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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 00574 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/15/2010 Parcel: 2S102BA01500 Jurisdiction: Tigard Site address: 12350 SW GRANT AVE Subdivision: Lot: 0 Project: NORTHWEST INVESTMENT HOLDINGS Project Description: Reconnect only. Owner: FEES NORTHWEST INVESTMENT HOLDINGS Quantity Description Date Amount P.O. BOX 1152 GIG HARBOR, WA 98335 1 ea Reconnect Only 10/15/2010 $67.84 PHONE: 503-789-7239 1 ea 12% State Surcharge - 10/15/2010 $8.14 Electrical Contractor: 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 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 ma o 'n a py-e rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. . A Issued B Permittee Signature: 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. 10/13/2010 15:39 5094691296 AFFORDABLE RENTALS PAGE 01 10/13/2010 10:56 5035981.960 . CITY OF TIGARD PAGE 01/02 ' RECEIVED Electericsll .Permit Application : , ; O C i 1 2 010 Reeei+ed • City of Tigard . ' ' A4iiiiill Ll ' °, � � 71 4 13124 SW Han Blvd.. TF - 972 3 l 3 4 . . Phone: 503.639.4171 fax: so3,S98.1960C> p F.T I G AR I Other Permit: inspection cr.gov - y `•• `.. ;'BOIL, DING DIVISI � �a: � .i ,y r' feria! ofi', .. .•... .. , , _ r , • ::1 ::•:, 4 . , ?r':, l;, .s,,,,4;-. _:-1%! :;. " iy�•:.,r ti, :p4,>+!7i_:c �r•° 1 1:1 New conStntetlon Q Additlon /tiltnratlok/re)rlhrcemctrt Fleece check all chat apply (submit $ versa of plans ergs checked beton* El swim or 0:040400 Imps or mare 0 Bondi% ever Naas 06e4e4 ❑ Demolition 7.1 Other: whoa the sa: Irian fault tenetp ❑ Meaner= mM 1edtyetde, r . '. •. . + r ' ' � exceeds 10,000 amps et 150 volts er 0 fleeting beadiest •• 1:1 to wovml, or saccade 14.000 0 Commercial-use a rt ulturel la 1 . and 2•41nily dwelling ❑ Coraruerca /industrial ❑ Accessory building wpm for ell ether ixxmfations. %aiding!. Q Mu1ti•dium;ly 0 Master builder 0 Other © Fire pmnp. El txmtellatiar of 79 KVA er „ 'f � 0 EmoraalmY ay M. larger sepermety derived !Went • 'i 1,6001ON IlAdditioe anew motor lead of ❑ -A-..v...1.2-.1-3". Bite address: 1001 mr moan. *mummy. Job no.: Job 12� 5c s.w G St. D sax err more repidemiet write. 0ldecrcetiexal vehicle peeks. C ity/State/ZIP: • ,, r U C{ 7 G 13cebh enre fhaeklea d supply ItI 8e for mew ehna 0 itaandeua wagon, II volts nominal. 5utteibldg. /apt. no,: Projeetfrsrnei CI Service or Seeder 600 amp ormete. - Cross street/directions to job lint` 74C∎ ' C e W y,,, . a _... elf too t'"11� ' �f� 1, hear residential single- or multi •family dwellir g unit. J J A. U. 7 - r+ 4 • to to ra . us■ • . dudes lambed garage. Subdivision: Lot no.; 1.000 en, fl, or lane 168 .54 1:n, WI sou • . it, or • • • 3392 Tax map /parcel no.: Lb 1h d cmagy, residemh o 7500 with above • R Limited arcrgy, mnitl•1ilmily 75.00 — yo•54- ( cif-- £le c -krfe. at e tc- — 'r0 residential . above R -I 1,. Services or ceders inandlatlen • and /or mown , .y'e i h•+L V h� IA J LI le - r a tom 464e, 2110 atop' of two Ng 100.70 © • C r i s r i a r • 201 , . t0000 .., .. _ 133.56 © 401 amps to600 200.34 El Name: K w er o 7 - ham. T • i • - 1 1 42 -/ 601 amps to 1,000 amps 1111 301.04 �� Addtem: . ,0 „ • X 152- over 1,000 amp et vole 552.26 ity P G; y Ratr b e . W A 9 5-3 3 5 d services or ceders insmliatioe, alteration, and/or Phone: ( •,•3) •7 84 — 7 2 31 J Fax: ( 34 ) 530 — 8 2-05 300 amp or leas II 59,36 INI Ovwier installation: This installation is being made on property that 1 own which is not ant ands to 400 anp• 125.08 intended 4br sale, leases rent, or -• _e, • • g to ORS 447, 449, 670, and 701_ 401 , to 599 :::. 168,51 _Routh tirades — J,,. alters , , . or • . pet Owner signature: f.. • ' • . —ii. . h _ Date: 1 D' ` 3 - ! A. Fee fbr branch , wank • MCAil81'' ' '• ; • •�' I conker . above service or Omer rex, 1,42 2 _ cash branch circuit Business name: 1 s td, •AV R. ' IA 4 01di ' 5 H• 8na En brunch circuits ammo service or feeder OA first 56.18 2 ( Contact mune: 1. cr., 13 - B Y 1 t , • ach atld'l branch circuit 7.42 2 Address: , airy — 7 MGM service or feeder not lfrelnd . • Each nratlauhatned or modular 67.84 Ow/State/ZIP: d la smiler iheder Phone; ( ) g : ( ) Imam anti) 67.84 E -mail: 11o•k2,W'or y Val► -Gen hy} 1 . c-,a, I i i . or ion tam 67.84 s ;gnat circuit(s) ) or mhitcdeee � �e Business name: ' . oreetetslon. — Ent aaditi0l$4l igmethm over allnwable In nay , the above , Address: Additional ine 66.2S/ hr City /State/VP: tnacatillotionil lir min) 66,25/ hr indulst/ial plant (1 hr min) 18.18/ hr Phu = ( ') 1 Fax: ( ) hspeettorm for which no is 90.00/ In saneifieshr MIN Mutt_ CCB Lie.: a trical Lie.: I Supra. Lie.: :.! c • Bli ' , r rK ' • Subtotal; q 7_8t- 6uprv. Electrician signature, ruin d: . )flan t emery of prnnit Re): Print name: I Date State surcharge of permit fee): TOTAL PERMIT F Authorized signature: Mb pernatappGmrsaa moms Ira pawn is not — - wtlbin lee Print name: Date: a after it Wan bane. romped as eornpiaet, Plumber orincpCabne aimed perm:nit. tASeltdu t0PernmM>'t[•PendMpp.eee Q7/D1fn 440•441Irrt11MS/COM/W08