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Permit _ ... i CITY OF TIGARD ELECTRICAL PERMIT il ` COMMU DEVE LOPMENT Permit #: ELC2009 -00602 • Date Issued: 11/10/2009 4-1.GARD,i 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S136CA03100 Jurisdiction: Tigard Site address: 11215 SW 79TH AVE Subdivision: FRIENDLY ACRES Lot: 18 Project: Sheldon Project Description: (1) branch circuit for reground of service for gas bond. Owner: FEES SHELDON, MELINDA L & DUANE C Quantity Description Date Amount 9610 SW HILLVIEW CT 1 crt Branch Circuits 11/10/2009 $56.18 TIGARD, OR 97223 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 11/10/2009 $6.74 Electrical Contractor: ACCURATE ELECTRIC P.O. BOX 873425 VANCOUVER, WA 98687 PHONE: 360 - 944 -7001 FAX: 360 - 944 -7013 Type of Use: SF 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 OAR 952 - 001 - 010. 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: 4tc47, Permittee Signature: 0� „4-7 z- /e"9 7711 /k/ 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. Calf 603.639.4175 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. '- r� r Inc. 3609947013 P 001 NOV-06-2009 14t c to Electric ..' Electrical Per le 1 ' /_ Ftd t, , ` ' {sJ �[{�r�y�) r^ w)1 ; " ^ -;�' ' t Cl} of Ti , ,a , N., ived emritNo.: r City " ' y `J t r ip . . Date ���0 C ELC �ao�'�o�� : • v 13125 SW Hall •: ��atttfffiii O K''599 777 222 2 3 ITY OF TI �,7�{fj �lanReview r Phone: 503.639,417 Fax: 503.598 1960 r.< eB Other PetmittAL�e aQS�% .'k Inspection LinGI BUILDING DIVISI ! e Read /B : Jug' H See Page 2 for T �+ p� Notified/Method: / y y ,✓ In tera c t: wrBUittjINGoDIVISION f _ Supplemental Information DUU�ILL1 TYPE OF WORK PLAN REVIEW ❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition 1 0 Other: where the available fault current ❑ Marinas and boatyards. • CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ['Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural and 2- family dwelling ❑ Cominercial /industrial ❑ Accessory building amps for all other installations. buildings. f l_ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E", "1 -2 ", "1 -3 ", Job no.: I Job site address: // ^^�� +_ / IOOHP or more. occupancy. / //J(�,� ,�Y 77/ Av� . ❑Six or more residential units, ❑ Recreational vehicle parks. City/ State/ZIP: i �� ' rr 77 ❑ Healthcare facilities. ❑ Supply voltage for more than .r.�,�r� /� /� ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ,0 `. 2/d ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: nescdpdon _I Qty. I Fee. ) Total 1 • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less I 145.15 4 Ea. add'I 500 sq. ft. or portion 1 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 DESCRIPTION OF . WORK (with above sq. ft.) Limited energy, multi - family t S'YvlC#, l ot/ residential (with above sq. ft.) 75.00 2 Services or feeders installation alteration and/or relocation ❑ PROPERTY OWNER '�," ( ❑ TENANT t . • 400 amps t. Name: SiELzs zi/9iv { rfE "'C t amps . 160.60 l •a. to 1,000 amps - 240.60 - Address: 90/6 .G -' , e fg7tJ (1 Over 1,000 amps or volts 454.65 2 City/State/ZIP: 7( 9 7 A. ! 7..2S? Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) I Fax: ( ) 200 amps or less 66.85 I Owner installation: This installation is being made on property that I own which is not 20I 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 I 133.75 f 2 Branch circuits - new, alteration, or extension, .er panel Owner signature: Date: A. Fee for branch circuits with © APPLICANT k CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: / _ B. Fee for branch circuits /./, . 1i, iG I C. 11 Contact name: De Jroc. 1-6/7 MP" without branch service circuit ui 46.85 feeder fee, 46. p first branch circuit / r0 Address: , _6 '� N E /12 {-� l - Each add'I branch circuit In 6.65 _© Misce service or f ee der not in cluded) City/State /ZIP: /i � � /�( f/� cl� Each manufactured or modulaz ■ 90.90 2 !/i v v `� dwelling, service and/or feeder Phone: 060 9// —WWO/ Fax:: c30) / % "' 7013 Reconnect only 2 E / - e � j ' f . /lttT st ,,,,i7 Pump or irrigation circle �- 2 CONTRACTOR • Sign or outline lighting 53.40 2 Business name: Accurate Electric, Inc. Signal panel, or limited + energy panel, alteration, or Address: P.O, Box 873425 extension. Describe: Page 2 2 Ciry /State /ZIP: Vancouver, Wa. 98687 Each additional inspection over allowable in any of the above Per inspection 62.50 f Phone: (360) 944 -7001 / I Fax: ( 360) 944 -7013 / Investigation per hour (I hr min) 62.50 p C CB Lic.: 1 58875 ✓ E lectrical Lie.: 37 -1029C lAuprv. Lic.: 5094S Industrial plant 73.75 l/ v e - ELECTRICAL PERMIT FEES, y , /,' Suprv. Electrician signature, required: , Subtotal„ Print name: Ken Sweo i Date: / G1 // / ///�� Plan review (25 % of pe�mti[ fee } : !/ �J ,�, � �y� � State surcharge (12% of permit fee): 6 Authorized signature: (O � C1 51•7� TOTAL PERMIT FEE: — . -- -- ■ 1 .9 This permit application expires if a permit is not obtained with n 1:0 Print names D / (" ..0417 , 6 , 1 ,_ Date: r 1/T /6l days after it has been accepted as complete. Number of inspections allowed per permit. /2 #, i / t: Buildin5Rerraits •ELC- PermitApp.d °c 05,23.06 440- 46IST(II,O.i,COM'WEB VW�