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Permit 111111 CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2009 -00159 Date Issued: 04/13/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103BB03600 Jurisdiction: Tigard Site address: 12173 SW 125TH AVE Subdivision: BROOKWAY Lot: 36 Project: Malik Project Description: Service change Owner: FEES MALIK, LESLIE MARIE Quantity Description Date Amount 12173 SW 125TH AVE 1 ea Services or Feeders - 200 04/13/2009 $80.30 TIGARD, OR 97224 amps or less PHONE: 1 ea 12% State Surcharge - 04/13/2009 $11.23 Electrical Contractor: 2 crt Branch Circuits w /Purchase 04/13/2009 $13.30 MIKE'S ELECTRIC Service or Feeder 11070 SW ALLEN BLVD BEAVERTON, OR 97005 PHONE: 503 - 649 -6991 FAX: 503- 641 -1902 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $104.83 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 ace, 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: Ore n re uires you to follow the rules adopted by the Oregon Utility Not Center. Those rules are set forth in OAR 952 -0 -0010 throu h OAR 9 -OQ1 -0 . You may obtain a copy of the rules or direct questions to OUNC by - i .! 4.6699 or 1.800.332.2 •4. / Is uedBy: \1 �/(/�/t- na — c — PermitteeSign• - - —' �..�:� / • / 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 7 l= • Date: i rmQ LICENSE NO. O 5 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. yr: MIKE'S ELECTRIC; 591 7847; Apr -8 -09 7:48; Page 1/2 1o: TiGARD At: 5035981960 Electrical Permit Api C licat' 1, � O volt (11/1'lc'1: 1 sh: 1);\ 11 City of Tigard Ci �� ;� h 13125 S W Hall Blvd., Tigard, OR 1 7 23 Q 1' JS_i pate Review ' D f S( Pormit Nu.: E —�/ ' Phone: 503.639.4171 Fax: 503.598,19 9. D LO T1 .!<! Inspection Line; 503.639.4173 O D Re , _ ... Other Permit: D oti Re fM mhc 1 , me....; ® See Peltc 2 for t: www.ligan! or.gnv 01G 1 Notifl mc ' O " ^,,1 SYpptlmmblteirmali0e Inte rne TYPE Old W 1S ` 1:1 Ne s construction 0 Addition /aitcr a replacement Please check all that apply (submit 1 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three acmes © De nUlilinn ❑Other: • where the available fault currant 0 Marinas and boatyards CAT tSlltl' ^ ,' o n exceeds I0 000 tamps at 150 votes or ❑Floating buildings. Iii dwelling ❑Commercial /industrial ksstogrouud,orexceeds 74,000 ❑Commercial - use agricultural I - Ind 2-tamily ❑ Accessory bt Ilding amps for all other installations etstatlazions. buildings. ❑ Mtltl- family _ ❑ Master builder ❑ Other: ❑ Fare pump. [] Installation of 75 KVA or 26223 Job add iuN ❑ Eleeritency " larger separately derived 'yetem 0 " A" .401i; CFf 1L .. ❑ Addirion of new motor lead of "F ", •9 -2",1 b -3 Jolt " ; address: 12173 SW i, 25th Ave. 100HP or more. occupancy ❑ Six or more residential tails. ❑ Reematiumr) vehicle parks C'it1 /tiu1C%LIh: Tigard, OR 97223 ❑Neatth -care faailitics. ❑ Supply voltage for more than -" ❑ Hazardous locations. 600 volts nominal. Suite /111dg, /apt. no.: Project name: I/1 ct `' 0 Ssrvtceorreeder 600 amps or Owe. Cross erect /dire! toms to job site: 1 11 t r :; 1 : u "` Z ,. . .. Description Fee, Total • _ New residential single- or multi - family d unit_ m Includes attached garage, Subdiv'sion: I,UW s Lot rm.: q• ft, or less 1 45.15 4 �.. Ea. add'I 500 sq. ft. or portion 3 p p nu.: 33.40 1 Tax rasp/parcel - -.— .., DESU1IP'fION .O r yyO TE ; : . . ', ;,: ,, ! . '' t ,whh above ay. 0) residential 75.0(1 — Limited Limited energy, multi - family T Se -vice change 7500 2 residential (with above mi. il,) Services or feeder* installation, alteration, a nd/o r relo " 200 amps or less 1 R0.30 ,$0.30 2 ❑ PROPERTY OWNER ., :;;.. , N :7 a8 1 201 amps to 400 amps 10665 2 Name; Andrew O'Neil 401 am to 6DD amps 1 60,60 2 _ amps Addres ?: 12173 SW 125th Ave. 601 amps to 1,000 amps 240.60 2 --- t7ver 1,000 amps Or volts 454.65 2 City /Stite/ZIP: Tigard, OR 97223 Temporary services or feeders inatattallon, alteration, attd/ur" H relocation Phone: 503 1747.9430 Fax: ( ) 200 amps or less 66.85 t Owner installation: This installation is being made on property that i own vnich is not 201 amps to 400 amps 100.30 2 intendet far sale. lease, rent. or exchange, according to ORS 447, 449, 670, acrd 701. 401 amps to 509 amps 133.75 2 Owner : ignah7rc: „„ hate: Branch circuits- new, alteration, or extension, p,r panel F for branch circ 1 Pi,1i oils wlrh A1 :.qeo!` �7 ,. - "' a service or feed ee '` ;, 2 6.65 1 Business name: each branch circuit 3.30 2 B. Fee for branch circuit —" Contact name: without service Or feeder fee, 46.85 2 first branch circuit Address Y Each add'I branch circuit 6.65 2 _Miscellaneous (service or feeder not included) .� City/Sta /Sts a /ZIP: s Each manufactured Or modular 90.90 2 dwelling. Phone: ( ) Fax :: ( ) g, service and/or feeder 2 E-mail: _, Reconnect only 66.85 Pump or irrigation circle 53.40 2 .. r,$xr' ...... v l r / .r e,* l i Sign or outline lighting 5340 2 Business name; JD Miller Construction DBA Mike's Electric Signal circuit( Of limited- • energy panel, , a al lteration, or Address 11070 SW Allen Blvd. extension. Describe: P age 2 2 City /Stale /ZIP: Beaverton, OR 97005 - Each additional inspection over allowable In am of the above y Phone: (li 03) 649,6991 I Fax: (503) 641.1902 _ Per iita 62.50 — - i Investigbliun per tutor ( 1 hr min) 62.50 CCB 1,1c.: 0511209_ Electrical Lic.: 34 -I8C ^ Suprv. Lic.: 4230S Industrial plant per hour 3.75 1$• -7 I .1 a 7 Suprv. E ectrician signature, required: Jd,' ;')'.."..1... ' ° "i4 .z+,. ....i� ; - -- . ::; Subtotal: 93.60 Print nave: Douglas J. Miller Date: 04 Plan review (25% permit ti e): // ��� , d --� ..... State surcharge (12% of permit - Authnri signatwe :� � +J ��t� 4`G � -- - TOTAL PERMIT FEE: 104.8,3 Print Ilene; � ..L/ . ��- m ate: I This Permit application aspires lien permit Is not obtained within 1*0 J days after It has been accepted as complete. I Vtuildigp ,,,iu�Rl.C- PermllApV.Ouc 05/23/f4 • Number of inapeci ions allowed per permit. C46 45 15T1 i /05/COMAVFN