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Permit ELECTRICAL PERMIT F fir; CITY OF TIGARD $ COMMUNITY DEVELOPMENT Permit #: ELC2010 -00278 7t GARO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/09/2010 Parcel: 1 S 133DD07200 Jurisdiction: Tigard Site address: 12714 SW DANBUSH CT Subdivision: VILLAGE AT SUMMER LAKE NO. 3 Lot: 111 Project: Parmley Project Description: Reconnect only. Owner: FEES BANK OF AMERICA Quantity Description Date Amount 12714 SW DANBUSH CT TIGARD, OR 97223 1 ea Reconnect Only 06/09/2010 $67.84 PHONE: 1 ea 12% State Surcharge - 06/09/2010 $8.14 Electrical Contractor: OWNER PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $75.98 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 11 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 503.246.6699 or 1.800.332.2344. S Issued By: / i — —;ii.- Permittee Signature: c GZ .c —r" 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. Jun. 8. 2010 11: 38AV . No. 2877 P. 1 Electrical Permit Applica' � ]ry — §1 7 -.� FOR OFFICE USE ONLY J•!✓M 1 . of Tigard - , • r'� Received �� t n 13123 SW Halt Blvd„ Tigard, OR Plan Review Phone: 503.639.4171 Fax: 503.5. 0O S 2010 DaieBv: 'r1GARD inspection Line 503.639.4175 Dare Ready/By ®Sec Page? fur Internet: www.tigard- or.gov CITY CF - c1 , • • _ Noti.5.N thak $ Supplemental Information TYPB� iltgLaiiiR Tii S! ' P 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 (3 Building over three stones. ❑ Demolition Other: 'c ecki' • t ca l IE I 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 ❑ 1- and 2- family dwelling ❑ Commercial /industrial [] Accessory building amps for another installations. buildings. 1:1 Multi- family ❑ Master builder ❑ Other: ❑ Fir pump. ❑ Installation of 75 KVA or - .. Emergency system. larger separately derived system, JOB SJII L\FOR L4TION' LOCATION Addition of new motor load of 1001 Job 110 106 site add ress: 1? or more. occupancy. lxl ��� ❑ Six or more residential units. ❑ Recreational vehicle parks. City /StatcJZIP: ' t o� . 9 Z2 s ❑ llealth•care facilities. ❑Supply voltaec for more than CA ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no,: Project name: y . , / D Service or feeder 600 amps or more. . FEE SCHEDtILE Cross street/directions to job site: Description 1 Oh. I Fee i Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision; Lot no,: 1,000 sq. ft. or less 168.54 4 Tax map /parcel no.: Fa. add') 300sq. ft, or portion 33.92 1 ...- lial ' %:`'...•• DESCRJPTION. OF a,NO iii. 67.84 Limited energy, rest en `, ( a sq. fl .) � -- Q Limited energy, multifamily l P C.� 1 c .31 R Q 17� residential (with above sq. ft.) 67.84 2 y S ervices or feeders i_n_stallation and/or relocation 200 amps or less 100,70 2 PROPJERTY Obi: ER ' ❑ :TEN.4N'T .. 201 amp to 400 amp 133.56 2 401 Name: 601 amps to 600 amps 200,34 - . 2 601 amps to 1,000 amps 301.04 2 Address: e c 0 , 7 V Over 1,000 amps or volts 552,26 2 Temporary services or feeders installation, alteration, and /or City/State/ZIP: relocation Phone; ( ) 1 Fa,x: ( ) 200 amps or less 59.36 1 Owner installation: ' 111is installation iS being made on property that I own which is not 201 amps to 400 amps 125 2 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exc.. IF, according to ORS 447, 449, 670, and 711. p p Branch circuits — new, alteration. or extension, per panel Owner signature: : ! Date: fa f. 2,©10 A. Fee for branch circuits with ,, �' `�� . �,, i,Y ..: ]iCA"iT > CO`tT ET. PERSON' above service or feeder fee 7.42 2 each branch circuit Business name: YuQ el tlt Q 't w �' rl prDpe 1 '� B. Fee for branch circuits without v 4 rt ( �a7 service or feeder fcc, first 56.1g 2 Contact name: Y.a_ Pa..frn branch circuit 1,.. Each add'I branch circuit 7.42 2 Address: 5( 1 an ► Jt t:b Miscellaneous (service or feeder not included) c Each manufactured or modular 67.84 2 City/State/ZIP: 4 p 00 a� o ql £ ) (p dwelling, service and/or feeder ) i Phonc: ( 5 02 ) - _ I/517 Fax:: ( ) 5zo _22� I Reconnect only / 67.84 Ur, pi 2 E mail: �, Z Pump or irrigation circle 67.84 2 _ r .. ' ► -'8' ... tit or outline lighting 67.84 2 .: a NTRA('1fOtt Si circuit(s) or li ener ID �,,,, Business name: •anal- alteration or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr . City /State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr mm) 78.181 hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed ('14 hr min) CCB Lic.: Electrical LAC.: Suprv, Lie.: ,. EL G ' ICAi; PERMrF_FEES ., <' Suorv. Electrician signature, required: Subtotal; (p`7 gy , Plum review (25% of permit fee); Print name: Date: . (12% of permit fcc): g, IL TOTAL PERMIT FEE: 75 a Y Authorized signature: - This permit application expires if a permit is not obtained within 180 Print name: Dale; • days after it has been accepted as complete, \ - Number of inspections allowed per permit. I.�Buildint;rennir /' LC- Frrmi:App.dv 10 /01 /09 ) 4 4615"t'(I /C0} iwn