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Permit CITY OF TIGARD ELECTRICAL PERMIT 71 c ` COMMUNITY DEVELOPMENT Permit #: ELC2009-00601 Date Issued: 11/06/2009 11GAA6 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S101AD01300 Jurisdiction: Tigard Site address: 12750 SW 68TH AVE Subdivision: WEST PORTLAND HEIGHTS Lot: 33 Project: Clear Choice Dental Project Description: (1) branch circuit Owner: FEES HAMPTON BUILDING, THE LLC Quantity Description Date Amount 75 -796 HIONA ST HOLUAIOA, HI 96725 1 crt Branch Circuits 11/06/2009 $56.18 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 11/06/2009 $6.74 Electrical Contractor: MCCOY ELECTRIC CO INC 2014 SE 9TH AVE PORTLAND, OR 97214 PHONE: 503 - 234 -7521 FAX: 503 - 234 -9473 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 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 OA 52- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. • Issued By: � g '..--- Permittee Signature: ©/(! r e.-/e4. . -/ e4 i / c'A . 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. - p N o 5 7 81 P ; 'Pas Electrical r r tu1.6 2 /iy p i1 CaL McCoy e i r c Co. t , ,. . °'_. City of Tigard a td .i4-- p j 7.7:1;7....-19,07,E.: ermi��ro t — D I V 13125 SW Hall Blvd., Tigard, OR 2 plan Review 2e Phone: 501639.4171 Fax: 503.598.1 1I q Date/fl : Other Permit:EZ —C6O3 3 err All Inspection Line: 503.639.4175 v 0 L 009 Date Ready /fir ) uric: 21 See Page 2 for ni Internet: v,ww.tigard- or.gov Notined/Method: i Supplemental Information F '.. ��° �,_ � � �, g t, ‘a' - , "�r� iC' . • _. z wc ' � �" � ; � � .., t � , .,,sue . ..r- 3 .. st ' [t ' . .. .. . -T. C ' •'� =e `q��� : Please check all that apply (submit Z sets of plans w /items checked below): ❑ New construction ❑ Addit10r1/altei ation/rcplacement ❑ Service or feeder400 amps or more 0 Building over three stories. ❑ Demolition (Other where the available fault current ❑ Marinas and boatyards, ,"riVt '� a' ` . 90 - :: a .1 1 "zt'•""ct ; , exceeds 10.000 amps at 150 wits or 0 Floating buildings. - ,:r..;,--9;.;;1.! � .. .. P, u rG' � �i; :.•- s.- -,.`. t +r+...,►Z+6 --r 1^�< -.. ices to ground, or exceeds 14,000 ❑ Commtrciel•use agricultural ❑ 1- and 2- family dwelling "Commercial /industrial ❑ Accessory building amps for all olherinstallatians. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. O Installation of 75 KVA or — . _ • , M v , • - v ❑Emergenoy system. larger separately derived sysiern. "71:47 � S 1 R RI►_.ATI lT, e '( ,„, a .;,�,�_ ' - .--• 0 Add ❑ "A ", "E °t V. x _ - ,,, , , Addition of motor of Job no.: 1282 y I Job site address: I z,'} ,0 f . IN - 6 8 ^ - I DOHP or Moro. occupancy. 1�� ❑ Six or morn residential units. ❑ Recreational vehiole parks. all City / State/ZIP: t 0 O "T 1 Z z3 ID Health-care facilities. ❑ Supply voltage for more 0 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 6c6,00._ , (wt, - Q Service or feeder 600 amps or more. :7;7. : : .', M M1 'Se ri Cross street/directions to job site: netcri rnsn Qtr. Fen Tom New residential single- or multi - family dwelling unit. Includes attached garage. _ 1,000 sq. ft. or less T 145.15 4 Subdivision: Lot no.. q _ Ea. add'' 500 sq. ft. or portion 33.40 I Tax map /parcel no.: _y�r__ p7_ Limited energy, residential 75.00 2 ^, r i --7.. .. ."rI_� ' �. - . •, T1 .. r , '' (wit11above Ft(. f ) A Limited energy, multi- family Fo 75.00 2 � �,r �� L,,( ( �, E ��- residential (with ab ove sq. ft.) ( 1 a L` ^ Sen'lces or feeders installatIon, alteration, and/or relocation �- 1 �• k 200 amps or less 80.30 2 - 3 ' �@ ' ° •w @,i, 4 igi 'r s 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps • 160.60 2 -- - 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/ State/ZIP: Temporary services or feeders installation, alter lion, and/or relocation _ _ Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner Installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps - 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits -- new, alteration, or extension, per panel Owner signature: Date: A. Pee for branch circuits with y , a - ; , t , i above service or feeder fee ,sa•wa ar. E'a - Y L 7 ^ - 1.':if9'2ii, '�: .. .+u{- . - -� =�o<i 6.65 1 2 each branch circuit Business name: McCoy Electric B. Pct: for branch circuits ' ' r o Hemp. Kell' q� without service or feeder fee, 46.85 2 1�- L� -'l Sr' first branch circuit Address: same Each add'l branch circuit 6.65 1 2 Miscellaneous (service or feeder not included) City /State/ZIP: same Each manufactured or modular 90.90 2 Phone: (503) 234 - 7521 1 Fax: : (503) 234 -9473 Recalnnne c only t onl and/or feeder cc 66.85 2 E - mail: ksloper @mccoyelectric.com Pump or irrigation circle 53.40 2 . - i =� .._:- .4� �""'°'°05 a : _ - _,a�,� ran :: Sign or outlinc lighting 53 -40 2 Business name: McCoy Electric Signal circuit(s) or limited- energy panel, alteration, or Address: 2014 SE 9 Ave extension. Describe: Page 2 2 City / State/ZIP; Portland, Or 97214 Each additional inspection over allowable In any of the above --- Per i Phone: (503) 234 -7521 Fax: (503) 234 -9473 inspection 62.50 Investigation n per hour (1 hr min) 62.50 CCB Lic.: 8277 Electrical Lie.: 26-82C Suprv. Lic.: 2175S Industrial plant per hour 73.75 -:) i f'RY `` "rP,Eikai ' EIiSL Suprv. Electrician signature, required: e t ,�� Subtotal: . Print name: James R. Hall - 1 Dale: , t - o-, µ o1 Plate review (25% of permit fee): S , IF State surcharge (12% of permit fee): , r Authorized signature: TOTAL PERMIT FEE: Print name: Date This permit Bpi/tuition expires Ira permit is not obtained within 180 days after it has been accepted as completf.. r t- Number of inspections allowed per permit. W A r l:\ iu1ldi0cnoitsIELC-PermiIApp.doc 0523/06 440-4615T(11705/COMPNEB _ /-7Q 7K%- \ 1 f /Oto ei 3 f