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Permit CITY OF TIGARD ELECTRICAL PERMIT -h , �: ` y COMMUNITY DEVELOPMENT Permit #: ELC2009-00554 .3101 ao Date Issued: 10/20/2009 TilaARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S110DD90231 Jurisdiction: Tigard Site address: 10905 SW MEADOWBROOK DR 23 Subdivision: Lot: 0 Project: Glidden Project Description: Install new electrical panel and grounding electrode Owner: FEES GLIDDEN, BERTHA C Quantity Description Date Amount 10905 SW MEADOWBROOK DR #23 TIGARD, OR 97224 1 ea Temp Services or Feeders - 10/20/2009 $59.36 200 amps or less PHONE: 1 ea 12% State Surcharge - 10/20/2009 $7.12 Electrical Contractor: PRO CIRCUIT ELECTRIC LLC PO BOX 3948 WILSONVILLE, OR 97070 PHONE: 971- 563 -8211 FAX: 503- 266 -1349 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $66.48 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 .246.6699or �� = / 07(-- r I/ Issued By: ' � - /- � / : ` • � Permittee Signature: - OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. EkctriCal Permit A IjC$t9 ©I$SLiCEI d E�J' �" t "amt t f t Yry4't��(t� •« of tt E Irt ( ' {,1` . tC t in nIt �, �d �r����f����r�.�1� QR�OF FIICC [ S U\ Llnr,���xi�; ,irT,' wt I `a„ rr� '»i A tai City of Tigard � r �L. ._ � .r?fi rot a,;+�y "r. ;. �6.4�ImL � . F 1 ., t �' y f , r �5 + nn Received �, .�� �:, F ! 13125 SW Hall Blvd., Tigard, OR 9722D C T 2 0 2009 Daie /B Penn it No.:�jLG '1,, rG �S ,r = ..4171 Fax: 503.598.1960 o`t/t/ t ;<. ''.. A 2 . Phone: 503639 Plan Review a pGAEhD Inspection Line: 503.639.4!75 Date/$ Other Permit: ;< .trai.c Interact: www.tigard.or. ov CITY OF TIGARD Bate ReadyBy: g Adis Bt Sec Page 2 for i ■ DIVISION Notified/Method: / 7 v Supplemental Information T'1'PE OF WORK ❑ New construction PLAN REVIEW' ►f • •dition/alteration/replacement Please check all that apply (submit 2 sets of plans steno checked below): CI Demolition 0 Other ❑ Service s or more or feeder 400 amps ❑ Building over three stories. where the available fault current CATEGORY OF CONSTRUCTION Er Marinas ng buildings, d boatyards. 1- and 2 - family dwelling exucds 1 0,000 amps at 150 volts or ❑Floating buildings. g ❑ Commercial /industrial less to ground e t. exceeds 14,000 ❑ Accessory building O Commercial - use apical ural Q Multi ❑Master builder amps for all other installations. buildings. ❑ Other: Fire pump' ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ID Emergency system. larger separately derived system. Job n0.: ❑ Addition anew motor load of Job site address: jog, _ 4(01444") , ' . , , I OOHP or more. occupancy. City /State/ZIP: ` 0.4 ❑Six or more residential units. ❑ Rrtxea iotctl vehicle parks. ❑Health- care.faculties. ❑ Supply voltage for more than Suite/bldg./apt no.: Z, Project name: O Hazardous locations. 600 volts nominal. ❑ Service or feeder 600 amps or more Cross street/directions to job site: FEE SCHEDULE E Demi • lion ®NIE1131111 New residential single- or multi - family dwelling unit. Subdivision: Includes attached garage. Lot no.: 1,000 sq. fl or Icss Tax map /parcel no.: Ea. add'! 500 sq. 11. or portion 33.40 �0 4 DESCRIPTION OF WORK Limited energy. residential _ ,� t (with above sq. fi l 75.00 r�( / V e(el -� PA_`E` Limited energy. multi- family ��Jl r Q�T • !v • a MP residential with above sy. ft.) 75.00 2 �` rvices or feeders installation, alteration, and/or relocation PROPERTY OWNER amps or less 80.30 �© ❑ TENANT 201 amps to 400 amps 106.85 �Q 401 amps to 600 amps 160.60 = Address: 601 amps to 1,000 reps 240.60 Over 3,000 amps or volts 1111 454.65 2 Temporary services or feeders installation, alteration, and/or Phone: ( ) relocation Fax: ( ) 200 amps or less Owner installation: This installation is being made on property that 1 own which is not ps to 400 amps 66.85 ���/, �Ia intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701. 201 am s 300.30 �� 401 am ps to 599 amps �1=rn Owner signature: Branch circuits –new, alteration, or extension, ter ones Date: ❑ APPLICANT' A. Fee for branch circuits with ❑ CONTACT PERSON above service or feeder fee, Business name: each branch circuit 6.65 2 Contact Warne: B. Fee for branch circuits without service or feeder fee, Address: first branch circuit 46.85 2 Each add'I branch circuit 6.65 r 2 Cit y /S tate/ZIP: Miscellaneous (service or feeder not included Each manufactured or modular MI Phone: ( ) dwellin_, service and/or feeder 90.90 Fax: : ( ) E-mail: Reconnect only 66.85 m Pump or irrigation circle 53.40 CONTRACTOR Sign or outline lighting ti f 53.40 � Signal circuit li s) or mited - Address: - �.. energy pastel, alieralion, or • extension. Describe: Page 2 2 City /State21P: i L� I e Cr), c17670 Each additional inspection over allowable in any of the above 1 Per inspection - • ; Fax: ( r 62.54 111111 Phone (q7I) Investigation per hour (1 hr min) 1111 62.50 CCB Lic.: '� Electrical Lic.: – f. %7 0' Suprv_ Lic.: 5-10_5 S Industrial plant per hour jamminin Supra. Electrician signature, required: ELECTRICAL P FEES Print name: Subtotal: �� r ��_ 69 • 3 La- Date: Plan review (25% of permit fee): , Authorized signature: State surcharge (12% of permit fee): Print name: TOTAL PERMIT FEE: 111015 -� Date: This permit application expires if permit is not obtained within 18 0 ^~ days after it has been accepted as complete • Q �p 1:1nuitdinglpermits'LC . eproitAyp doe 05!23106 • Numberofirtspeclioeu allayed per permit. 1 40- 1ti1STI1 DO5feomAVEB Z'd 617E199ZE09 ouloeI )!nai!0 0 - 1 d d90 :80 60 61 100 * 41(