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Permit v CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 -00387 TEGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/28/2010 Parcel: 2S111CB01721 Jurisdiction: Tigard Site address: 10250 SW KABLE ST Subdivision: HOOD VIEW NO. 2 Lot: 20 Project: Dorr Project Description: (5) branch circuits for laundry room. Owner: FEES DORR, PATRICK M Quantity Description Date Amount JANICE M, 10250 SW KABLE ST TIGARD, OR 97224 5 crt Branch Circuits 07/28/2010 $85.86 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 07/28/2010 $10.30 Electrical Contractor: GAW ELECTRIC 21215 SW MARTINAZZI AVE TUALATIN, OR 97062 PHONE: 503 - 482 -5213 FAX: 503- 268 -7554 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $96.16 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 80 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set f- rth/ I.AR 952 - 001 -0010 through OA 2- 001 -0100. You o• irect questions to OUNC by call' S .6699 or 1.800.33.. 344. �'/ • Issued By: � Permittee Signature: / ? Air OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent, OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: • LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. ', Electrical Electrical Permit Applicatio 1 , cc :I 1 1R �l r l:tc E 1 • i 0 City of Tigard Q X14 "�`� "7 1 Permit No.: o _ ra r SW Hall 03 639.41171 Tigard, F 03 598 1960 �`�` v Mao Review Other Permit: ARD Datdn tJ or31 fT r l ' x. I n w�ww.ligard-or.ga•75 ON.. Q0,`�D�vl$°i,� . , �II�l(�� Su ppl Supplemental f ormation OF WOri 11Lv PLAN REVIEW ❑ New construction Addition /alteration/replacement Please cheek all that apply (submit 2 sets of plans wfiteins deiced below): ❑ Service or feeder 400 amps or more ❑ Bolding over three stories. 0 Demolition C1 Other. where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION arceeds 10,000 amps at I50 volts or ❑ Floating buildings. and 2 falr»1 dwelling less to ground, or eraocds 14.000 ❑ Commercial -use agricultural I y g 0 Commercial /industrial ❑ Accessory building terms for all other installations. buildings. ❑ Multi- family 0 Master builder ❑ Other: 0 Fire pump. ❑ Installation ot75 Kw. or .1OB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ P:', "E , 1 -2 °. 1 -3", Job no.: lob site address: /0, �-; /� I00HParmore. y - l_� � l ` - i4� 1� ❑ six ormonrrsneat>mes ❑ Recreational vehicMparta. City/State/ZIP: � �* k f 1 �� ❑ Hrakh-e facilities. ❑ Supply voltage for more than l' it ❑ Hz�nluus locations. 600 volts nominal. Suite/bldg./apt no.: 1 Project name: J r :l fi j L - ❑ Servirx or feeler 600 amps or morn. FEE SCHEDULE Cross street/directions to job site: f ZI,,_.,� , n�.;m;., 1 qtr. 1 F. 1 Taal — b'�" New residential single- or multi -family dwelling unit lndudes attached garages Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168 f 4 Ea. add9 500 sq. It or portion 33.92 i 1 Tax map/parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. It.) 75.00 2 -7 K-6 ----76 / �1 Limited energy. multi- family 75.00 � 2 C 4 7 6 �"^ 7.''`f � ! 0 6.4 �g /k e '7— residential (with above sq. R) Services or feeders installation, alteration, amVor relocation 200 amps or less 100.70 1 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 - 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 T services or feeders installation, alteration, and/or City/State/ZIP: Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125 08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, resit, or cxchangc, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits new, alteration, or ntension. per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I 0 CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit Business name: B. Fee for brand[ circuits without n service or feeder fee fast ( 56.18 5r V� , 2 Contact name: branch circuit v Each add'1 branch circuit 4 742 25C1 , 4 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: /StateJ%IP: Each manufactured or modular r Iy dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67 -84 2 E -mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited -energy Business name: 62-)44) LT/ G- 7 /'L panel, alteration, or extension. Paget _ 2 Each additional inspection over allows - Mein any of the a bove , Address: �1 r Additional inspection (I hr min) 6625/ hr Gi} min) City/Stale/ZIP: /StateJ/IP: I.......` Investigation (1 tar miry) 66.25/1n ,C_ /�- 14 ,L,1) d /Z- 9 >c c, 2_ Industri plant (1 hr min) 78,18/ hr ph ( / ._ _ s / 3 Fax: (50:3) 7.SS L Inspect for which no fee is 9o.o90.00f In 1 3' seed fxally listed (f, hr c C S I ie: J oar 1 Electrical L' (d s rv_ tic.: / L r MIT IFS h EC1U AL PER Suprv. El e ciricia�S required: - v71 1 I �i � 1' — _..__ _.... - - .._. -- subtotal: t5 , b. 4 , .� W Plan review (25% of permit fee): --_ Print name: r f ' " / ate: ! Slate surcharge (f 2% of permit fete J © , �� fir rY 1 f!✓�'?'.o TOTAL PERMIT FEE: 9 .I ( Authorized si � l G ,�G //, -ii[/ This permit apphe' s a to Mimi expires it permit t ablaiard wilhm ISO r --, days afterit has been accepted as complete Print name: -%./- 9 , Dal C; ,Ifz/L , ✓e2 , Number of inspections allowed pespermit. 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