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Permit _ y n CITY OF TIGARD ELECTRICAL PERMIT " s COMMUNITY DEVELOPMENT Permit #: ELC2013 00282 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2013 Parcel: 2S103CA00106 Jurisdiction: Tigard Site address: 13475 SW 115TH AVE Project: Morganthaler Subdivision: 2008 -056 PARTITION PLAT Lot: 3 Project Description: Kitchen remodel, (7) branch circuits. Contractor: OWNER Owner: MORGENTHALER, CASS MORGENTHALER, JENNA 13475 SW 115TH AVE TIGARD, OR 97223 PHONE: PHONE: 503 - 209 -2630 FAX: FEES Quantity Description Date Amount 7 crt Branch Circuits wo /Purchase 05/21/2013 $100.70 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/21/2013 $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. ATTENTION: Oregon law requires you you to follow the rules adopted by the Oregon Utility Notification Cente . Those rules are set forth in OAR 952 -0 0010 through OAR 952- 0 ,l may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 or 1.800.332.2344. z. Is ued By: • �Q//i22" " '- Permittee Signature: ?( OWNER INSTALLATION ONLY The installation is being made on property wn which is of intended or -le, lease or rent. i / //� OWNER'S SIGNATURE / f % ��% -7 X � //V Date: 3 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. 5/i 1/3 2 E /5 -ooa G i ON C' �,� l ,, Electrical Permit Application ah 1 3 `� .� - ' Washington County, 155 N. 1 AV, Suite 35i� " "r�, st 9 124 : 503 -846- 4 5 3- 4 , - t ` °'° a OREGO Phone 3 70, F x: a 0 8 6 3993, ' ! � Inspection Requests: 503- 846 -3699, www.co.waghitlito!.4.un 3 TYPE OF WORK PLAN REVIEW ❑ New construction ;21. Addition /alteration /replacement ❑ OtheI OF i KUik( U Please check all that apply: rr B t� &'/+ � (� Service or feeder 400 amps El Hazardous locations Buil l 1ING l_11 \Ic. I °' or more where the available ❑ Service or feeder 600 amps or more CATEGORY OF CONSTRUCTION fault current exceeds ❑ Building over three stories kl 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building 10,000 amps at 150 volts or ❑ Marinas and boatyards less to ground, or exceeds El Floating buildings ❑ Multi ❑ Master builder ❑ Ot her: 14,000 amps for all other JOB SITE INFORMATION AND LOCATION installations. ❑ Commercial -use agricultural El Fire pump buildings Job no.: Job address: /3417 S - 5,., Ji S tm Ape ❑ Emergency system ❑ Installation of 150 KVA or larger separately derived system (� El Addition of new motor El City/State /ZIP: 7' Ord (� Yom- ! 7ZZ g load of I00HP or more "A," E, 1 -2, 1 -3" occupancy Suite/bldg. /apt. no.: // Project name: ❑ Six or more residential units El Recreational vehicle parks b r g (t2� ❑ Supply voltage for more than 9 ❑ Health -care facilities 600 volts nominal Cross street/directions to job site: A 11 12t/ e. FEE SCHEDULE Description Qty. I Fee Total * Subdivision: Lot no Residential single- or multi - family dwelling unit. Includes attached garage. Tax map /parcel no.: 1,000 sq. ft. or less 163.75 4 DESCRIPTION OF WORK Ea. add'I 500 sq. ft. or portion 46.00 1 � / Limited energy, residential 105.00 2 /{ / 1AC ,ULUiv APemDSiiL (with above sq. ft.) Limited energy, multi - family 105.00 2 residential (with above sq. ft.) (r PROPERTY OWNER ❑ TENANT Services or feeders installation, alteration, and/or relocation ^ 200 amps or less 105.00 2 Name: L ASS h 99C/J J4- L 47 ✓G S /V '}Y10( )°.-- 201 amps to 400 amps 158.00 2 Address: ) 3 q7.1" SW f l '* /O I/ e... 401 amps to 600 amps 210.00 2 City/State /ZIP: �qe rd ©r- 67 z z T Over 1,000 to amps amps 60.00 2 Over I ,000 amps or volts 630.00 2 Phone: ( 5,43) Zdg 76 36 Fax: (S 03 ) 7 66 d 3 y9 Temporary services or feeders installation, alteration, and/or relocation Owner installation: This installation is being made on residential or farm property owned by me or a member of 200 atups or less 105.00 2 my immediate fancily. This roperty is nn intended ors Ic, exchange or rent. (ORS 479.540(1) and 479.560(1). 201 amps to 400 amps 158.00 2 Owner signature: r 44 " . 7 Date: ���49 401 amps to 599 amps 210.00 2 ❑ APPLICANT I=1 CONTACT PERSON Branch circuits— new, alteration, or extension, per panel A. Fcc for branch circuits with Business name: 4 4 above service or feeder fee, 9.25 each branch circuit 2 Contact name: B. Fee for branch circuits cep. / 5-- . /9 without service or feeder f J &� / 0 fee, first branch circuit Address: 2 . , City/State /ZIP: Each add'l branch circuit 6 /.°L W. Miscellaneous (service or feeder not included) Phone: ( ) Fax: ( ) Each manufactured or modular dwelling, service, and/or feeder 111.25 2 E - mail: Reconnect only 105.00 1 CONTRACTOR Pump or irrigation circle 105.00 2 Business name: 14 Sign or outline lighting 105.00 2 Signal circuit(s) or limited - Address: energy panel, alteration, or 105.00 extension. Describe: City/State /ZIP: 2 Phone: ( ) Fax: ( ) Each additional inspection over allowable in any of the above Per inspection 105.00 E -mail: CCB lic. no.: Investigation fee (See compliance) Electrical lic. no.: City or metro lie.: Other: Supervising electrician ELECTRICAL PERMIT FEES Subtotal signature, required: �- /°°' Print name: Date: Plan review ( 25% of permit fee) — ' State surcharge (12% of permit fee) /A, og Authorized /�j/ff signature: mete �/ie,"11 74 TOTAL PERMIT FEE ' .7 8' y� S This permit application expires if a permit is not obtained Print name: � A $S "fa rG C/✓ ivicti.ev Date: /zgr /,3 within 180 days after it has been accepted as complete • Number of inspections allowed per permit. Revision 6/12 Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 13475 SW 115TH AVE, TIGARD, OR, 97223 Residential - Electrical 199 Electrical final 2013-10-29 00:00:00 ELC2013-00282 PASS - No C of O Violation Summary: Inspector Contractor