Permit d ., , CITY OF TIGARD ELECTRICAL PERMIT
-_
'.! C COMMUNITY DEVELOPMENT Permit #: ELC201 1 -0041 0
T1GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/22/2011
Parcel: 2S111CA11300
Jurisdiction: Tigard
Site address: 9521 SW LAKESIDE DR
Project: Holland Subdivision:
Lot:
Project Description: (1) branch circuit for range.
Contractor: MCCOY ELECTRIC CO INC Owner: HOLLAND, JO
2014 SE 9TH AVE 9521 SW LAKESIDE DR
PORTLAND, OR 97214 TIGARD, OR 97224
PHONE: 503 - 234 -7521 PHONE: 503 - 684 -9703
FAX: 503 - 234 -9473
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 07/22/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/22/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 O -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: 1(: Permittee Signature: ,'N (� P ,e G / /7 — /U!\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.
Jul. 21. 2011 4:03PM McCoy Electric Co. No. 5809 P. 1
Electrical Permit Application FOR Ol ICE USE ONLY
RECE L
City of Tigard «`
Y 13125 SW Hail Blvd., Tigard, OR 97223
� O 9/0 / ` Permit No. ��.. —�
(P,tan Review
Phone: 503.718.2439 Fax: 503.598.1960 JUL � bate/BV: Ocher Permit
f t A..1 Id I1 Inspection Line; 503.639.4175 2 1 2011 Dale Ready/Illy; !u See Page 2 for
bCotil o d:
- Notified/Method: Supplemental Information I
Internet: w�,nv -tgard or.gov
'.' ". T•1iPE' ON:IV 3 I t : ;1 * . ' •: ' • PI;A111MykE . •
❑ New construction (c] Addltton/alteratiote pl ` ih &f I t).1( V Please beck all that apply (submit 2 sets of plans v: /items checked below):
❑ Service or feeder 400 amps or more CI13uilding over three stories.
0 Demolition 0 Other: where the available fault current ❑ Marinas and boatyards.
rt
S "M` J kind "' ` ' + I` h A 7 .. Olt % ' i R t „ o , ';‘ , exceeds 10,000 amps al 150 volts or ❑ Floating buildings,
' ,_ ` ,7, " °” m a " -.... '"`"1�`. " •. "` I „� *` `j° it '�i`i lilr ' 'iF; e;:*7 ' less (0 g round, or exceeds 14,000 ❑ Commercial -use agricultural
El 1- and 2-family dwelling ❑ Commercial/industrial 0 Accessory building amps for all other installations. buildings.
Multi - family ❑ Master builder ❑ Other: 0 fire pump. ❑ Installation 075 KVA or
❑Hwergenc system. larger separately derived system.
Y
.. .JOa . s><T0NvonarATroN . Arrn LocATrm . ,
❑ Addition of new motor load of ❑ "A", "E", "1 -2", "1 -3 ",
Job no.: 05844 Job site address: 9521 SW LAKESIDE DRIVE 100HP or more. occupancy.
El Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD, OR 97224 ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locutions. 600 volts nominal.
Suite/bldg. /apt. no.: ` Project name: KITCHEN REMODEL ❑ Service or feeder 600 snips or more.
: §5 7 : f ::!;'. 7 4.
S° 5 , T1 E S CHEDUL .. '.': i
Cross street/directions to job site_ ptscesono
Olr. � 1; P I Total I
New residential single- or nndti- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. fl, or less 168.54 4
Ea, add'I 500 sq. It. or portion 3192 1
Tax map /parcel no.: Limited energy, residential
. . DESCRIPTION 'OF WORK. ',... :..' . ' » ..' : : ,;. (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.1)0 2
NEW CIRCUIT FOR RANGE residential (with above sq. di )
Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2
: ' JI PROPERTV ::OWNER ' l ' ' ❑ TENANT' 201 amps to 400 amps 133.56 2
v
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /Z1P: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I 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
Branch circuits— new, alteration, or extension, per panel
Owner signature; Date: A. Fee for branch circuits lrltlt
r �t i C R14.dacu' ',e! above service or 742 2
1uE' ; a �
m�ze.1 �_,,.,• uLe. Szr each branch circuit
Business name: H, Fee for branch circuits 1 rflhon!
service or feeder fee, first l 56 l8 56 8 2
Contact name: branch circuit
Each add' l branch circuit 7.42 2
Address; Miscellaneous (service or feeder not included)
CitylStale /ZIP; Each manufactured or modular 67.54 2
dwelling, service and/or feeder
Phone: ( ) I Fax:: ( ) Reconnect only 67,64 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or OLIO ine lighiing 67.84 2
.: ' • COV1'RACf011 . ' , ' , Signal circuit(s) or limited- energy
Business name: MCCOY ELECTRIC CO., INC panel. alteration. or extension. Page 2 2 ,
Each Additional inspection over allowable in any of the above
Address: 2014 SE 9 AVENUE Additional inspection (1 hr min) 66.25/hr
City /Slate /ZIP: PORTLAND OR 97214 Investigation (1 hr min) 66,25/ hr
Industrial plant (1 hr min) 78,181 hr
P se: (503) 234 -7521 I Fax: (503) 23 9473 Inspections for which no fee is 90.001 hr
y - specifically listed (i4 hr min) CCB Lic.. 8277 I Electrical Lic -. 26 -$2C Suprv. Lic.: 5208S . ..' ELECTRICAL PERMIT'. FEES; ;;, ;( c;: 1
Suprv. Electrician signature, required: j I Subtotal: 56.18
Plan review (25% of permit fee):
Print name: ZACK ARMSTRONG Date: 7 -21 -2011 Slate surcharge (12% of permit fee): 6 - /
TOTAL PERMIT FEE: 62.92 V
Authorized signature: This permit application expires If a permit fs not obtained within 180
days alter it has been accepted as complete.
Print name: Date: • Nsmber inspections allowed per permit.
I:l nuttding \Permils\ELC- PermitApp.doe 07/01/10 440- 4615T(11/0SICoavwea