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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2013 00660 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/04/2013 Parcel: 1 S133DC03500 Jurisdiction: Tigard Site address: 13190 SW FALCON RISE DR Project: Neuman Subdivision: MORNING HILL NO.1 Lot: 28 Project Description: Reworking existing circuits in kitchen and bathroom. Contractor: GRIZZLY ELECTRIC Owner: NEUMAN,AMY C 8002 NE HWY 99 PMB#248 NEUMAN, DUSTIN VANCOUVER,WA 98665 13190 SW FALCON RISE DR TIGARD,OR 97223 PHONE: 360-909-4080 PHONE: FAX: 360-694-8939 FEES Quantity Description Date Amount 8 crt Branch Circuits wo/Purchase 11/04/2013 $108.12 Specifics: Service or Feeder 1 ea 12%State Surcharge- 11/04/2013 $12.97 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $121.09 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. Yo - --.- • of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. g q5,1‘--- -1 :3*, Issued •er•Mee 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. Grizzly Bea 360-694-8939 P. 2 Electrical Permit Applica'r. ( CEIVED )::Olt Oi l if ,: I 1.tl•,.1 •City of Tigard Received q '`' •►r ig Date/Bc: / 3 tT/! — Permit No.: j� �I l.,�c/�O ;. • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review r p Phone: 503.718.2439 Fax: 503,59�1(9t'rp 3 1 2013 Date/By: Other Permit. �[t/Y) 13()o 3p 7 Inspection Line: 503.639.4175 ``�' Date Rrady/By: hum. BI s©Page 2 for Internet<,;;ti 1:17 www.tigard-or.gov gr.gov Notified/Method: Zo Supplemental Information TYPE < ILTADF TIGARD PLAN REVIEW �l � ❑New construction dditl 4jlt 6b 1O N Please check all that apply(submit 3 sets of plans w/items checked below). ❑Service or feeder 400 amps or more ❑Building over three stones. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings. • less to ground,or exceeds 14,000 ❑Commercial-use agricultural 13-1.—and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder 0 Other. ❑Fire pump. ❑installation of 150 K VA or ❑Emergency system. larger separately derived system, JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑`A",`l".`t-2",'I-3 n 1001 W or more. occupancy. Job no.: Job site address: /3/�/u .51:✓ ,elr`i r,5e. 1�/- ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than/ ❑Hazardous locations 600 volts nominal. Puite/bIdgJapt no.: Project name: Nut,> ❑Service or feeder 600 amps or more FEE SCHEDULE ' Cross street/directions to job site: Description I ate. I ler I Total I • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 16854 4 Ea.add'1 500 sq.ft.or portion 33.92 1 Tax map/parcel no.: Limited energy,residential DESCRIPTION OF WORK (with above sq.II.) 75 00 2 S Limited energy,rgy,multi-family 75.00 2 % i,y/coi 1j Cg) 6�s 4, skis / bl (. residential(with above sq.It) Ic ZI� ` Renewable Energy ❑ See Page 2 ') AO) Services or feeders installation,alteration,and/or relocation ❑ PROPERTY OWNER l ❑ TENANT 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Q Name: 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation,alteration,and/or relocation Phone:( ) Fax:( ) 200 amps or loss 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 to 399 amps 168,54 2 'T.4-%'... Owner signature: Date: Branch cirruits—new,alteration,or extension,per panel ❑ APPLICANT [ ❑ CONTACT PERSON A.Fee for branch circuits with above service or feeder tee. 7.42 , Business name: each branch circuit B.Fee for branch circuits without ,,..7„,• ��Conta.ct name: service or feeder fix,first 56.18 77.--1 2 branch circuit Address: Each add'I branch circuit 7 7 42 57,lei 2 Miscellaneous(service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 dwelling,service and/or feeder Phone:( ) Fax: ( ) Reconnect only 67.84 2 2 E-mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: G 1e—/��s C f(� Signal circuit(s)or limited-energy See 2 Oh. Z panel,alteration.or extension. Page 2 2 Address: BOO z �/� (i `�/ 1 2'/ Each additional inspection over allowable in any of the above - `_ Additional inspection(I hr min) 66.25/hr City/State/ZIP: VttI,(CW kiee. /A 1-94t6 5-- Investigation(1 hr min) 66.25/hr Phone:( j) 9,9q-4p�j'0 Fax:(3 , )) L qt•j-- 5 / Industrial plann(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.:186�.( i I Electrical Lic.:Y7.���� /Suprv.Lic.: C C/�`� specifically listed(/z hr min) �yy��l�rtl'' d, r' �L " I ELECTRICAL PERMIT FEES Suprv.Electricians r ,required: L. � Subtotal: �• I k Print name: r„,4 �e/ eel Date: 004/` Plan review(25%of permit fee): r^' State surcharge(12%of permit fee): a,q 7 Authorized signature: �'' • ' TOTAL PERMIT FEE: /AI,Oq Print name: �., ,/// Date: —3/ —t,; This permit application expires if a permit is nut obtained within 180 fQ days after it has been accepted as complete. • Number of inspections allowed per permit. 1:\Buildir gWvmhstELC_PamitApp_PJ-R_ERE.doc Rev 05212013 440-46i ST(1 I/OS/C'OM/WFR •