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Permit CITY OF TIGARD ELECTRICAL PERMIT • ` °'! COMMUNITY DEVELOPMENT Permit #: ELC2011 -00713 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2011 Parcel: 1 S126DC04900 Jurisdiction: Tigard Site address: 9445 SW LOCUST ST Project: Tigard Ortho & Fracture Subdivision: LEHMANN ACRE TRACT Lot: 3 Project Description: (1) branch circuit for clothes washer. Contractor: WILCOX ELECTRIC Owner: LOCUST PROPERTIES LLC 300 WASHINGTON ST 5632 SW EDGEMONT PL VANCOUVER, WA 98660 PORTLAND, OR 97239 PHONE: 360- 694 -3800 PHONE: FAX: 360- 694 -3801 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 12/21/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/21/2011 $6.74 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 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 obi-'s - • • of the rules o •irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344. • e , Issued B . %� �� 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. Dec 20 11 02:42p Wilcox Electric 3606943801 p.2 Electrical Permit APPIicatiO EC,E�VE� — i;oR vvic t LsE o Li _ __ ^._. ___ City of Tigard Rue;vcd r DaIrIB : IO����� �� Y 13125 SW Hall Blvd., Tigard, OR 97223" C 2 0 2 011 Plan Review Phone: 503.718.2439 Fax: 503.598.19 Date/13 Date/13 - Atha Permit: / ' I TIGARD Inspection Line: 503.639.4175 Date Ready/By: See Page 2 for .. Internet_ www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information TYPE OFU4 ING DIVISION PLAN REVIEW ❑ New construction 6rldditionlalteration /replacement Please cheek all that apply (submit it 2 sets of plans wliterns checked below): © Demolition ❑Other: 0 Service or feeder 400 amps or more ❑ Building over three stories. where the available fault amen ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 0 Commercial -use agricultural ❑ 1 - and 2- family dwellingCommercial /industrial ❑ Accessory building amps far all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. i ❑ Addition of new motor load of 0 "A ", "E", "1-2 "1 -3' Job no.: l�l'C Job site address: tr , .1 LOC , L " t i or or more. Occupancy. �I �t ❑ SiSix oc mare residential u »ts. 0 Recreational vehicle parks, City/State/ZIP: "11 b, • C'7- 2 2) ❑ Health -care facilities. 0 Supply voltage for more than g p NA I t (k ❑ Hazardous locations. 600 volts nominal. S tlitelbld /a t no.: Pro J ect name ll V �v (� ) El Service or r feeder 600 amps or m are. job site: y r/ t , FEE SCHEDULE Cross street/directions to J ' L Ark/ y( 6 CIA I V - 7 (ge I Qtr. I Fee I Tat.! I ^ U l/ 'Let�� �' i ei V it C j i ii n y ;;) New residential single- or multi- tamily dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'1500 sq. ft, or portion 33.92 I Tax map/parcel no.: Limited energy, residential DESCRIPTION OF WORK . (with above sq. ft.) 75.00 2 �/� f � Limited energy, multi - family Ath (4 ,Lr t-u. c� V `Fs ! ��1 � 1 residential (with above sq. ft.) 75.00 2 "( • Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ' .NANT 201 turps to 400 amps 133.56 2 Natrte. 3, 401 amps to 600 amps 200.34 2 ` b C r � "''i `` r ( C''' kla -1 ' ' �i l (rlv1L' 601 amps to 1,000 amps 301.04 2 Address: el e ' L 0 L d ��r Over 1,000 amps or volts 552.26 2 City/State/ZIP: -} �� Temporary services or feeders installation, alteration, and/o • �t L relocation Phone: (5. ) A � S 2 ...... ( (2 Fax: ( "fl ?C - l ` 3 ( 1 I 200 amps or less 5936 1 made on I ! '•-no 201 amps to 400 amps 125.00 2 Owner installation: This installation is being property that I own which is not 401 amps to 599 amps intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. am p 168.54 2 Branch circuits — new, alteration, or extension, per panel _ Owner signature: Date: A. Fee for branch circuits with 0 APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 'ayt't 7.42 2 �*" each branch circuit Business name: ..� e A 1 .� /6 B. Fee for branch circuits without /1 ��! Sr Ll f e. �( �Y service or feeder fee, that 56. l 2 Contact name: (1 y j�•l l'Lyi i(9 ') -- '3 y 7. j f I t ! 1 branch circuit Address: co vi ` • �1 " 1 Each add't branch circuit 7.42 j 2 Miscellaneous (service or feeder not included) City/State /ZIP: Fach manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) I Fax: : ( ) Reconnect only 67.84 ' 2 E - mail: Pump or irrigation circle 67.84 2 CONTRACTOR i Sign or outline lighting 67.84 2 Signal circuit(s) or limited-energy Business name: d Yl Li � i �� i panel, alteration, or extension. , Page 2 2 Each additional inspection over allowable in any of the above Address: E) N� 75 , It' r 1 fl7) � Additional inspection (I hr min) I 66.25/ hr City/State/ZIP: �l � ) � ' t , y t ,A Ci ipt [L, 0 /� t/ f /� Investigation (I hr min) 66.25/hr /State/ZIP' - 1, Y ' t ( ( w Industrial plant (1 hr min) 1 78.18/ hr .• Phone: ( 6,1 of ''� om`++ I/ j/7) Fax: ( 7 j? Ie i�4 ,& ; Inspections for which no fee is t VV ' r specifically listed ('A hr min) I 90.00/ hr CCB Lie.: I tt' jt-- I Electrical Lie.: � 1,1, J l I uprv- Lic.: 3 '3 6 ELECIIUCAL PERMIT FEES Suprv. Electrici f t , required: 7/ � /'1 i i/i //) Subtotal: Plan review (25% of permit fee): Print name: hi �V'� , �� Date: /-21 ii v State surcharge (12 %of permit fee): TOTAL PERMIT FEE: /,� �! �,, Authorized Signature J ci4t-----'.. f `� This permit application empires if a permit is not obtained within 180 Print name: Date: days after it ban been accepted as complete. • ' Number of inspections allowed per permit. I:Inuadtu5P meslELC-PamitApp.doc 07/01/10 440- 441$T(11/051CQM/WFB