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Permit CITY OF TIGARD ELECTRICAL PERMIT • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00082 T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/04/2013 • Parcel: 2S 111 BCO3400 Jurisdiction: Tigard Site address: 10405 SW VIEW TER Project: Gosselin Subdivision: DOUGLAS HEIGHTS Lot: 7 Project Description: Panel change Contractor: WEST SIDE ELECTRIC CO INC Owner: GOSSELIN, BETTY J REVOCABLE TRUS 1834 SE 8TH AVE 10405 SW VIEW TER PORTLAND, OR 97214 TIGARD, OR 97224 PHONE: 503 - 231 -1548 PHONE: FAX: 503 - 736 -0677 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 02/04/2013 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 02/04/2013 $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. ATTEN : Oregon - re. ' = you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -00 throug OAR 952 -00 -• ' 90. Yo ay obtain a copy of the rules or direct questions to OUNC by `.1987 or 1.800.332.234.. // Issued ` � ' Permittee Signatu i 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' 10.1/ <49 Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. Thls 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. RECEIVED ramie: aVJ: t 17!:6439 CMMR: y03. 9a.l91511 Iii iitiy; Cane herunt: u Inspection Line: 503.639.4175 . JAN 3 1 2013 Date ReadyBy: 1uri See Page for Internet www,tigard- or,gpv Notified/Method: Supplemental Information ... .: :�lE: O)R'..WO� .. , . i�'.. .:. • • • � ': • r•` . •` : rr, 'C::; � `.;� ;�:�PIIAl�A': • ❑ New construction - Addition/alteration I L onSION please cheek all that apply (submit t sets Of plans w /items check ed below); El Demolition ❑ �; where available 0 Service or feeder 400 amps or more ❑ Building over Nee stories, > : M1 boatyards. fault current Marinas and boatyar .. , ; '' CATEGOR'L O : T,g1'RUCflON .:. :. - :. :. '.. •:! •. f : ' '•' ;: ;;r.; 0 ,: exceeds 10,000 amps at ISO volts or 0 Floating buildings, less to ground, or exceeds 14,000 ❑ Commercial -use agricultural and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings, ❑ Multi family 0 Master builder • :•. :,::,:,,: , - .: . . 0 Fire c e arn ❑ l arge of KVA er b 0th P� lotion o or 0 :rC °':!*$.;" 51 IQ ltit MATI tlif,* ;tri0(iA Q ' ;:z`..!,1 ;:: ::,:':'.:' '`.;^:`; ° ition o f new alga separately derived system . � ..ti... �. � +��` ?•`' `.� '�•:` . .:'`'.:.•�. Addition o for load f Job no. : Mg 1 5 Job site address: I � CS SW \/I, e. ; --Y.Q �� I ❑ Six or morn. oaapa i o n, x or or mote residential units. ❑ Recreational vehicle pork9, City /StaterZIP L•i 0 Health -care facilities, 0 Supply voltage for more than l ltat:r a �2 1 Oitomraouslo�ltions 600 volts nominal. • Suite/bldg./apt no.: JJ I Project name :C. — (d 1Y1 j C t? ` ©Stavt00 0r feeder 600 amps or more, " ..•.«•.fir k��SC1�ID� Cross street/directions to job site: Desceiptlon I Qw. I Pee. t To t.l New residential single- or multi family dwelling unit Includes attached garage. Subdivision: Lot no.: 1.000 sq, & or less 168.54 4 Tax map /parcel no.: Ea. add'I $00 sq. ft. or portion 33.92 I it Limed energy, 75.00 2 �.: w „-; r �, < ,';.• 4:,..,.,: , M1 • icsidential • .:.::��-: ; ;+.; ;�- • •...• !r ) i b� ► ;��f!OItICv?. ? ; "::�. ';(": �:,:'�- t.�:u4•:. L, •v�'u �.' Y 41:1{! nl;i (with above aq. ft) Limited energy, multi - family 75.00 2 1 ( .y .� ttr\ Ole residential (with above so, R) Services Or feeders instalIation and/or relocation 200 amps or lass I 100,70 100.10 2 , - •;ac'. g*? ;' -1w' -fir`; ;iQ" �r .�.�r . • ;r::' . .. rq.,. ;.V. 201 amps to 400 amps 133,56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 , Temporary services or feeders insmllgtion, alteration, and/or City/State/ZIP: relocation Phone: ( ) [Fax:( ) 200 amps or less 59,36 I Owner installation: This installation is being made on property that i own which is not 201 amps to 400 amps 125,08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps i0 599 amps 168.54 2 Branch circuits — new, alteration, or extension, per panel Owner signature: , Date: A. Fee for branch circuits with • • ;. ■' " ": •"'' N, ° •ice sri;y bove service or e, [� 'AiI��CA,Mr:: % ; ;.'`il:. �'•%;,-, '�� „CAtil�cxxltSON =,,,. ,.G� ;�TT%i: a each branch circuit feeder k 7.42 2 Business name: B, Fee for branch circuits wlthpvt - service or fecdcr fee, first 56.1 2 Contact name: branch circuit Address: Each add'! branch circuit 7.42 I , 2 Miscellaneous (service or feeder not included) City /State/ZIP: Each 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 + , ChM, ski Signor outline lighting 67.84 2 !..t0 L' A O `:1 , }�v !s'` . :t il:. °� ,,is '': � '” x:= '' ° �� : '� Y � :. ,, Signal cinvit(s)orlimited-energy Business name: West Side Electric Co., inc. panel, alteration, or extension. Pape 2 2 Each additional inspection over allowable in any of the above Address: 1834 SE 8` Ave. Additional inspection (I hr min) 66.25/ hr City/State/ZIP: Portland/OR/9 7214 Investigation (1 hr min) 66 25/ hr Industrial plant (I hr min) 78,18/ hr Phone: (503) 231 - 1548 I Fax: (503) 736 - 0677 Inspections for which no fee is specifically listed (4 hr min) 90,00 / hr CCB Lic.: 13306 J Electrical Lic.: 26 -135C I Suprv. Lic.: 4654 -S Srz: r; _'c::!l:rV;is >ELT.,C1g>[ ap)E) r:'.pEES..: • . Suprv. Electrician signature, requi • , Subtotal: (np,'°2 0 �-� i Plan review (25% of permit fee): Print name: Randall F Roberts Date: t - T 1'� State surcharge (1 fee): il- r tr j TOTAL PERMIT FEE: 1 l 2. , —j p Authorized signature: This pet7nk application aspires if a permit is not obtained within 1 84 days after It has been accepted as completes Print name: Date: • Number of inspections allowed per permit 8't IAtiuUdln ¢IFernohs&C.ParniAeo.eee 07/01 /10 mn,atiiWI lm o- rnunvnn Z /1 # L866L£Z£05! 0961.86S609: °!a } °a13 aP!S ;s9M:woJd: L5:91f£L -LE -LO