 Project: Osbo Project Description: Ground rods. Owner: FEES OSBO, JAN D Quantity Description Date Amount 12000 SW 122ND CT 1 hr Hourly Electrical Rate 08/21/2009 $62.50 TIGARD, OR 97223 1 ea Hourly Electrical 12% 08/21/2009 $7.50 PHONE: 503 - 524 -3505 Surcharge Contractor: MCCOY ELECTRIC CO INC 2014 SE 9TH AVE PORTLAND, OR 97214 PHONE: 503 - 234 -7521 FAX: 503 - 234 -9473 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $70.00 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 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: . L , - 1 /� - 7 — Permittee Signature: ON ,7/©.-% �� r 1 O 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 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. - Aug. 20. 2009 8:51AM McCoy Electric Co. No. 4176 P. 1 E >ICC�r11Ci111 r erlu>I � Iw 11 FOR OFFICE l • . • EIVED 1 leM ;w<d 93.-5 City' of Tigard p ti. Permit No r _ . 2 v 13125 SW Hall Blvd., Tigard, O 97223cc Pl R V i6 ' �— — / 2 Phone; 503,639.4171 Fax: 501 0 2009 bate/By; Other Permit: TIGI\Rll Inspection Line: 503.639.4175 bale Ready/Ey: tarts: El See Page2 far Internet uww.tigard- or "gov CITYOFTIGARD Notified/Method: Air--- Supplemental Information ^.^, - z , + , Z, ' o i Y _ Z �. 91 _� t Ass Sets of lets Wilms 41 ch e cked below): N ❑ New construction .1 Addition/alteration/replacement Please check all that app, (submit 2 p 0 Service or feeder 400 amps or more 0 Building over three stories. ❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards. .. - '74. ` eexooeds 10,000 am sa 150 v olts or ❑ Floating '— � . ,l ¢' 0 �_� _. p buildin r' P 11 1J 1':9 e er gs• `� �" =�••u• '�- J � ' � � •" "'" � less to ound, or exceeds U Commercial agricultural - and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family [] Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or r � a a = 0 Emergency o em. larger separately derived system. '7 °i:. ' ' OBT y - Ui� .�7 ' D AdditionoPnew motor load of D .p., "E", u ., Job no.: !, Job site address:, • , g looxt or more. ocaupaney. 1. ua t.► 10, 1 0 Six or more residential units. D Recreational vehicle packs, ❑ Neal th -care facilities. ❑ Supply voltage for more than D Hazardous locations. 600 volts nominal" Suite/bldg. /apt no.: ° Project name: t ii II 0 Service or de re feer 600 amps or mo job site: - o f " Dccriptioa — Cross street/directions to Q. Pee. Total • New residential single- or multi •family dwelling unit, Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea, add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: t —_ yW - i s -c „ Limited energy, residential -- 75.00 2 • , . � r . t ° ' , ` . i.: . :L.- ;--,, • r 7 ,7,- (with above aq fl Limited energy, multi•family f • 11/1 ID fel residential (with above eq.11) 75.00 2 0 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 l +t r `9 I a s i ` v ; ": ....9.. T b . , `_ 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State/ZIT': Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 • 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits — new, alteration or extension, er pallet Owner signature: Date: q. ,y� �s�. � y +.^� A. Fee for branch circuits with fi . " 1i s 4, 4 . - — Ke 4 , ,-P`t: t f a scrv or f ee d er f ee, *� ' -- ;. 6.65 2 Electric Fee or branch c Business name: McCoy B. Fee for branch circuits I— • Contact nme: Tze!!i without service or feeder fee, 46.85 2 first briuti li ulil6pit Address: same Each add"' branch circuit I 6.65 2 Miscellaneous (service or feeder not included) City/State/ZIP: same Each manufactured or modular - dwelling, service asidfor feeder 90.90 2 Phone: (503) 234 -7521 Fax: : (503) 234 -9473 Reconnect only 66.85 2 E -mail: ksloper®mccoyelectric.com Pump or irrigation circle 53.40 2 lx'i, ` " , . M;M t " �' " , ;' ; t K V „ IT'; Sign or outline lighting 53.40 2 Business name: McCoy Electric Signal circuit(s) or limited energy panel, alteration, or Address: 2014 SE 9 Ave extension. Describe: Page 2 2 City/Statc/ZIP: Portland, Or 97214 Each additional Inspection over allowable In any of the above Per Phone: (503) 234.7521 Fax: (503) 234 - 9473 inspection 62.50 ionper hour (thrmin) 62,50 irw i CCB Lie.: 8277 ✓ Electrical Lie.: 26 •112C Suprv. Lie,: 2175S Industrial plant per ho6r 73.75 S ; Fi V .rtrill.r TIDES Suprv. E lectrician signature, required: , �' Su P e9 h �,, Subtotal: �d SD Plan review (25% of permit fee): Print name. James R. HaII Date: 6 WO State surcharge (12 °rb of permit fee): Authorized signature: TOTAL PERMIT FEE: 9 Q This permit application expires if a permit is not obtalnea within 180 Print name: Date: days after it has been accepted rs completes Number of allowed per permit. r:V 3ulldingwcrniislELC .PemiilApp.doe 05/13!06 460.1615T(I1/OS1COMIWPa