Permit .
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Y ' y✓' r � CITY OF TIGARD ELECTRICAL PERMIT
i• � - ! : COMMUNITY DEVELOPMENT
Permit #: ELC2009 -00537
-41,40,44/11111 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/08/2009
,TIGARD g Parcel: 2S103DA06900
Jurisdiction: Tigard
Site address: 10925 SW MIRA CT
Subdivision: Lot: 0
. Project: Reiney
Project Description: Air Conditioner and GFI Must maintain a 3' rear and side yard setback
Owner: FEES
REINEY, MICHAEL G Quantity Description Date Amount
10925 SW MIRA CT
TIGARD, OR 97223 2 crt Branch Circuits 10/08/2009 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/08/2009 $7.63
Electrical
Contractor:
SIMPSON ELECTRICAL CONSTRUCTION
2145 NE MCDONALD LN # C
MCMINNVILLE, OR 97128
PHONE: 503 - 472 -2530
FAX: 503 - 435 -0157
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 wit
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 , ma � j yy �� ob b tain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: ✓`���5`^-'U� -k�� �,{�1 4 C- -1 Permittee Signature: OThk. Ct /A7 ke r l 1----
1 1
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.
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° ' � RECE�IEI� - �. �-� � ���1� �� =�I��;��� a �
Electrical Permit Application n I' ; R s cs a ti> t 14 4 4 �.
ti ; City of Tigard OCT 0 8 2009 Received permit No.: � j� a1J 537
r
� 13125 SW Hall 13Ivd., Tigard, OR 97223 Plan Review
• 4 . - " _. ( . I ' Phone: 503 - 639.4171 Fax: 503.59 � ? O F TIGAIZD DatelByc
OotelBv. Older Permit:
.--, 3 f°Ay. R-D Ins ction Line: 503.639.4175 Date Ready:'By: ro.is• El Sec Page 2 for
Internet: www.tigard•er - go y BUILDING DIVISIO NotitiedTlethod: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction AdditionlalterationJreplacement P'�ea>r check all at apply (submit 1 sets of plans niitems checked bclo, +t
❑ Service or fe ..cr 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the a 'table fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION I exceeds lo,t. amps at 150 volts or ❑ Floating buildings.
less to groun or exceeds 14,000 ❑ Commercial -use agricultural
D el- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all her ins buildings.
❑ Multi- family 1] Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 1:VA or
Q Emergency • stem. larger separately derived system.
JOB SITE INFORMATION AND LOCATION 0 Addition of v motor load of
/� M 100HPo: m e. occupancy.
Job no.: Job site address:
(V 4 .Z S SW, r r 1 1 /ra. C l • ❑ Six or more idential units. ❑ Recreational vehicle parks.
� - y - ❑ Health -care cilitics. ❑ Supply voltage for mere than
CitylStatel7_lP: 1 t f 2 ['Hazardous! lions. 600 volts nominal.
Suite/bldgJapt_ no.: ; 1 Project name: ❑ Service or f• Cr 600.amps ar more.
-- FEE SCHEDULE
Cross'street/directions to job site: Des rripe m - f Q y I F. 1 Totni I •
New residen a al single- or multi- family dwelling unit.
Includes atr•• hed garage.
Subdivision: • Lot no.: 1,000 sq. ft.. less 145.15 4
Ea. add't 500 .q. 11. or portion 33.40 I
Tax map /parcel no.: • Limited encrt,', residential
DESCRIPTION OF WORK . (with above . . ft.)
75.00 2
Limited enern ∎', multi - fancily 75 00' 2
01 i Ctrl 01.. - .� nat A. 6 F r residential with above sq. ft.) 1
Services or eders installation, alteration, and /u relocatio
200 amps or ..s 80.30 2
❑ PROPERTY' QWNER . l ❑ TENANT 201 amps to 00 amps 106.85 f j 2
Name: 401 amps to 00 amps 160.60 2
601 amps to ,000 amps 240.60 2
Address: Over 1.000 . ps or volts 454.65 2
City /State/ZIP: Temporary .crvices or feeders installation, alteration andlo
relocation
Phone: ( ) Fax: ( ) 200 amps or ess 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 00 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 99 amps 133.75 2
Branch circ • its - new, alteration, or extension. per panel
Owner signature: ___ -____. Date: A. Fee for b ch circuits ndrh
❑ APPLICANT • • ••1' ' ❑ CONTACT' PERSON above se • ice or feeder fee, 6.65 2
each bran h circuit
Business name: S. Fee for b ' nch circuits
Contact name: without s• : icc er feeder fee, / 46.85 '/5 2
first bran• ' circuit
Address: Each add'I . ch circuit ( 6.65 6 -( 2
Mliscelfaane.: s (service nr feeder not included) I 1
City /State /ZIP: Each manuf.ctured or modular • 90.90 ! 2
dwelling, se ice and /or feeder -
Phone: ( ) Fax: : ( ) Reconnect . ly 66.85 j 1 2
E -mail: Pump or irri ration circle - 1 53.40_' 2
• . . CONTRACTOR Sign or outl e lighting 53.40 2 -
.---. Business name: 1 / . Signal circu (s) or limited-
�1 �Yl Cl e -ei Citti lS r( ,(( - energy pan . alteration. or
Address: c 11. kit,
' r c., 1 (A ( j extension. cribe: Page 2 2
City /Stale/ZIP: X � l Each addi final inspection over allow- m' ble in a of the above
P l r ,n �1���� �' ' �'Z� Per inspectirn ^I, 62.50
Phone: (5M 4 -7L 2.5t3c) Fax: (563) L) -0I6-7 Invesligatio• per hour (1 hr min) ` 62.50 I I
CCB Lie.: j 33gg Electrical 6, 8z 2 Suprv. Lic.: r , Industrial p r t per hour • 73.75
tD c� ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: o (PS - b 0
-
Plan review (25% of permit fee): _
Print name: ✓ , f Date: /O
F�V (� l� �t r m 00 9 • tate surcharge (12% of permit fee): 6 -- 7 -CO-'
Authorized signature:
Print name: I Dale: TOTAL PERMIT FEE: 5.
This pearl application expires if a permit is not obtained ttithin 180
dais after it has been accepted as complete. t-
° Number inspections allowed per permit.
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