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Permit n CITY OF TIGARD ELECTRICAL PERMIT 11 4 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00628 Date Issued: 11/04/2011 T[GrRD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 2S102CD03300 Jurisdiction: Tigard Site address: 13810 SW 100TH AVE Project: HSBC Mortgage Services Subdivision: SHILO Lot: 2 Project Description: (2) branch circuits Contractor: BUCKAROO ELECTRIC Owner: HOUSEHOLD FINANCE CORPORATION II 31601 S WRIGHT RD BY HSBC MORTGAGE SERVICES INC MOLALLA, OR 97038 636 GRAND REGENCY BLVD BRANDON, FL 33510 PHONE. 503 - 880 -6326 PHONE: FAX 503 - 829 -5207 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 11/04/2011 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 11/04/2011 $7.63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71 23 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 may obtain a copy of the rules '� irect questions to OUNC by calling 503 232 1987 or 1 800.332 2344, �(J Issued By: ---- --_.....k... _ -__"� Permittee Signature: ...`Z 5 f J 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. Nov 04 11 01:38a Karen Veltman (503)829 -5207 p.2 Electrical Permit Application - ck, FOR OFFICE USE ONL.\ City of Tigard 9722 ) +lo�` A RccenBed Permit No.: - City Y b Qate /9v. 1/ © !yam i >l — �` W ' r • 13125 SW Hall Blvd., Tigar O R tan eview Phone: 503.718 2439 Fax: 503 598.1960 \` ` Q l♦� s C `Sl Other Tl -[] Inspection Line: 503.639.4175 �•' ``` e Ready/By rams l� See Page 2for Internet: www.tigard or.gov Oil Ol`t ' Notified/Method ' f, Supplemental information I TYPE OF WORK PLAN REVIEW ❑ New construction it Additi011ialterabi011/1411ent Please check at that apply submit 2 sets efplans whtems checked below). ❑ Service or feeder 400 amps or more 0 Building over three stones ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or D Floating buildings. less to ground, ar exceeds 14,000 0 Contniercia rise aprir:vlteral /g--I- and 2- family dwelling ❑ Cornmercial/industrial ❑ Accessory building amps for all other installations. building. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system ❑ Addaion of new motor load of ❑ "A ", "E', "I -2', "l -3 ", Job no.: Job site address: t 3 co 0 G (0 1 /"1/)`I to /1 v 1_ • 100FIP or more, occupancy. 1 vv CT ❑ Six or more residential units ❑ Recreational vehick parks City /State /ZIP: "\- " ( f) Q 9 '-'' ?..)--3 ❑ Health-eare facilities ❑ voltage more than ��1 � ' t 1 � ❑ Hazardous locations 600 volts nominal. Suite/bldg. /apt no.: J I 600 vo Project name: ❑ Service or feeder 600 amps or more. !FEE SCHEDULE Cross street/directions to job site: Deseripfi.n J Qty. l Fee. I Total New residential single or multi - family dwelling unit. Includes attached garage. Subdivision Lot no.: 1,000 sq. ft or less 168.54 4 l Ea. add' l 500 sq ft. or portion 33.92 I Tax map /parcel no.: Limited energy. residential 75.00 2 DESCRIPTION OF WORK (with above sq ft) / P Limited energy, multi- family 75.0D 2 Z. C.-1' rat / L(J `�l 7 p /(,to, S ..- swr}�•t'gl c, residential (with above sq. f.) r 7 Services or feeders installation, alteration, and /or relocation 200 amps or less I00 70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or soils 552.26 2 Temporary services or feeders installation, alteration, and /or City /State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125 08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 54 2 i Branch circuits — new, alteration, or extension, per panel Owner signature: _ Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT' PERSON above service or feeder fee, 7.42. 2 . each branch circuit Business name: B Fee for branch circuits without service or feeder fee, first Contact name: branch circuit I 56.18 54,, ) s 2 Each add'I branch circuit 1 7.42 - 2 . L(V 2 Address: Miscellaneous (service or.fceder not included) Each City /State/ZIP: dwelli service manufactured nd/or feeder 67 84 2 Phone: ( ) Fax : : ( ) Reconnect only 67 84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67 84 2 CONTRACTOR Signal crrcuit(s) or limited Business name: C�r�t �. w1 r���y 1 e hhh"' YYY 11' ` t �: ! L 1-G panel, alteration, or extension. Page 2 2 �(1�1 � � J t LLL 111 i Each additional inspection over allowable in any of the above Address: ,/, ,L d Additional inspection(1 hr min) 6625/ Investigation t rK- L , u t -r �. f i e , / (1 Industrial pll ant t (1 1 h hrr min) 78 I , /Z ✓l 9 - ?to G; mi 66.25/ 8/ hr 8! hr Phone: (spa) R'97),_..6,.3 z, 6 Fax: ( ) F2 g� 7 Inspections for which no the is 90.00/ hr specifically listed ('3 hr nun) CCB Lie.: i s-,.,,,,,7s.-0 L f//zz Electrical Lic.:3C / Suprv. Lic.:�i CI G/ S ELECTRICAL PERMIT FEES Suprv. Electric esi�rfatiir'e, required: f —7/' Mil /i 3 u Subtotal (, 3 - (4 /7� fi�/j� ` �a� Plan review (25% of permit fee): Print name: 446;-,. / t-t / � f Date: //_/./...„.# State surcharge (12% of permit fee): ) , (t 3. I TOTAL PERMIT FEE: - 1 1 . 7r . Authorized signature: This permit applrcahon expires if a permit is not obtained within ISO Print name: Date' • days after it has been accepted as complete. • Number of inspections allowed per permit t tButldingiPennnstELC'PermitApp doe 07.'01/10 440- 4615T(11/05 ,COMJW®