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Permit CITY OF TIGARD ELECTRICAL PERMIT III 3:- - COMMUNITY DEVELOPMENT Permit #: ELC2009 -00287 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/15/2009 Parcel: 1 S134BD07005 Jurisdiction: Tigard Site address: 1 1350 SW C_OTTONWOOD LN_, Subdivision: Lot: 0 Project: Speaks Project Description: Change 200 amp or less panel. Owner: FEES SPEAKS, STANLEY M & LOIS J Quantity Description Date Amount 11350 SW COTTONWOOD LN TIGARD, OR 97223 1 ea Services or Feeders - 200 06/15/2009 $80.30 amps or less PHONE: 1 ea 12% State Surcharge - 06/15/2009 $9.64 Electrical Contractor: JD MILLER CONSTRUCTION CO 11070 SW ALLEN BLVD BEAVERTON, OR 97005 PHONE: 503 - 649 -6991 FAX: 503 - 641 -1902 • 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 OAR 952 - 001 -0100. You may obtain a copy of the rules o di questions to OUNC by calling 503.246.6699 or 1.800.332.2344. � Issued By: u �� X / \JV Permittee Signature: 01JC Q ‘)APP 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. Sent fay: MIKE'S ELECTRIC; 591 7847; Jun -11 -09 15:32; Page 1/1 To TIG.A D At: 5035981960 i . R E C E IV ED . • Electrical Permit Application JUN 1 1 2009 .rl:;UN+, r ; ,. E .. c trea 4! floor, Hiltlhilro oR =97 ,2,3 l ate received: ► Permit I70•: F I nspectio3) :6811-G244R0 le ate issued: Bid Permit no.: am-(49-3toe-i- C 69 13UILDING DIVISION l at eferral: YES/NO fi et,YU • — .. TYPE:OF W� fltc ' ... .. •• . PLAN. R ' • Fv1 W _ ' , . © New construction 0 Addition /alteration /replaccment Please check all that apply. ❑Service over 400 amps, comm'l ❑suilding over 10,000 sq. ft, El Demnlition 9 Other € DServire over 120 amps - rating ❑4 or more new residential CATECOORY OF OONgti 11C4'117N of 1- and 2- family dwellings units in one structure - • ` • •••_. • QSystem over 600 volts nominal DFeeders, 400 amps or more MI- I- and 2- family dwelling 9 Commercial /industrial ❑ Acces60ry Wilding ❑Building over three stories ❑Manufactured structures or 0 Multi - family 9 Master builder 9 Other: ©Occupant load over 99 persons RV park - - - -- ❑Special Occupancy as per ❑aher: JOB BITE INFORMATION AND LOCAT'it N 4 Chapter 5 of NEC • Submit 2 sets of plans with any of the above. Job 11m:26407 Job address: 11350 SW Cottonwood Lit. The above are not applicable to temporar�oonstruction service, C.it /State/ /.i -- Tlg d OR 9722 ' ;;,,,.... w�:, *,i E . i I(Et Ul Crate/ hid /a Y j pt. no.: Project name, ptlm, v J Qty. Fee I Te�ei ___ _ ., .. New residential single- or multi - family dwelling unit. Cross Street/directions to job site: a includes attached garaec. Subdivision: Lot no.: 1,000 Sq. ft, or less • 151,04 4 _ Ea. add'I 500 sq, ft. or portion 25.96 Tax map/parcel no.: Limited energy, residential - 3540 _ 2 DESCRIP.TiO4 OF rWORK' Limited energy, non - residential 70.80 2 • —, �-, - ' ' Each manufactured or modular Service Change dwelling, service and/or feeder 70.80 , 2 Services or feeders installation, alteration, and /or relocation _ 200 amps or loss � i ?: 1 © 80.3 ❑ PROP OWNER . Q. TENANT ' ' 201 amps to 400 amps I116. 401 amps to 600 amps 177 U1.1 Name: Stan Speaks 1 1350 SW Cottonwood Ln, hat am 5 +v mps oampa 130 io Pw,.W Address: Over 1 amps or v 531,ao Tigard, OR 97223 Reconnectoniv 70 80 1 - - Temporary services or feeders Installation, alteration, and /or i'hoite: ( 503 )579.8393 FEIN: ( ) relocation Owner installation: This installation is being made on property that I own, which is not 200 am or ices 70,80 2 — 201 am P a to 400 snipe 96,76 II intended tar sale, lease, rent, or exchange. 1 Owner signature: W. Date: _ C 401 amps to 600 amps 141.60 "' r ^"^ Branch circuits -• new, alteration, or extension, er r pnneE .�- Bra In • APPLICANT . , . - , :C I' dON �' ilitION• • - A Fee for branch circuits with Business Warne: service or feeder fee, each _ branch circuit 3.54 2 Contact name: B Fee for branch circuits --- t tvfrlrour service or feeder ft, Address: I each branch circuit 64.vu 2 I Each add'I branch circuit City /State /ZIP: i . Miscellaneous (service or feeder not included) Phone: ( ) Fax: ( J ) � Pump or irrigation circuit 70.80 2 —� Sign or outline lighting 2 Ella il: Signal circuit(s) or limited- , CONTRACTOR : , , . energy panel, alteration, or -- extension. Describe: Business name: JD Miller Construction DBA Mike f s electric _ 70.80 2 Each additional iltapection over allowable In any of the above Address: 11070 SW Allen Blvd. it Inspection 60,90 City /State /zIP: Beaverton, OR 97005 i _investigation fee 55.00 Phone: (503 )649.6991 Fax: ( 50 641.1902 Other. r • 64,90 ELECTRIoAL; P ERluilt lees- . 34 -18C ., ... :.... ... L ie, rte CCB tic. nn. 050209 -; e p. _.— s u btUtal X30 80 Supervising electriciarf - signature. required: lI kj,, _ f /,�� Sup. lie no,: +2305 Plan review (25 /o of permit fee) / ,I, Print name: Douglas . , J ./Mill Date: 06.1 F. .09 State surcharge (12% of permit fee) ' `tc Authorized �— . 4'1 TOTAL PERMIT FEE