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Permit CITY OF TIGARD ELECTRICAL PERMIT ' - g . _' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00243 Date Issued: 05/27/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S114AB15400 Jurisdiction: Tigard Site address: 93�_SW_DURHAM -RD Subdivision: Lot: 0 Project: Whitney Project Description: Install 200 amp panel. Owner: FEES WHITNEY, ERIK & ALAN Quantity Description Date Amount 9300 SW DURHAM RD TIGARD, OR 97224 1 ea Services or Feeders - 200 05/27/2009 $80.30 amps or less PHONE: 1 ea 12% State Surcharge - 05/27/2009 $9.64 Electrical Contractor: OWNER PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $89.94 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 R 952- 001 -Q100. 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: r S` �'� Perm ittee Signature: X 0 AV y�' 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 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. . MAY -22 -2009 FRI 03:57 PM AMERICAN MEDICAL CONCEPT FAX NO. 5032184805 P. 01 Electrical Permit �lpplicat .,,,,--, t h <�lz t ►t. r tr is t,. ,t: t ►'St ti' - il U ; y j I Received M1a, City of.Tigard 33 tt 3 t11Y��!! �J Qat� : P l r1o, f( 2 ' • 042 13i25 SW Hdl Blvd.. Tigard. OR 973^ Y plan Review rhlwrpermit; � P 503,639,4.171 Fax; 503,598,1'9 +i�1 2 2 200 AatelBy;. : i . t, i Inspection Line: 503,639,4175 Dare R eddy» See Page 2 ref Internet: wwwafa- or,gnv CITY OF TICAR�L "all eam�lethad: k s,tvvl l Lrar�t,tben • . ' ' 1 1 / P E o » ? V OR1KG DiVI,Si 1 ... ';;, -: - ;,,� ,.: , .,.,, ... New cot ® Addjtion /alteration /replac - Please cheek all that apply (snttmit a so, prilmns w /item eheckedbefew); O Service or feeder 400 amps or mare O building over three stories. Demolition ❑ Q Other: where tha available fault mow rttt 0 Marinas and boatyards. ,,,,.,,C IIZGORV OF CONNSIRUCT"ION ... exceed% 10.000 amps at 150 volts or © Fleming hslldincs. • less ro around, or exceeds 14000 ❑ Commemial.amc agriculture! g 1- and 2- family dwelling 1:1 Commercial /industrial 0 Accessory building emus far all other instillations. bnildinga. Multi- fLtmily C1 Master builder Q Other: ❑Piro pump. Cl Installation or 75 Kvn or ' ' KID SITE INFORMATION AND LOCATION � O t magenev syatom_ larger sepnratnly derived system. ,, '. ©Additinr us' now motor load or 0"A". "p' "1-2","1-37. Mb b no.: Job site address: d 0 5' IA) n w - - • sit or man. occupancy. 0 Si `t or more residential unite. ❑ Rtlera banal VohiGle petite, City/State /ZiP: j , e tom% a / a R Oticalth•aare racilltics_ ❑ supply volmgo roc more than ❑H,oteudona locations. 600 volts nominal, Suite/bldg, /apt no.: Project name: S w , a (7 scrviaa et feeder 600 amps or more Job A. bt 001.,_ ., 1 1,1 j e .. 54- uL>� Cross atreet'Jdirtxtions to o b site 1 „w ; � � . �, i >fi j New residential single- or multi - family dwelling unit. +_ t - 't. y Tti 4t S , A. - A Indlgdea att ched pray. Subdivision: Co I6, 0 y (z.. t,.rn no.: ` 1,000 s., R, or less 145.15 4 > Tax map/parcel no.: e. add'/ 500 sq. R. or portion MI 33.40 �d r Limited energy, rcai • ential NI 75.00 El DE9CRIPlION d]tt WOR7f, with above s , ft. /� -� /j Limited energy, multi - family 75,D0 1 0 Lit PQ 14 /0:: 5 pa vie. ( c20 a J'f' raidcritiat with Above a.. ft. • a ` d 1 Services or feeders installation alteration and/or . ocntion i I = al 200 amps or less 50.30 y 2 • . j g PROPERTY( OWNER; ` d TENANT 201 am 4 9 to 400 amps 106.85 2 • 401 amps to 600 amn 160 - 60 2 Name: ,; (/1/4..) I 11 601 amps to 1 ,000 .5 240.60 2 Address; 9360 r� i t i+1. f• Over 1,000 amps or volts _ II City /StatcfZtP: "-r a ( 4 / o l 7' 4)y e ry services or feeders rnataklagan, alteration, and/or relocation Phone; ( C7 7n 6,(//— ,(717./ Fax: ( ) 200 stops 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 salt. lease, rent. or exchange. according to ORS 447, 449, 670, and 701. 401 amps to 599 mops 133.75 2 Owner signature: Ao: 5 /a? p Brands thralls —new alteration or eaten WI, . er • me ! IL pee for hninch circuits with C[11VTACI PBRS , .. each rach c feeder fee, � III ^° -- each ch branch circuit Business n able: B. Fee for h„ineh circuits Contact. Warne: without service or feeder fee, 46 RS first branch circuit _ Address: Each ad41 branch circuit 6.65 11'Iiacelaneovs aervlce or feeder not Included City /StatefZiP: Each manufactured or mo. a ar dweltjn _. service and/or feeder 90 90 Phone. ( ) 1 Fax:: ( ) Reconnect only 1 �II E -mail: P . orirri;.ationcircle - -- 0014"I'RACI't]R . . Sign or outline lighting 53.40 Business narno: Signal circhlt(s) or limited- energy panel, altcrettolt, or — Address: extension. Describe: Page 2 City /State/ZIP^ Baci additional inspection over allowable in an of the above Phone ( ) P ( Per inspection _ 62. 1 — ) Investigation per hOUr (! nr mini 62,50 CC3 Lie.: Electrical Lie.: Suprv. Lie.: v industrial -/ant per hour IIIM El . , ELRcmict1I. PEtitA='IMES: Suprv. Electrician signature, required: Subtotal: MEM print tltlrtic: Date: Plan review (25% of . ormit feu): ��� State stlrohargo (l2 % of Permit fec): M Authorized signature: TOTAL PERMIT FEE: a:own e permit spoliation atpiaen If a permit net attained w1 t. in ISO Print name y 1 Tkt Date: der after itMs beta seeapftd as annotate. • Number of lrlspcetions else. rod per permit, I:tallding\Pirmltat0LC- ParmhI ,ppdoc OS/29/06 4404615T(II10SICOWW'1A