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Permit Fi. CITY OF TIGARD ELECTRICAL PERMIT " D COMMUNITY DEVELOPMENT Permit #: ELC2009 -00173 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/21/2009 Parcel: 25111 CB04000 Jurisdiction: Tigard Site address: 10415 SW LADY MARION DR Subdivision: Lot: 0 Project: Gustafson Project Description: Install a/c and plug. Owner: FEES GUSTAFSON, DEAN S & GLORIA J Quantity Description Date Amount 10415 SW LADY MARION DR 2 crt Branch Circuits 04/21/2009 $53.50 TIGARD, OR 97224 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 04/21/2009 $6.42 Contractor: Electrical CANBY ELECTRIC INC 790 S IVY ST CANBY, OR 97013 PHONE: 503 - 266 -7878 FAX: 503 - 266 -5543 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $59.92 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 O / �C OAR 952 -Q01- 01100.. You ma obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Mai ai ! l QU 9AL Perm ittee Signature: I _ 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'N 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. Electrical Permit Applica • it 1, . : , F()ItO1�1r10EIJ EO11 , ; t n� � , " ' ftcdcivcd City ty Of 11lg u L � ' " =iv . 20 G t (crate `n.' f ' 00 ( l • « 13125 SW Hall Blvd„ Tigard, O . 97.7.23 00J P Review Odic( Rcvi — Phone: 503.639,4171 Fax: 503.596. .4 2 0 2 Dat : (Perm, H Tf`C A &I)' Inspection fine: 503,6394175 Date heady /By. t'= - Sc� I'aee x fur .. internel: wwW Tigard (>rgov �AQ® Notified/Method.. ( - , ti m(and Information '� �� � �' e . � r � tear �Wir Wt)Yr''t`� ,�i�,4�t , rare ii dii Vf 111 i t " '...:, f E [) ,,, P1 A.N f2CVILly '' t '' " !t'IE' " 0 � �, t �','� �. .�rrt {,h �,ra,:���;1� ,�hf� � � k. 8 ��o _ :� (( �Pb,� ,d. � I. .❑ :N z constructi l � J Addition /altv abbe e /replacement lcese check all that apply 1 ubmh r sets of plans w/ltrut. checked bcloj+') , ❑ service or feeder 400 amps or nwre ❑ tiuttding over three storinb. ❑.Demolition Other: where the available fault current (] Mminas and boatyards. ri I n ttu r rep 1 r ' 0 t-loatin' buildings. , �.ATE�t"O , GF �ik.;Q� Q]�4' � � ��� r, lh �u l) I�N b� h��`JI�' R �o1'`I ��'r CxoCCClc 10,00 arll�6 at I SQ v0115 or t+ '. ', , loss to ground, or cacccds 14,( ❑ (:osnmwcial -use ab'ricultural ' M 1.7 and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other nutalletioni htuldvtg • .Multi -family ❑ Master builder [3 Other © Fire pump. ❑ lnstalldhon 01'75 KVA or �••- r•-- -• Em ", slr�n. I;u zre ci�raccl derived stcrtm. � r q, t +t,(, `lakl'r,ti4 erg o is i Y y ! Ii *. 1 0 , ri '0:4,n(^ i n .0 �i t .. 11 :,± D O Add inoa of new motor toa+i nl ❑ v se Job no,: Jo _ .lUs bR ■T 1 00HP of more. occupancy. ' b site atldrr s : ' (1 � � U9 � m� l �' �• ❑ SIX or more reb un ILI itec rc ational "chicle part(.•. . Ciry /State /ZIP: [ ? [ S. ` ❑ Service or feeder G00 amps or more tit) volt. huge for more than 1 � 1 / Health care facilities Supply 4 I htr�r'dous locanoo , , tinsi Suite(bldg. %apt. no.: Project Hama: CI ? ,.f., F �+ y + Vin' i vyy,, rryy yy��,,ryry��'�r rrrr _. ,.,._._ -- -.. ice . IF A�,' W, �...._ . *.f.'r �` :Il G.LVL '.1 /, t�I,MW O. ° iIi N�'k :`: Cross street /directions to job sire: peso; Han 1 ..2szJ r•c,. 1 Total ' I - New residential single- or multi - family dwelling unit. Includes a ttached garage. Subdivision: Lot no.: 1 .000 sq. ft. or less -- i 45 15 Ea, add'I 500 sq. tt or portion 33.40 4 ' Tax map /parcel no.. Limited energy, residential r „ Y t ,' 1ti I „ t t, , u ,��r "i t (w a se 0 ) 'S00 • — Dp3CR1„ Ox filr� !e,,rIi' ^;, It:) __. PTIUIV;,. ! r rrrl Limited energy, multi-family 75.00 - / re sidential (with above s t, 0) W � I J � Services or feeders installation, xhcration, and /o r relocation. ^^ • 200 amps _ g0 .. ., r g : ' �,y ur ., t v i+ , A Ck ttuy, , H"' ^'^', �, or less . .,. _., .. U 11 PaOP f Y f LR f ° ' r t ' ` p1I,tI ^fi l �,iw�, {� " 2 01 amps to 400 amps - 2 ( 450'n 401 amps to 001) amps 160 60 Name: +4 00 am ps t0 I ,000 amps - 240.60 2' . Address: Over 1,000 ant p s or vo 454 6ti 2 ' • ' _ - - �.. ' "- T Temporary services or feeders installation, alteration, slid /or : City/ Tem ora /ZIP; relocation Phone: ( 53) b ., 1 O5 ) p (? Fax: ( ) 200 amps or less ' „ -_ i t e.85 i.. 201 amps to 4 00 amps 100.30 2 ' Owner. installation: This installation is being made on property that I own which is not • intcnded for ;ale, lease, rent, or exchange. according to ORS 447, 449, 670, and 70 401 amps to 599 amps '133,75 2 s- n ew, alteration, or e'ttension, er panel . Branch circuits _..., .. Owner signature: ��, . Date:' fir`' A Fee for branch circuits n',r /i , .. !, , >r �, !F P4 ,r I+ !,,� An',l h iJ73farlt t °rt .hove Service of feeder fee. 6.65 2 '.: a ti , .' .' ❑' *PELICAN'[' 1 > t , c Cra, ` F ,, rx., „ , S. „ �,,' . ,.,�,.,: 3 each branch circuit S:tisineBS name: B, Fee for branch circuits - - without strviee or tcedCr fee. 46.8 (� � ` 2 : ' C first branch circuit .) _' "" ;• -' Each add'I branch circuit 6.05 6 5 a - -2 Address:, ,w ." - � Miscellaneous s ervice o r feeder not included) • " City /State /ZIP: _ Each manufactured or (nodular 91).90 . . 2 .. dwdllinr, service trod /or feeder • • Phone: ( ) Fax; ; ( ) Reconnect only , -- 66.85 2 _ Pump or ter e ttu arch P marl �. S c.4 TO1 �Rt HI''�' �prL trl r , A ,,., Y'm VRU „','t „r,r.ui..l ; il y; 8', ,,,' �/� Si or outline ligh ng — a. .. - or limited- 0 2 . Signal circuit(s) Address: , Business name: _p 1 t ---- 14 r — energy panel, alteration, or Pape 2 '- w additi0d th inspection over — the hove /.,TI': h _ -10 i 1 al • "� City /State / iori in any of L' a ,y-i Li l PCr inspection 62.$0 0 • Phone: 6-0'7)1 I Fax: (S 0 'Lfo (C, ._, S" 6 LA `.s Investigation per hour (1 ht nu; • ? , CCB Lie.. l k Z C- Su i v. Lie.: Indusu"ial plmn iirr hou r.ic tr +c ai,l c '' P l -� i t _ z ( Q .,,, -� CLI( I'Hia n t St:,ft11f1' fl: i r��._. � Su blui t l f � _... _ ..._,. sup,. Electrtc'nut ';igtIol u Cc: • - - . malt ik:vik C''''' i Date: Stick,Li , ha r t , ( I' f itcrtutl it 6, 'f 7-- Print erotic' c , l � ht (Or t -- --- - -- .. . — Authorized I, — ..1 T - -- n . , n o with 180 .. - . . ' - �'�"'" _ - -.�_ - hie pe mh app l'�pitn :9 a pt'rt it i oat Irlai nCd . Date' Qalti a9'trt it h,t> I,, '�t ril V u't . mplc 1 tt� . t ' Print 11£1111 r', \ j t t ' ... 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