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Permit CITY OF TIGARD • ELECTRICAL PERMIT '- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00438 Date Issued: 08/03/2011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S111 DD01700 Jurisdiction: Tigard Site address: 8865 SW AVON CT Project: FEDERAL NATIONAL MORTGAGE Subdivision: Lot: Project Description: Panel replacement Contractor: WHITE LIGHTNING ELECTRIC CO. Owner: FEDERAL NATIONAL MORTGAGE ASSN 7524 SE 52ND PO BOX 650043 PORTLAND, OR 97206 DALLAS, TX 75265 PHONE: 503 - 772 - 3009 PHONE: FAX: 503 - 772 -4008 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 08/03/2011 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 08/03/2011 $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 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 ma e = . - : •y oft - ru es • -'rect questions to OUNC by calling 503.232.1987 or 1.800.332.2244. t Issued By: / = Permittee Signature: d 7 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 A licatio _ %,, FOR O FICf: LSE ONlA l s v Rece Pennil No: City of Tigard e : $ . / Al i.' E__, If 1 I • 13125 SW Hall Blvd., Tigard, OR 97223 Au G, 2011 Received 0 2 Plan Review Other Petrnit: Phone: 503.639.4171 Fax: 503.598.1960 Date.'B Jutis: Sc ®e Page 2 for Inspection Line: 503.639.4175 OF I k` R Date e dimeti m - , I Supplemental information T1GARD P �` � Date Internet: www.tigard or.gov ttt r oNi!` ry�+i^"`I ri. Tl F WO , C ""4 y.+ PLAN REVIEW 0 Plr.sr check all that apply (submit 2 sets of plans wfitems checked below): New construction AddiUonlalterationlrep{acement 0Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demoliti • ❑ Other: where the available fault current iJ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 70,000 amps at 150 volts or 0 Floating buildings. less to ground, or exceeds 14,000 ❑ Commereial.usc agricultural - and 2- family dwelling 0 Commercial /industrial ❑ Accessory building • amps for all other installations. ©buildings. il ei ❑ Multi- family ❑ Master builder n of 75 KVA or - © Ot her: El Fire pump. ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A" "E ° l r', l ", /� L I OOl-IP or more. occupancy. Job no.: 1 Job site address: Rd t9 5w 14 0� U7 QR ecr eatianal vehicle parks. ❑ Six or more residential unit Supply volt for more than A (�, Q wealth -care facilities. O a City /State /ZIP: �Q> br-lJ� C`_7 'IA-. r �Z -1 �`��� ❑Hazardous locations. 600 volts nominal P roject name: ^ ( I ' t ❑ Service or feeder 600 amps or more. Suite/bldg./apt. no.: �- ' '� 1 / FEE SCHEDULE I Qty. { Fee- I Total I " Description Cross street/directions to job site: - New residential single- or multi- family dwelling unit. Includes attached garage. 1,000 so. ft. or less I 168,54 4 Subdivision: Lot no.: Err. add'/ 500 sq. ft. or port 33 92 l ion _ Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft) Limited energy, multi - family 75.00 2 t (j 1� b residential Services o r feeders above a e rs installation, ove tt.} 1.„ 1.„ �,t.- Q X, Cj Se rvi c es t il a fee oveq. ft.) alteration, and/or relocation 200 snips or less 100.70 100 ,Z 0 2 ❑ TENANT 201 antes to 400 amps 33.56 1 2 ❑ PROPERLY OWNER 20034 2 401 amps to 60 0 amps /y� 301.04 2 Name: F o .e - iel ( P1 ' A`G ( / ► l(I n 6 01 amps to 1,000 amps • b� '' _' �(f U 552.26 2 Over 1,000 amps or volts Address: Temporary services or feeders installation, alteration, and/or City/State/ZIP: relocation 1 59.36 Phone: ( ) ` Fax: ( 200 amps or less 59 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits- new, alteration, or extension, per panel Date: A. Fee for branch circuits with Owner signature: above service or feeder fee, 7.42 2 ❑ APPLICANT 1 El CONTACT PERSON each branch circuit B. Fee for branch circuits without Business name: service or feeder fee, first 56.18 2 branch circuit Contact name: Each add'l branch circuit 7.42 I 1 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular 1 67.84 2 City/State/ZIP: dwelling, service and/or feeder 1 2 Phone: ( ) } Fax: : ( Reconnect only 67.84 Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 E -mail: CONTRACTOR Signal cimsit(s) or l limited - energy 2 2 // ` L A panel, alteration, or extension. Business name: ("014 t, t 6 I C � rv � j ,, C ii--C E f �1 •'" C'' Each additional inspection over allowable in any of the above 7 V 6. Additional inspection ( 1 hr min) I 66.25 / hr Address: 7 5 2_4 6 6 G Investigation (1 hr min) 66.25/ hr II LA_it c Industrial plant (/ hr min) 78.18/ hr a City/State/ZIP: - 4 I• i � Q" � � 2-0 Phone: ( ) }Fax: ( ) Inspections for which no fee is 90.00/ hr s. • ificall listed ('A hr min) Suprv. Lie.: E LE(,'TRICAL PERMIT FEES t � ' ] I Elec t rical Lic.:3� °� G 1 P ���� 5 Subtotal: r� t"7 a ' CCB Lie.: �.�- j /� Plan review (25 %of permit fee): Suprv. Electrician signature, required: E, �'- State surcharge (12% o of permit fee): f � , - q , • r Date: Print name: �� �w.. �p r r� TOTAL PERMIT FE MEM • { This p ermit implicit lion expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Date: e dumber of inspections allowed per permit. Print name: 440-46 t ST(1 Ilo51COM /WF.a 1:1Buildingll'erm ItatC- PermitApp.doc 07M1/10 Z'd 800ib-ZLL(£O9) oialoeo 6uiuly6ii el!gm e6Z: l, 1. l l ZO 5 nb'