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Permit (42) CITY OF TIGARD ELECTRICAL PERMIT Permit#: ELC2017-00401 111 COMMUNITY DEVELOPMENT � > 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/01/2017 T["~ •"�f' Parcel: 2S104AD03504 Jurisdiction: Tigard Site address: 12800 SW WALNUT ST Project: CULWELL Subdivision: None Lot: None Project Description: (3)branch circuits for garage addition and hot tub. Contractor: ALTEC ELECTRIC LLC Owner: CULWELL, LESLIE D AND 9655 SW NORTH DAKOTA ST STE#23 DIANNA L TIGARD, OR 97223 12800 SW WALNUT TIGARD, OR 97223 PHONE: 503-888-9505 PHONE: FAX: 503-372-5501 FEES Quantity Description Date Amount 3 crt Branch Circuits wo/Purchase 06/01/2017 $71.02 Specifics: Service or Feeder 1 ea 12%State Surcharge- 06/01/2017 $8.52 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $79.54 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. You may obtain a co ules or direct questions to OUNC by calling 503.232.1987 or 1.800. .2344. Issued Permittee 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 603.639.4175 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. moi" e' Electrical PermitApplication ,.,-,,,:c4\+" ,,, FOR OFFICE USE ONLY A(44\ . Received City of Tigard `A Date/B . - 1I 11 ■ 13125 SW Hall Blvd,Tigard,0'• w!,' � � '\t Plan Review �. Phone:ill 503.718.2439 Fax: 503• 1960 "� l0 Date/B RelatedPemiti _- T i c h n Inspection Line: 503.639.4175 \)� ' Ready Date/By: ® - Page 2for Internet: wwwtigard-orgw (Vo Iiii�'� ill I �-y NotifiedlMelfio� information 1�OF IIS : w 1 PLAN REVIEW New construction A ddltion/alterati• ► '�' "1 Please check ell that arpiy(submit 2 sets of plats witterrs checked): Service or feeder 400 errs or more Buldng over three stories. Demolition Other' lit, where the available fault arrert Marines and boatyards. ,044FifitOOF OF coSsiRuCtioN exceeds 10,000 amps at 150 vdts or Floating bullrings. 1-and 2-family dwelling I/ Conerciairndustrial Accessory building lesstogr«.d aexceeds14,000 carmherctai ueeegriadtural mr wnpsfor WI other installations. buildrgs. Multi-family Master builder Other: Fire pump. Installation of 150 KVA or INFO MAT N AND LOCATION., ,." „ = EmergencyAddtion of new load of system larger separately derived motor system Job#: I Job site address .'12 00 S W vJct l AU Z S z, 1o0HP or more. "A","E","1-2*,"1-3', City/State/ZIP. Ti O Y q ©R 9 7.2 2; Six or more residential units. occuPancY- Health-care facilities R verde parks. 0o Suite/bldg./apt#: I Project name: Hazardous locations. Supply voltage for more than Service or feeder 600 an>ps or more. 600 volts nominal. Cross street/directions to job site >SCHEDULE Drviolim I Orz I Each I total I * New residential single-or mufti-family dwelling unit Subdivision: Lot#; includes attached garage. Tax map/parcel# 1,000 sq.ft or less 168.54 4 Ea addI 500 s4 ft.of portio33.92 1 DESCRIPTION OF WOR Limitedatergr,residential ,.,t ) (with abae sq ft.) 00 2 ��i'O( e lu`r i✓/ h o� L v b f Joo op-hoicks t uo Limted energy, Liti-family gY h�t&i e r V S ' id d(with above s4 ft.) 75.00 2 ._ Renewable Enemy See Page 2 .v ' OWISal I .. 1044 Services or feeders installationnalt ration andkr relocation Name: 200 arrps or less 100.70 2 Address 201 slim to400artps 13356 2 401 arms to600arps 200.34 2 City/State/ZIP. 601arrpsto1,000awe 301.04 2 Phone:0 I Fax:0 Over 1,000 amps or volts 55226 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 nal 200 amps a less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 arrpsto400amps 125:08 2 Owner signature: Date: 401arpsto599arrps 168.54 2 Brandt drafts-new,Maratha!,or extension,per panel A.Fee for branch draits Kitt Business name: above service or feeder fee, 742 2 each brarxit trait Contact name: B.Fee for branch draits without servioe or feeder fee Address transit draft 'fits 5618 7 2 City/State/ZIP: Each addl branch droit 7.42 2_ 2 Miscellaneous(service or feeder not included) Phone:0 Fax::0 Each menufachred or nloddar dMellino. vice and/or feeder 6784 2 ser Email: Recamect only 67.84 2 CONTRACTOR Rrrp or irrigstim drde 6784 2 Business name: pt i'ce_c Eisitsi.p r'c l_L C.._ Sign a outline licrting 67.84 2 Signal drait(s)a limited See Page 2 2 Address p 0,Gox 1(-001© panel,alteration,a extension pp �2 �a Inspection over allowable in any of the above City/State/ZIP': f R ND Additimal inspection(1 hr min) 66.25/M Phone:0,S03-88',-4SO5 Fax:0503-02 34 — -4-6114 Investigation(1 hr min) 90.00/hr Irdatrial plant(1 hr rrin) 78.1$/hr Email: V l le-'tO la GQ 4- L0 1:10@__G fitea. a • el i Inspections for which no fee is 90.00/IT CCB Lic.: IS ;12c) I Electrical Li„Si-103 �;,,.Lic.: 43gq-S speaficailyhsted(14Mmn) T"f>1 Suprv.Electrician signature,required Alb.. � - . / " ��,�//�l ICAL P RMISubtotal: 1_e), Print name: f&U r N tyt 0 f' " Date: 5-3O- /Z- Plan Review Reglired(25%of permit fee): State surcharge(12%of permit fee): �- , TOTAL PERMIT FEE: 1/.511 Authorized sigrrahre: /' This penult gpp/tcadan expires Ma permit isnot obtained within 180 Print name: V 1 Imo' °r (cf2-+Sic rc I Date: S-30—/"3_ * Number ofdays terits ashewowed accepted rp as I:\BuadnVemitslELC_riemitApp—ELR ERE the Rev 0E07/2015 440-4615T(11/05/COMJWEB