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Permit CITY OF TIGARD ELECTRICAL PERMIT 111 " COMMUNITY DEVELOPMENT Permit #: ELC2011 -00515 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Date Issued: 09/20/2011 Parcel: 2S111AD00700 Jurisdiction: Tigard Site address: 14620 SW 87TH AVE Project: HARDENBURGER Subdivision: PINEBROOK TERRACE Lot: 4 Project Description: Panel replacement Contractor: NORTHSIDE ELECTRIC Owner: HARDENBURGER, JOE L & JANICE K PO BOX 12323 14620 SW 87TH SALEM, OR 97309 TIGARD, OR 97224 PHONE 503 - 585 -4879 PHONE FAX 503 - 364 -0248 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 09/20/2011 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 09/20/2011 $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 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 throu•11.OAR"• 001 -0090 You may obtain a • • - ii i% • -ct 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: 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. SEP /20 /2011 /TUE 10:24 AM NORTHSIDE ELECTRIC FAX No. 503 P.001 Electrical Permit Apyl ica io , 7 r o , ) ' ] FOR ( �l VICE .� i'L ONL Reserved City of Tigard • ' ° ,ti A r' 23125 SW Hall Blvd., Tigard, OR 9728r Re . P L a iv . Plan Review m Phone: 503.639.4171 Fax: 503.598,1960 Date/f3 : Other Permit: 1: i:c \ R r, Inspection Line: 503.639.4175 CITY (' Tr G ii ter Date Ready /By: E7 See Page 2 for r Inernet: ww w,tigard- or.gov °0 " j rti tf� Notified /lvlethod: Supplemental Informaarioo i. 6 ki 1 91 r\.atf'+ ri.iiii' -tai k;•' : ,' • ;?,. � ; ;4*; Tx 1 Pt , 1 0f1fi3ik; <� ,o,•',': :: , ° i'" , ;`;. , ;7 " '..1., ,., ',i � - ,141-10^APY,1E�m,, •,,., _ - - 0 New construction 51 Addition /alteration/replacement Please check all that apply (submit I sets of plans w /items checked below): ❑ Service Cr feeder 400 amps or more ❑ Building over three stories, Li Demolition ❑ Other: where the available fault current ❑ marinas and boatyards. �'•' .. ;..' - °i ; t<.w1TFGO�i1( : QB CONS7CXtfT��lfOli/ ;; .,%:.„ d exceeds 10,000 amps at 150 volts or ❑ Floating buildings 1 � � less to ground, or exceeds 14,000 0 Commercial -use agricultural ' !4 I- and 2- family dwelling d Commercial/industrial ['Accessory building amps for all other inslallat ons. buildings rr--II Master builder Other: 11 Fire pump, El Installation of 75 KVA or Multi - family : ' M r b t r 0 Emergency system. l arger separately derived system. „'.: JQB :siTE.I Fd TON'ANn - &Q 4701 ‘,;';'='.',:""',•;, ''' ='r +. t t ;'. ❑ Addition of new motor load of © • Job no.: ' 5j / Job site address: ` �, ' c' `I loop or more, oecupatioy, tJ ` v V V Q Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: 1 `. .. • l� +, l „AD ❑ Health -care &edifies ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name ' 1 kt! r 0 Service or feeder 600 amps or more, „ ;,?!, . 1 ;,' TEE'rSCIi�DUL1� -. ', ,;:;,,5 >'• „r ''.c r"ti Cross street/directions to job site: • , ® ” New residential single or multi - fancily dwelling unit. Includes attached gara e. Subdivision: Lot no.: 1,000 sq. ft. or less I= 168.54 —. 4 Tax map/parcel n0. Ha, add'l 500 sq. ft or portion NM 33.92 1 Limited energy, residential _ , ,. '• , r ,' a. w, t • ' rs'� lrr,;,.,,..b with above 5.. ft. 7500 2 1 Lim enr, multi -fam III 75 00 2 � , ( M . i , PIT f resi denti gy with above ily s.. ft. services or feeders installation alteration, and /or relocation 200 amps or less am 100.70 Ems 2 ;,, •4,,= , ;i• L i #A F RT' ' ".OWNER i^, t:� `; ,i "' .°, :! A':` ` . „ , • "',I.Tri. `? " , , 201 amps to 400 amps II. 33,56 2 401 amps to 600 amps ION 200.34 2 Name: 601 amps to 1,000 amps - 301.04 2 ' }lddress: Over 1,000 amps or volts =MB 2 City/State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) 200 amps or less MI 59.36 1 201 amps to 400 amps MIN 125,08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168x4 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. -- Branch circuits — new alteration or extension ier anel Owner signature: .._ Date: A. Pee for branch circuits with 9t'PI CA1V T z .. `i` >,.1 t':,.,• Q, above service or feeder fee. 7.42 2 G , ,: :1",,,-;: CONTACT 'pER5t?N each branch circuit B. Fee for branch circuits without service-or feeder fee, first . 56. 2 Contact name: branch circuit Each add'l branch circuit =MEI 2 Address: Miscellaneous service or feeder not included City /State /ZIP: Each manufactured or modular 11.1 67 84 MI 2 dwellin•. service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only n 67 84 2 . Pump or irrigation circle 67 84 2 Email: Sign or outline lighting MI 67.84 2 ',` • . ' • •,. ', ;J , ',.. ' r; -i /: .. ICONTRACTORf " u ,.. t,':," : qi':•rj. , : 1: Signal circuit(s) or limited-energy Business name: ,anel alteration or extension. MEN 2 b ,t � $ • — w• C1 Each additional ins i ection over allowable in an of the above Address: a 4. titil..._ • tr.!! Additional inspection (1 hr min) 66 25/ hr Investigation (1 hr min) 66.25/ hr 4� Industrial plant (1 hr min) 78.18/ hr Phone: jr r � - - -- Fait: 4 '( )" \ - — Inspections for which no fee is - -- ' -' - 9O 00/ hr s.ecifioal listed rl hr min -- -- CC3 Lie.: * EIZEIVIA112 Suprv. Lie.: 5 ( S $I RCTRICAL PERMIT • :, uprv. Electrician signature, required: ' � ., (o) l 13 5ubtotal Plan review (25% of permit fee). ' r rint name: 0 Au • . F I' Dat State surcharge (12% of permit fee). ! TOTAL PERMIT FEE: • Authorized signature: ‘ i' � This permit application expires if a permit is not obtained within 150 Print name: Date: days after It has been accepted as complete. p of inspections allowed per permit. 1.18mlding \Permits 'nLC- Permithpp,dac 07/01/10 440 -4616T(11 /65/COMMell