Permit P ;
CITY OF TIGARD ELECTRICAL PERMIT
M I COMMU NITY DEVELOPMENT Permit #: ELC2009 -00422
Date Issued: 08/14/2009
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1 S134DC09900
Jurisdiction: Tigard
Site address: 11485 SW CORNELL PL
Subdivision: Lot: 0
Project:
Project Description: (6) branch circuits for fire restoration
FEES
Owner:
ADAMSKI, CURTIS R Quantity Description Date Amount
4109 FIR ST 6 crt Branch Circuits 08/14/2009 $80.10
VANCOUVER, WA 98660 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/14/2009 $9.61
Electrical
Contractor:
MCCOY ELECTRIC CO INC
2014 SE 9TH AVE
PORTLAND, OR 97214
PHONE: 503 - 234 -7521
FAX: 503 - 234 -9473
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.71
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 -0100. 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: Permittee Signature: �� °/ eef 0,1
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 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.
,.
%. ,. ., Aug. 13. 20 r i 09 2:47PM , McCoy Elect c Co. No. 4085 P. 1
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Foit ofricE-
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l.1 1" ertill t Pip pH ca 1101I RECEIVE .. .. ..
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City of Tigard Reoeived
14 Pernn"Nze„? M3Y: 4-a- 0 i - - if / 9,z
1,
, ...... ' 13125 SW Hall Blvd., Ti Da or//y/i 7
gard, OR 97223 Plan Review
2 2
• • Phone; 503.639,4171 Fax: 503.598 1960 AUG M 1 - ) I -I- 3 2 00
Date/By: Other Pe
TIGARD
Inspection Line: 503.639.4175 Date Ready/By: runs: gi See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Noliftedthlethod: i . Supplementer Information
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" Please check all that apply (submit a sets of plans whims checked below):
0 New construction gs: Addition/alteration/replacement
°Service or feeder 400 amps or more °Building over three Entries.
0 Demolition LI Cher: whe the available fault current 0 Marinas end boatyads,
a ps w....--vpgrialepa .! li'lt0 exceeds 10.000 amps at 150 volts or 0 Floating buildings.
, Jatee tittmamiani skim . • - .,,,,,,, „„t - • . ,. - . . ,.. .
1095 to around, or exceeds 14,000 0 Commercial-use agricultural
and 2-family dwelling 0 Commercial/industrial El Accessory building amps for all other installations. buildings.
0 Multi-family 111Mastor builder D Other: 0 Fire pump. 0 Installation of 75 KVA or
. 1 0 Emergency ;:yStera. larger separately derived system.
Ft' i g- 7 1i f iiii ti f=0Wp:4 1 .4a 2 57 4 . - - • dition of new motor load of 12
- Z....:,7_...,.-.-t- 0 Ad
' .....t.r. ,
Job no.: 111,q1 Job site address: I L155 51 (I fy 1001iP or Mere.
0 Six or more residenlial unite. 0 Rre
occupancy,
ecational vehicle parks.
City/State/Z2P: 1 1 44, d 4 0 0 Health facilities. 0 Supply voltage for more than
. Ofbaardous locaiions. 600 volts nominal.
.
Suite/bldg./apt. no.: Project name: 6 ' e 1 0 D Salim or feeder 600 amps or more.
.4, .... 1 it 141 A d i .. t-,■ . tn - 4'
Cross street/directions to job site; nertrlpitoa ury. Yee Total •
New residential single- or multi-family dwelling unit
-
. - Includes attached garage,
. -
Subdivision: Lot no.: 1,000 sq. ft. or less [ 145.15 I 4
Ea. addl. 500 sq. ft. or ponion 33.40 1
Tax map/parcel no.: -. Limited energy, residential
FaI:.-::-....37 AWAiat- (with above sq. It) 75.00 2
. ... .. .. ,_, . - ,4...,-.. - L,Lt-,L II .. =
Limited energy. multi-family
1 1 Ihe .iCtsearitA-tic)0 residential (with above sq. ft.) 75.00 2
Services or feeders Installation, alteration, and/or relocation
200 amps or loss 80.30 2
ra '', It.t .: 201 amps to 400 amps 106.85 2
laa.F...-s -e•--- - - --- - _
401 amps to 600 amps • 160.60 2
• Name: -
601 amps to 1,000 amps 240 _ .60 2
_ • Address: • Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone; ( ) I Fax: ( ) 200 amps or less IIII 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps 10 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits- new, Alteration, or extension, per panel
0%vner signature: Date: A. Fee for branch circuits with
FIV,ZreL,P=•7.47:5 OrgligaMT-X--4„,..' above service or feeder fee,
z- ••,,,;,\-.-_,4 --.... 6.65 2
each branch circuit
Business name: McCoy Electric B. Fee for branch circuits
• • Contact name: Kalil
without service or feeder fee, L IG/ $ 2
first blanch circuit 46.5
8
Each addi branch circuit 6.65 4 ' 1 15'4 2
Address: same ' .9
- - Minchancous service or feeder not included
City/State/ZIP: same Each manufactured or modular
90.90 2
-
dwelling, service and/or feeder
Phone: (503) 234 I Fax: : (503) 234 Reconnect only 66.85 2 '
• E lisloper@mecoyelectric.cOm Pump or irrigation circle 53.40 2
EFTWEFTSP 7 : LI: Sign or outline lighting 5340 2
Business name: McCoy Electric Signal circuit(s) or limited-
energy panel, altendion, or
Address; 2014 SE 9 Ave extension, Describe: Page 2 2
_
•
City/State/ZIP: Portland, Or 97244 Each additional Inspection= allowable In any of the above
_
Per inspection 62.50
Phone; (503) 234-7521 Fax: (503) 234-9473
Investigation per hour (1 hr min) 62.50
CCB Lic.: 8277 EleCtriCal Lic.: 26-82C Suprv. Lie.: 2175S 1,/ Industrial plant per hour 73.75
•.,;";A' ,7"#, .E.G. a* :gol__ __• ...1.' ::i#4.
Suprv. Electrician signature, required: . • fh . i
■ 01,1A1 • • PAA,-. Subtotd: Lag 4 •
Print name: James R_ Hall 4 Date: c: 8 13 oci ___________
Plan review (25% of pemi it fee); _
S tate surchtu-ge (12% of pm* fee); ti , -,
tv
Authorized signature: ' TOTAL PERMIT FEE: II
+ 1--
This permit opplleatlen aspires If a perMit is oat obtained within 1130
Print name: Date: days after It hes been accepted as complete.
4 Number of inspections allowed per permit. 841J11
11■BultdingweemIrstEtz-Permitetpp doe 05/23/06 4 404615TO 1 /05/COM.AVEB