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Permit • `'. CITY OF TIGARD ELECTRICAL PERMIT 'r it . . ;, COMMUNITY DEVELOPMENT Permit #: ELC2009 -00551 ;, , Date Issued: 10/20/2009 LT,LGAXRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S104BA03400 Jurisdiction: Tigard Site address: 12067 SW WESTBURY TER Subdivision: Lot: 0 Project: Lynch Project Description: Add /alter (8) branch circuits. Owner: FEES LYNCH Quantity Description Date Amount 12067 SW WESTBURY TER TIGARD, OR 97223 8 crt Branch Circuits 10/20/2009 $108.12 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 10/20/2009 $12.97 Electrical Contractor: CONDUIT ELECTRIC 19461 SW 89TH AVE TUALATIN, OR 97062 PHONE: 503- 692 -1428 FAX: 503- 692 -3652 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $121.09 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 (95 // 001- 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503 800.33272344. Issued By: JdI ji1/4 Permittee Signature: U ri— 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. CaII 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. ' 'From.-CONDUIT ELECTRIC 5036923652 10/16/2009 11:15 #782 P.001/002 R.y< VEr Electrical Permit Application' o mac` r City of Tigard Received Date %B Permtl No • 13125 SW Hall Blvd., Tigard, OR 97223 Pln Review Phone: 503.639.4171 Fax: 503.598 196a t . ( Other Permit: 7FTIGArt~ Daate%B Inspection Line 503.639.4175 s ,.I t r) Date Ready/By: 1 B) See Paget for lntemer w'ww.tigard-or.gov 7. Df ~I ~t ` IS I 1otified1Me1hod Supplemental Information TYPE OF WORK PLAN REVIEW El New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans u,/items checked below) ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition Other: where the availabie 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 I - and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings 9-Multi-family ❑ Master builder ❑ Other'. ❑ Fire PUMP ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system JOB SITE INFORMATION AND LOCATION Addition of neu motor load of ❑ "A", "E "t -2', "1 CD~ looHP or more occupancy. Job no.: lob site address rLJ Si, or more residential units. ❑ Recreational vehicle parks. % ti O ❑ Health-care facilities. ❑ Supply voltage for more than j Ciry/SlateZ]P: , t ❑ Hazardous locations. FEE SCIIEDUL600 Evohs nominal Suit~e/bldg./apt. no.: Project name: 1„ - U❑escriService ion or feeder 600 amps or more. ee 7oiai Cross street/directions to job site F _ New residential single- or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. fl. or less 168.54 4 J, Fa. add'I 500 sq ft or portion I 33.92 3 1 Tax map/parcel no.: Limited energy, residential with above s ft. 67.84 2 k nsc RnPrsoiv OF WORK 1 Limited energy, multi-family 67.84 n 2 __residential (with above sq f ) Services or feeders installation alteration and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2 I _ 401 amps to 600 amps 200.34 2 11 Name - - - 601 amps to 1,000 amps 301.04 2 i Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State/ZIP: j relocation ~Phone. ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, Or exchange, according to ORS 447, 449, 670, and 701. 40) amps to 599 amps 168.54 2T Branch circuits -new, alteration, or extension, er anal Owner signature: _ _Date: - A Fee for branch circuits new, a wide © APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 42 each br-drich circuit 2 Business name: B. Fee for branch circuits v without service or feeder fee, I 0 Contact name: 56.18 2 first branch circuit _ i Address: Each add_I branch circuit 742 2 j - Miscellaneous (service or feeder not included) _ City/State/ZIP: Each manufactured or modular dwellin , service and%or feeder 67.84 2 Phone: ( ) Fax: ( ) Reconnect only 67.84 _ 2 E-mail: Pump or irrigation circle 6284 2 CONTRACTOR Sign or outline lighting 67.84 2 1 limited- Business name: T_ Signal circuit(s) or limited- COridUlt E).eCtZ'1C energy panel, alteration, or Address: extension. Describe: Page 2 2 I_ ...-.19461 SW -8.9th Ave City/State/ZIP: Each additional inspection over allowable in any of the above Tualatin, OR 9706a Per inspection 6625 Phone: (5 0 3) 6 9 2 -1 4 2 8 Fax: (5 0 3) 6 9 2- 3 6 5 2 Investigation per hour (1 h e min) 66,25 CCB Lic.: Electrical Lic.' SuPrv. Lic.: Industrial plant per hour 78.]8 1 0 9 6 6 9 2 6- 9 0 5 C_ 4 5 015 ELtECfRf PERMIT FEES 9 Suprv. Electrician signature, required: fl/ Subtotal g j Plan review (25% of permit fee)' J Print name: Date: U - Charles Parker State surcharge (12% of permit fee) a Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained vrithin 180 I Print name Date: days after it has been accepted as complete. • plumber of inspections aliowed per pennd. 1.Bm'dmt'Pcnnns.I I.C PrrmltAp➢ doe ICCI'0, 4ao.4615T(IU0,(70M WEB