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Permit �k$ CITY OF TIGARD ELECTRICAL PERMIT ° COMMUNITY DEVELOPMENT Permit #: ELC2010 -00116 ft f GrCRLy; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/11/2010 Parcel: 2S111 DD10500 Jurisdiction: Tigard Site address: 8570 SW STRATFORD CT Subdivision: CHESSMAN DOWNS Lot: 31 Project: Boggs Project Description: Electrical reconnect for furnace replacement. Owner: FEES BOGGS, ANDREW Quantity Description Date Amount 8570 SW STRATFORD CT TIGARD, OR 97224 1 crt Branch Circuits 03/11/2010 $56.18 wo /Purchase Service or PHONE: 503 - 684 -1686 Feeder 1 ea 12% State Surcharge - 03/11/2010 $6.74 Electrical Contractor: OWNER PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 Required Items and Reports (Conditions) This permit is is - - • su•lec • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in - cordance with appro• - • • • ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATT' NTION: Oregon law e.uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -' 91 0 thro gh OAR 952- o ,- obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.3322344 (V'�� /�.�1� tom Permittee Si ure: ^: "i e! Issu • By: g OWNER INSTALLATION ONLY The installation is being made on pr pe I hick is not intended for sale, I age or rent. OWNER'S SIGNATURE Date: /e, CONTRACTOR CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. Electrical Permit Application . , i O R 0 1 i (l iS O N ti. � < � � ��_, F / ,a ph. . . Cit o Ti g ar d Date/B Received : / Permit No.: hC 09010'05/ ' ( L q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 13 Phone: 503.639.4171 Fax: 503.598.1960 DateB : Other Permit:W JJ„, _ q I, Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for IL: Internet: www.tigard - or.gov Notified/Method: Supplemental lnformation ' TYPE OF WORK PLAN REVIEW ❑ New construction '- Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ 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 R 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: Job site address: GT I00HP or more. occupancy. f35 Sw SYA�T r� n ❑ Six or more residential units. 0 Recreational vehicle parks. City /State /ZIP: `Ty6 ACID, b CL g -72Z4 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: 8`7 1 1't '' h r4wl l STrr GT_ Description 1 Qty. 1 Fee. I Total 1 New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential (with above sq. ft. 67 2 DESCRIPTION OF WORK ( q ) Limited energy, multi - family 67.84 2 0—C_pt— 'c Fj vyl 14CC / Ire er_i el tvj 61GC:.11✓10r1t, residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 & PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: A.n Drw C. / 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: 83'70 St,t - S fl14 — 043 C j Over 1,000 amps or volts 552.26 2 - n 6 ykri6 ©riZ Temporary services or feeders installation, alteration, and/or City/State /ZIP: �`'' j&. 'I`1 relocation 6e- f Phone: (.03 ) -k Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that 1 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 599 amps 168.54 2 / Branch circuits - new, alteration, or extension, per panel Owner signature' c -'— ' Date: O- / // / /t% A. Fee for branch circuits with ' ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first l 56.18 See .1 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 y dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (% hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT .FEES Suprv. Electrician signature, required: Subtotal: 5 ( , . Plan review (25% of permit fee): . - Print name: Date: State surcharge (12% of permit fee): . 7 ef TOTAL PERMIT FEE: (QA l Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. I:\ B uilding \ Permits\ELC- PennitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB