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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2012 -00342 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2012 Parcel: 1 S134DB04000 Jurisdiction: Tigard Site address: 11165 SW 109TH AVE Project: Lehmann Subdivision:4HAN'S ADDITION TO THE CITY OF TI Lot: 2 Project Description: Panel change Contractor: A & J ELECTRIC Owner: LEHMANN, COLE E PO BOX 330 208 SLATER DR FOREST GROVE, OR 97116 FAIRBANKS, AK 99701 PHONE: 503 - 359 -5891 PHONE: 907- 699 -2653 FAX: 503 - 359 -1981 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 06/05/2012 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 06/05/2012 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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 OA - 001 -00 . You may o tain a copy of the rules or direct questions to OUNC by calling 503.232.198 or 1.8000.332.2344. 1 Issued By: Permittee Signature: ' ` 91 } Q Po n0 Q. 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. Jun 01 12 01:46p Leeann Gleason 503 -359 -1981 p.1 / (It Electrical Permit Applica FC L\j � '� ONI .1 City of Tigard J U N 0 12012 Reedved • 13125 SW Hall Blvd., Tigard, OR 9722 PAR ' $ • Peril* �-�/ d (a" �D r Phone: 501639.4171 Fax: 503.598.1 9 Z ateaB : Other Pernit T I G A R D Inspection line: 103.639.4175 G OF T IGA�D Date Ready/By. 1 Internet: www.tigerd or.gor , NO DIVISION ,( c „ Paget for S applemenlal Information ; � _ ,` ,y. 5ch ) - „ � ..r... ', '�'.* . i r '� -- '. -7,7".117`.,. - x J - - - l - 7 - w' S• pit '. ❑ New cons r _ . • - - . - :. ®Additi terat1071/r 1 I • cement cheek all that apply (submit 2 sets claims wviteme checked below): construction ❑ Demolition Other: El Setvioeor feeder 4 00atnpsormore ❑ Building over three stories. r - 't,,,1,-._ r where the available fault current !-e "tt z , S a © p. '` % .'= '< � �-'t � ^;'t!. �`'Y"'��'� �, ,: ezeeeds l_Ovoltso ❑ Flwtia boatyards. ens 14 - . _ . - � _.�_ . , tea 1. - ..:a_• -- ' F _-‘-..v.:- :_ y builder. ins ® I - and2- family dwelling ❑Commercial/industrial ❑Accessory building amps fo or []bo . ❑ Multi laseagiwltarrl y ❑ Master builder for ail °�� installations Installation ❑ Other: arum amp. - -. : V -a: = •_ , '-' ..A aFr , - _ 3 ,f sl ,n t - OE>ner •y system. lnslalla[ien of 75 KVn or - : . 1 '.' ". " . .: • . , .; -, Z: r - , : ter` ! • . S-w ::,%:,, ;3;w .2:..._ c L larger E ''. "1 eel 1 system. y d z_. ❑ Addi of new motor load of ❑ - A', .•E' - 1 - "1 3" Job no.: Job SitC address IOO IP ormore. occup 11165 SW 109th Ave ❑ Six or more residential unit. ❑ Recreational vehicle packs. City /Slate /ZIP: Tigard, OR 97223 0 Healtb-can facilnies. 0 SSppI) voltage for more than ❑lfazendoas locations. 600 volts nominal Suile/bldgiapt. no.: 1 Project name: ❑ Service or feeder 600 amps or more. Cross street/directions to job site: --'7':---''-::::". ' F ' 't` DyeeApaoe Qrs. Fee Tool • New residential single or multi-family dwelling unit Includes attached garage. Subdivision: 1 Lot no.: 1.000 sq. ft or less 168_54 14 Tax map/parcel no.: Ea. add'l 500 sq. ft or portion 33.92 1 N Y' y ` W 1 L C �' yy x; '" w ,t : s I k Limited energy, residential • i JY i ll :t1� Q 11..,1 t .V:. ,' ;',. :;1,4.... aS t � _. •-.�•: � ^ �i,"i , • LR ... . . _ (with above s R) 67.84 2 Panel change, limited energy, multi- family residential (with above sq. P..) . 67.84 I 2 Services or feeders installation, alteration, and/or relocation o i� - 'i� x ? `' r' 200 amps or less 1 100.70 100.70 2 . 1.. te a` ..... T . 1.. s 201 amps to two amps 133 _56 2 Name: Co - Lehmann 401 amps eo600amps 200.34 2 Address: �� 601 amps to 1,000 amps 301.04 2 11.65 SW 109th Ave Over 1,001 amps or volts 552. City /State/ZIP; 2 Tigard , OR 9 722 3 Temporary services or feeders installation, alteration, and/or Phone: 1 relocation 907 ) 699 -2653 I Fax: ( ) 200 amps or lass 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.0B i 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 l 2 Owner signature: Date Breach circuits- new, alteration, or extension, ter panel h ., 4 A. Fee for branch circuits with �. �: .:. . L_� ti° .' I .r: :lt';< '. r above service or feeder fee, l Business name: each brooch circuit 7.42 1 2 B. Fee for branch circuits Contact name: without service or feeder fee, _ first branch circuit 56.18 I 2 Address: Each add'I branch circuit 7.42 2 Ci[y /StatelZlP: Miscellaneous (service or feeder not included) Each manufactured or modular . Phone: ( ) ) dwelling, service and/or feeder 67.84 2 Fax:: E-mail: Recomreetonly 67.84 2 Pump or irrigation circle _,. ,,, .. i r 67.84 2 �y,� >L rt_t: �. , r4. �:'.fiS�tia , 14• ° nil Sign or outline lighting 67.84 2 Business name: A&J Electric, Inc Signal crrcult(s) or limited- ' Address: PO Box 330 energy panel, alteration, or extension. Describe: Page 2 12 . City /State/ZIP: Forest Grove, OR 97116 ' � ( , h l Each additional Inspection over allowable iu env of the above I �( fi Li c.: 959 Phon:: (503) 359-58 9 1 Fax: (503) 359 -1981 I ►r ,_ : r Per insection f 66.25 (� ' _ investigation per hour p hr min) 66.25 - I leclricai Lie.: 34 -1c uprv. r- '4 Industrial plant . r hour 78 Suprv. Electrician signature, required: ' P.. ?A` • :4:: ,:-.7 r. Print name: Anthony Wilson Subtotal: 100.7 I Date: 6 / 1/12 mon review (25% of permit fee): Authorized sictlature: State surcharge (12% of permit fee): TOTAL PERMIT FEE: Print name: 112.74 Date: This permit application expires if a permit ie Dot obtained within 160 day after It has beta accepted as complete. r'•au rni P i's' t c Pc m rnpp,30o raorm9 • Number ofinapecaons allowed per pen sit 44.461 ST(1 t /'01;CpMAVFR