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Permit CITY OF TIGARD ELECTRICAL PERMIT '� 2 '� .- COMMUNITY DEVELOPMENT Permit #: ELC2009 -00518 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009 Parcel: 2S 114BA09700 Jurisdiction: Tigard Site address: 16445 SW MEADOWOOD WAY Subdivision: Lot: 0 Project: Project Description: Install grounding rod, metallic piping no longer grounding system. Owner: FEES PIETILA, LINDA L Quantity Description Date Amount 16445 SW MEADOWWOOD WAY TIGARD, OR 97224 1 crt Branch Circuits 10/07/2009 $56.18 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 10/07/2009 $6.74 Electrical Contractor: METRO ELECTRIC INC 2809 SE MYRTLEWOOD WAY GRESHAM, OR 97080 PHONE: 503 - 666 -2159 FAX: 503- 674 -0123 Type of Use: SF 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- 0 -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: s m� 61.L V N) Q X4/0___ Permittee Signature: %--Q Q Al l� OWNER INSTALLATION ONLY 1 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. r ;w Electrical Permit Applieatio tb ( tl 1 .-1 ,1:,.,. -, t ., w; �Ie ,1, : City of Tigard 0CT 02 2 009 pe , ) 1' iiNo : C 2 O 8 �� 13125 SW Holt Blvd.. Ti 1,Olt 97223 � ` 2 �� LJ � p • i Phone: 503.63).417I Fax 503.598.1960 Date Rai : a t eI ty; harir 1i9 crtnic x; , : Inspector, , Liner: 903.639.4177 CITY OF TIGARD f?ueRr�y Sao Page 2 for ' _ %. w Interne:: ww.tiaard- or,lpn' . I _ ■ DIVISION '''''' Tic 1 Supple,xnnil tntbray,Sm` TYPE OF WORK PLAN REVIEW © nl New cons ction 0 , 4dditivn /o1 teratiomr piaccmenl ' `Mama eheel, all that apply (submit y sots of pltats.r/iron chocked Wow): ❑ Detlxrli4on (Chet I E: Stamice or fcedte 400 arpe m more IZI Mailing over three stories . whoa the available fwt: atrrent ❑ Marinas and tmatyuds. CATEGORY OP CONSTRUCTION acmes IVOOnemat iso vola O Flaming buildings. lento ground oc elute& 14,nnp O Conner aal -are agricultural 1- arid 2- family dwelling ❑ CotttmmeiaUindu.4trlai ❑ Accessory building amts Forell ahc imtdh ions. hal!dlnps, S 2,4 ulti- family 0 Master builder 0 Oiher: ❑rra pump. 01 am/huicvn of 75 KVA in JOB sire i] FO�tMAUON AND LOCATION Darn:gamy system. larger scparetdy derived system. C] � 36 site address: / L /.� � C Addititvt ofnew mama /and of Q "is'. "E - , "1.2". w.2 ~. Iob n0,; 1 b 1 J � - Oa i 1001 '= nett, ost money. n / (( �, O Six grin= =den tin nails- ❑ Raroational vehicle pales, City/Sts VP: ((Gl ( _l' , t � y( -c.:: u. ) t 10Etxtrh -rffic facilities. l7 Sway voltage for morn Man J / /' ID lianas-dons ttrafions. 6 4tavi3t$nominal. Suitefbldglnptfso.: Project name: i rl Service orfeeder amps rrmom. Cross street/directions SCHEDULE dircctton4 to job Site: I io i pem 14r• I Fsw 1 'rates 1 - New reddening atingle- or staid- fatally dwelline unit. Includes attached garage. Subdivision: Lot no : 1,u00 *q R less 145.15 4 Ea. add'i 500 sq. flu or portion 33.40 1 r Tax mtlp /psrccl no.: Limited energy, residential ' bESCRIPTICN U€ WORK (with above sq. IL) 75.00 2 a- , Limited energy, multi - family 75.00 2 i'1 residentialswitl above RAI_ Serrkes or feeder's Installation, alteration. Nadia relocation I - 200 amps or less 80.30 - 2 ❑ PROPERTY OWNER f 0 TENANT L 201 amps to 400 snips , 10623 i 2 Name: ' 401 amps to 600 amiss 160 2 • 601 amps to 1.000 amps 240-40 2 Addtt:sa: Over 1,000 amps or vole ? 454.65 2 Cis J eute!G1Y: l'ensporary earnest Or feeders in9taDation. alteration., tadror relocation Phone: { ) I l=ax: ( ) 204 amps or loss 66.65 I t , Owner installation: This installation is being made on property that I own which is not 12D1 amps to 400 maps [00.30 2 iotcndcd for sale, lease. rent_ or ex.ehange, according to 01 4.47.449. 670, and 701. I 401 arr)Ps W 5995) Ws E 133.95 E 2 I 1 Brand circuits - sew, alteration, or extension. • panel Owner signarure: Data: ' A. Fee fort:tru h circuits with 0 AM/CANT I Q CO1►"TAC I PERSON above service or feeder foe, Business name. each branct circuit G• 2 B. Fee for branch circuits Contact name: . without service or fader fa. I J 4.1W> '' 2 5 ( • I Cost branch circuit 1?`D - Address: Frith add'( branch circuit 6.65 I 2 Ci:TISta» 12IP: 34 isadlaoeeu (service or feeder not included) Each mmtuthemred or modular Phone: dwelling, service itndior feeder 90.4(1 2 ( ) I Pao :: ( ) ` Reconnect only i 66.85 2 E -mail: Pump or irrigation circle l 33.4() 2 CONTRACTOR Sign or outline lidg 33.40 2 Signal circuits) or limit energy paael, alteration, or AdCreea: '1 G Ct Gam 0v)... ` i� z: l tom. cxrensirn.l7rscrOlel Page 2 2 Clry'Start ZIP: .,.. q "" Q (3 EaC adtBtienel impaction paction overatlo,relde in tiny of the above Pct inspection 62.50 Phone: ( ) 06� � ? -15 1 C � Fax: ( ) 6 1 -0 i z. 3 ! 1trvesegaxinn per hour(I brain} 62.50 CCB Lie.: 7 (it 73 i "Elccttial Lic,:� - -i.- ( Suprv. Lic.: j_ j >. j Industrial plsm per hour 73.75 Suprv. Electrician signature. require: •G i t ELECTRICAL P3>�M11T )F7E$S • Subtotal: , 3 5 ( 0• i 8 Print name: f Daze: f l Plan review (25%offycrmit fee): 1 State surchargc (12 %ofpermit fee); L (0 ' Authorized Signature: TOTAL PERMIT FEE: IlZ,/, Print tsetse: Date: itris p!rnit tpitcatian wares If a permit is not odtaiiixd bin I clays a(ler ie8as Imam acuptud as camplere NSmber of inspwtions allowed per permit. t-t6•" ldinaW .(' unI .�nidsrn./.04 n,:/yyob • ast. s I Srti rlurrcossV B _...- r • I•' ti`✓Z LO 'out oi_1)oe3 o_geW 8 90:90 60 ZO PO