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Permit CITY OF TIGARD ELECTRICAL PERMIT 0 : COMMUNITY DEVELOPMENT Permit #: ELC2012 -00186 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/03/2012 Parcel: 2S 111 AD01900 Jurisdiction: Tigard Site address: 14580 SW 88TH AVE Project: CHAMBERLIN Subdivision: PINEBROOK TERRACE Lot: 16 Project Description: Power for electric mini - boiler. Contractor: GENIE ELECTRIC CONSTRUCTION INC Owner: CHAMBERLIN, GENE H 8701 SE 156TH AVE EILEEN J HAPPY VALLEY, OR 97086 14580 SW 88TH AVE TIGARD, OR 97223 PHONE: 503 - 762 -9296 PHONE: FAX: 503 - 762 -9188 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 04 /03/2012 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 04/03/2012 $6.74 Type of Use: SF 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 obtain a copy of the or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. "- Issued By: - 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. y Mar.30.2012 05:02 PM Genie Ele \ Constructi 503 762 9296 PAGE. 1/ 2 Electrical Permit ADalicati e ,� 1,'()R rir cl1.I�"l:1 r: ��.1.) City of Tigard ��' ti% Received 13125 SW Ball Blvd., Tigard, o �0 •)',S) Dates i � s• 1r ~ I 111 t .'� \ Other Permit: ER �� 11 Phone: 503.639.4171 Fan; 503. 98.19tP .` \(j , , , ; ,., i ; , , Inspeclinrl Line 503.639.4175 O ff( \�\ Date Ready/By; &I See Page 2 for Internet: www.tigard- or.gov \- 1 , \ 4Q Naifed/Method; A� Supplementollnformation • TYPE OF WOKi V PLAN REVIEW ' ID New Construction A(Idition/alteratio pineement Remo check all that apply (submit j sets of plans w /items checked below); Other: ❑ Service or lbcder 400 amps or more ❑ Building over three stories. ❑ Dcm0111ion ❑ where the available Ibult cwmnt ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION weeds 10,000 amps at 150 volts or D Floating buildings. ba I - and 2- family dwelling ❑Commercial/industrial 0 Accessory buildin has «,not p b i ld ings .nl•nse,tar�nll„rnl g amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump, 0 Installation of 75 KVA or JOB SITS INIPORMATION AND LOCATION • Q Emergency system. Larger separately derived system. . D Addition of new motor load of C3 "A", ••t •2". - l-3', Job no.: 7 ; a Job site address: 1 g' ) 100HPormorn eec �/ ❑ gin or mn,e ,esldnntial noiw. Cl Recreational vehicle perks. • City/State/ZIP: r, • `T O Health•eare facilities Supply voltage rot mom than CI Hrrardous locations. 600 volts nominal. Suite/bldg. /apt. no.: 11 Project name; J9") : /7 ❑ ServIce or feeder 600 amps or mom. FEE SCHEDULE Cross street/directions to job site: trod —"" . New residential single- or multi - family dwelling unit: Includes attached garage. Subdivision: I Lot no.: 1,000 sq. IL or lest 168.54 4 E. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. R.) /" �} / is- Limited energy, multi- tinnily 75.00 2 Q (0 4 .t7/i '�ta V /5d 6 ('e ,L.w 6 Services l orfceden o e sq. ion, alteration, and/or relocation al, / a / N 6 q.r at 6.. 200 amps or less 100.70 2 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133,56 2 • 401 amps to 600 amps 200.34 3 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 1 2 Temporary aervicea or feeders installation, alteration, and/or City /State/ZIP: relocation Phone; ( ) I 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 maps to 599 amps 168.54 2 Braaeh tlreui a - alteration or extend() . er • ael Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑CONTACT PERSON above service or feeder fee. 7.42 1111 ; each branch circuit Business name: � �,p,�1 + ( � � 8. Fee or circuits without r " w � f ' � � service ice or Ibeder fee, first O Contact name: /..P�!'C O C If , branch circuit w 2 �L:- Miscellaneous iq MIs addi 7,42 2 1 Address: /510 cellananeoua (selvlt a or feeder not included) O Clty /State ZIP: !4, p1120.1 ,� p A , k © Each manufactured or modular g�p dwellinervice and/or g,_ s . f eeder 6784 2 N. Phone: (Sr?r�.2 ,_4 d Fax ) Reconnect only 67.M 2 0 Pump or irrigation circle 67.84 2 E -mail. _ Signor online lighting 67.84 2 CONTRACTOR Signal eircuit(s) or limited-energy / Business name: C / j�,. �mtcl, alteration, or exlensiat. Page 2 _ 2 �� r (��t /+ ` � L.(�� Each additional Inspection over allowable in any of the above i Address: 415101 .56 { t 1 �I p Additional inspection (I hr min) 66.25/ hr .� / V Yell. / C qG� Investigation (I hr mm) 66.25/ hr City/State/ZIP: 4- �n ( IcWusuwl plain (I hr min) 78.18/ hr Phone: ('05) 74, ..q Fax: ( 55 �) 7 a ` QI Inspections for which no fee is 90.00/ hr L 1 - r4 - specifically liste (K hr min) G COB Lie.: 5 66 y Electrical Lie.: 3q-�f Suprv. Lie.: by (p 5 _ ELECTRICAL PERMIT. FEES Suprv. Electrician signature, required: _ Subtotal: r Plan review (25 %of permit fee): e Print name: I ' . f V a �, 1 Date: State surcharge (12% of permit fcc): d . 111 V /e,-,,ivia TOTAL PERMIT FEE: 4 �� Authorized signature: • this permit applicnaoa cspiren It a permit is not obtained within 180 Print name: L- p ( Date , . days after it Ira. trees accepted as complete. a Number of inspections allowed per permit. t:l&dldiaaVera InELC-M+mMpp.dsa 07/01/IO 410 4615Th 1/0VCOM/wEa •