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Permit (16) — CITY OF TIGARD ELECTRICAL PERMIT `g! ' • COMMUNITY DEVELOPMENT Permit#: ELC2016-00659 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/25/2016 Parcel: 2S103CA02400 Jurisdiction: Tigard Site address: 11900 SW JAMES CT Project: Hartley Subdivision: TRAVPORT PARK Lot: 4 Project Description: Replacing panel and adding(3)branch circuits. Contractor: AC ELECTRICAL CONTRACTOR LLC Owner: US BANK NATIONAL ASSN TR 5 CENTER POINTE DR SUITE 400 BY CHAMPION MORTGAGE CO LAKE OSWEGO, OR 97035 8950 CYPRESS WATER BLVD COPPELL,TX 75019 PHONE: 503-910-3514 PHONE: FAX: 503-845-9633 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 08/25/2016 $100.70 Specifics: amps or less 3 crt Branch Circuits w/Purchase 08/25/2016 $22.26 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 08/25/2016 $14.76 Electrical Type of Const: Occupancy Grp: Total $137.72 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notif tion Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y• ..- •. ,'i a •• - ules or direct questions to OUNC by calli g 50 2 .1987 J�\\1.800.33122 4. Issued By: g714---71.04.--- _�---� Permittee Signature: \ 6 OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application "� FOR OFFICE t SE ONL.l CityofTigard Received Permit#: 11111 0 13125 SW all Blvd.,Tigard,OR 97223 DateBy: �$�/��p ��p2c)�(o-- �� g � ) Plan Review Phone: 503.718.2439 Fax: 503.598.196 q%16 Date/By: Related Permit#: A' 1(0,...a311 T 1 GARD Inspection Line: 503.639.4175 0.), $� 8vdy Date/By: Juris H See Page 2 for Internet: www.tigard-or.gov ,'rti -d/Method: Supplemental Information ME I ' i'+ '� ,., ' 1C�Y . � - ., ,,cam.. D New construction RAddition/alteration/repk(, Ile a Please check all that apply(submit 2 sets of plans w/items checked): f acs ' ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: S� S where the available fault current ❑Marinas and boatyards. `` CATEGORY ,,,,, '!PRU , t, l/ - exceeds 10,000 amps at 150 volts or „• ;,'„ , � ,�, 0 Floating buildings. g 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or 41tI E'INFORMATION,AND » i15 a ❑Emergency system. larger separately derived Job#: Job site address: t :2..7----"'";_ ❑Addition of new motor load of system. 4 t q Q G .�C.'� �,y--C� _ 100HP or more. 0"A","E","1-2","1-3", City/State/ZIP: / ❑Six or more residential units. occupancy. k Cit 4, ( � . 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: Description Qty. I Each I y Total New residential single-or multi-family dwelling unit. Subdivision: 1 Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel# Ea.add'l 500 sq.ft.or portion 33.92 1 i i `,:• !e, ov:, ; 4l l #3.. ..OF W:„ oLimited energy,residential 75.00 2 (with above sq.ft.) cp LCy w-.k A df (,4 4 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 `" f C Y 4(c-,:—•:-1 'or!.Renewable Energy 0 See Page 2 ,ERTY OWNER �'� '• ' 0 TEN, „,,`1:\--c,,, _ :. Services or feeders installation,alteration,and/or relocation Name: 200 amps or less E 100.70 /O(J t-70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) J Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 1: Branch circuits-new,alteration,or extension,per panel � ....'. :�GAT�"I' I ©"', aN�rACT PE11�I`� A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without service or feeder fee,first Address: branch circuit 56.18 2 City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder Reconnect only 67.84 2 "n;, Y ,, CO•;",:• 1 ,moi` ,- Pump or irrigation circle 67.84 2 Business name: It Ct.p C i t k ti._ � CS { I 9 (' Sign or outline lighting 67.84 2 /� ^1%.- -- Signal circuit(s)or limited-energy Address: 5 c..�y,�,G, f t I ,,6_,_ ` �s v`4 e cm, panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP: /�� ` Each additional inspection over allowable in any of the above 43 I Q Additional inspection(1 hr min) 66.25/hr Phone:(5:53) Ct (l 3 J /9 Fax:( ) Investigation(1 hr min) 90.00/hr Email: `! Industrial plant(1 hr min) 78.18/hr Likv P C3 c Y t C 1 cq��1 p..V�c,. Ll C c/CA.k-k Z -- uk Inspections for which no fee is 90.00/hr CCB Lic.: ii_a S s- Electrical Lic.: t Suply.Lic.:$ 1 p, p specifically listed(%2 hr mm) h0 ,a_ , .: EINE 11, ` 5 Suprv.Electrician signature,required: IA � A4tt1 bit o iA c'tiMtI lOcSubtotal `?�—.Tc.Print name: (� nt t 1l� Date: Ol p�/ f( ❑Plan Review Required(25%of permit fee): ( l State surcharge(12%of permit fee): /41`.`70' Authorized signature: TOTAL PERMIT FEE: ► P 3 7 7.2, This permit application expires if a permit is not o i tamed within 180 Print name: Date: days after it has been accepted as complete. : Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 11900 SW JAMES CT, TIGARD, OR, 97223 Record Type: Residential - Electrical Inspection Type: 199 Electrical final Result: PASS- NoCofO Comments: Violation Summary: Inspector Tel: 503.718.2439 Inspection Date: Record ID: ELC2016-00659 Inspector: Jeff Grove Contractor