Permit lki n CITY OF TIGAR ELECTRICAL PERMIT
Is COMMUNITY DEVELOPMENT Permit #: ELC2009 -00303
T I G A R L? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/22/2009
Parcel: 1 S 136AA01600
Jurisdiction: Tigard
Site address: 10345 SW 69TH AVE
Subdivision: FUR VALLEY Lot: 5
Project: Perri
Project Description: Emergency no power. Make repair to feeder between meter and panel.
Owner: - FEES
PERRI, JULIE Quantity Description Date Amount
10345 SW 69TH AVE
TIGARD, OR 97223 1 ea Services or Feeders - 200 06/22/2009 $80.30
amps or less
PHONE: 1 ea 12% State Surcharge - 06/22/2009 $9.64
Electrical
Contractor:
MCCOY ELECTRIC CO INC
2014 SE 9TH AVE
PORTLAND, OR 97214
PHONE: 503 -234 -7521
FAX: 503- 234 -9473
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.94
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 -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: & l.d !LI(l ,t VC, < LUi. Permittee Signature: S2
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.
y Jun, 19. 2009 3:33PM McCoy El c EIVE 1 ' No, 3011 P. 1
r .t Lemnos' remit Applleauon FOR OFFICE. USE °NIA'
City Tigard a Received eCC� p 3
>� JUN 1 200 ` Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Date/By
Review
Phone: 503.639.4171 Fax 503.598,1960 CITY OF TIGA ' II. tci . Caber Permit:
I action line: 503.639.4175 BUILDING DIVIS ( 1 ®sea Pace 3 tor
-
Ti U Il D p Re adyBy. hat
Internet we•.tigard -or ed/M pt eats information
.
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� � .� C�r�i�.:��;.� �y� r'd -- �� '��:��hft
t,•� �.J - nti4 - 1wama •,�� -I . _
� '' �`�•, -,� un � ` 4`.', =,,,_ " . � _« -, •-a.wK a � _�:anrr, =--•• 1 ;,�` " � •,m" - ^.:�: '�- '-� .
❑ New construction I Addition/alteration/replacement Please check all that apply (submit a sets of plans wtlems checked below):
❑ Demolition ❑Other: 0 Service or feeder 400ampsormore 0 Building over threeStories.
Demolition
where the available fault current ❑ Marinas and boatyards.
s re .= e 'e'} - el :ii ^p? ty T11� s�air;f: =. .- ti ' P s or ❑ Floating buildings,
-�- ~-• ��; - r �ll, ; �� - , exceeds 10.000 amps ISO volt
' i:. l u> �T u3 �:.- �.: Y4c, ral =e�' `rte -..Y ..,.' ✓_ •.!
'h less to ground. or exceeds 14.000 ❑ Commercial -use agricultural
►e 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: O Fire pump. 01nstallation of KVA or
pl, �t --_w :: s , .: ❑Emergency system. huger tee derive
k B , . ' . 1 - Ct �`�" ' b ey _ 6 derived em.
1eu _ - L.' as ^ ? _ ❑ Addrnonof new motor load of 0 A",'E", 41 -3".
Job no.:Da3 lob site address: I ' C. S1 1 100HP or more. occupancy.
❑ Six or more residential units, 0 Recreational vehicle parka.
City /State/ZIP: , . • ❑ Health-care facilities. ❑ Supply voltage for more th®
./ 1, n0.: I a
Sllife/bid ❑Iisrardous locations. 600 volts nominal.
(; ap Project namal� 7-- 0 Service or feeder 600 amps or more -
_
to site: co, U ! "— =' _` T. ;;I s i i i i c "` � = :" •' --ri
Cross street/directions t ::. _ ._ _ .... e . , ,� _,
nncrlptton .._ Qty. Pea Total •
- New residential single- or multi- family dwelling unit.
_ Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
e:,_ T Tax map /parcel no.: — Ba. add'I 500 sq. It. or portion _ 33.40 1
a �•_ = -; .T - a -�__. - _ •Limited energy. residential
(c_ - , :�: L .._. a r _ =tz.4.i uj ,, n: ' tzJt = sl ' ,- ; f'� £" r L -, ti_• ( withabovesec,It) 75 - 2
�� - Limited energy, multi - family
-- _,Y , n r e 1` RI 0 ta I 9 A ' � � 1 , 1 residential (with above sq i 75.00 2
r Services or feeders installation, alteration, and/or reloc
WAS
{ y i $ ` & I _ 200 amps or less 80.30
1: 2 i '
;rrn �h< �, . a r- - --, •,. �'7. ,t � t _< <--•' ...s: --, a; u s ec •.;
�__� . �, , _ � . .. 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, alteration, and/or
relocation
Phone: ( ) . Pax: ( ) 200 amps or less 66.85 1 ~_ , 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 salt, (case, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits -- new, alteration, or extension, pet panel
L•; l L , __,_• Pee for branch circuits with
` l 7 c1i�e1'V; r g M � ' ' t a1 L3 b aove service feeder f
ce or eeer ee,
� . _.. - . : -��� -� � � - - � - - „ � x '_ -,.� . � ° >�� ±I dc`e�u-•x- '� :� 6.65 2
each branch circuit
Business name: McCoy Electric r B. Fee for branch circuits —
Contact name: Kent without service or feeder Pee, 46,85 2
fast ibiwich circuit
Address: same Each add'I branch circuit I 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: same
— r Each manufactured or modular '
dwelling, service and/or feeder 90.90 2
Phone: (503) 234 - 7521 Fax :: (503) 234-9473 __ Reconnect only 66.85 2
' E- mail: ksloper@mccoyelectric.com
�= - t� -•� � usT - -s - , ; x� g--___,57 — - .�_.. Pump or irrigation circle 53.40 2
'[�i�t� ��� G tl �0 _r�• .",'.C7�. � °n SI or 11n
,�� �'rti*;c^- ,:2;c:_ .=._ o outline 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 an of the above
Phone: (503) 234-7521 Per inspection 62.50
Pax: (503) 234 9473
Investigation per hour (I hr min) 62,50
CCB Lic.: 8277 I Electrical Lic.: 26.82C Suprv. Lic_: 2175S Industrial plant per hour 73.75
• -- _ .
-
Suprv. Electrician signature, requit4 . I l �k� - - - - -- `d T : ` :/ � �' ` '`
wa: -��'• sue.
j y Subtotal: ;•..'1,_
Print name: lames R. Hall Date: Plan review (25% of permit fee):
- State surcharge (12% of permit fee): 9•, act
Authorized signature:
TOTAL PERMIT RE: y
Print name: Date: This Permit application expires Ira a permit is not obtaln q will w 80
days after it has been Accepted as complete, ,
' Number of inspections allowed per permit
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