Permit rt CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00597
Date Issued: 10/26/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S 26/201 7800
Jurisdiction: Tigard
Site address: 14511 SW 128TH PL
Subdivision: ELK HORN RIDGE ESTATES Lot: 4
Project: Christian
Project Description: (3) branch circuits for kitchen restoration
Owner: FEES
CHRISTIAN, DAVID & KELLI Quantity Description Date Amount
14511 SW 128TH PL
TIGARD, OR 97224 3 crt Branch Circuits 10/26/2010 $71.02
wo /Purchase Service or
PHONE Feeder
1 ea 12% State Surcharge - 10/26/2010 $8.52
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 $79.54
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: .1L_Y� � 4 L4
r� e— Permittee Signature: e/17 MG �
/� 1 C 77 e' ^ `,
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 603.639.4176 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.
Oct. 25. 2010 7:42AM McCoy E1 ect r i t a No. 1670 P. 1
Electrical Permit Application A C 1 roR orricr. i'sr. ()NIX
�
City of Tigard C ^ a.. awe . Reconvert fd 26 /d Pe+mt A; /0 DOS9
• ..---q 13125 SW Hall Blvd.. Tigard. OR 97223 n CI p v LO Plan Review p permit:
Phone: 503.639.4171 Pax: 503.598.1960 U ` +M Or TIC; A 1; r, Inspection Line: 503.639.4175 Oc 1,Cj' t - : r edy/Dy: Iu See Page 2 for
Internet: www.tigard- or r ,1G ... ,' 11 ' elhod: � Supplemental Information
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D New construction ad Addition /alteration/replacement Please check all that apply (submit 1 sets ofplansw /items decked below):
❑ Service or feeder 400 amps or more ❑ Building over three atdnca.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
?CATBQO ' ;OP COrl UCI`kON exceeds 10,000 amps al 150 volts or El Floating buildings.
':;,•:!:.:;F'.,,.::::' : :' ' : '�• ' ; "� 'r ....: : : �,. � ' • � ' �';• .;. less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑Eire pump. 13 Installation of KVA or
..
; - :;_ , ``• ❑ cy Emergen system. larger separately derived system.
.: rOB'SX T ; . ❑ Addition of new motor load of 13 "A" "E"."1-2"."1-3",
=1
Job no.: D4 11 1 I Job site address: 1 L 511 5W 1 a I 1 pI Six o or more. R.ec ea ncy. occ
(/ lyl ❑Six or more residential snits. ❑ Recreational vehicle parks.
T(9ar
City /State /ZIP' d 0 R a4 ❑ ❑
Health -care facilities. Supply voltage for more than
R ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: 0 Service or feeder 600 amps or more.
a..
Cross street/directions to job site: neccdWlon 1 Qtr. 1 rte. 1 'total I
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. D. or les , 168.54 4
Tax map/parcel n0.: - Ea. addi 500 sq. (1. or portion 33.92 1
T- Imitedenergy,residential 75.00 2
. ' 000:00: .cs iypi* ::. : '..'. :: ! ' Swith above sq. ft)
Limited energy, multi- family
/ AWE �r II �L�i�� l 7 residential („nth above sq. R.) 75.00 2 .
Scniccs or feeder's installation and/or relocation
e� 200 amps or less 100.70 2
' Ili PROPiRTY'OWNE1t : . Q TAT . 201 amps 13356 2
Name: (: - SST / �� �0-o L ��`/ 401 a to 1, 0 0 am 20034 2
601 amps 101,000 amps 301.04 2
Address: S e fr Over 1,000 amps or volts 552.26 2
Cil ' /Stale /ZIP: Temporary services or feeders installation, alteration, and/or
> relocation
Phone: ( ) 1 (tax: ( ) 200 amps or leas 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. 401 amps to 599 amps 168.54 2
Branch circuits new, alteration, or extension, cr panel
Owner signature: Date: A. Fee for branch circuits with '
• above service or feeder fee
I�'APPLICAigT; ' : I' " ❑;CON7`ACT.'PEROSN ....' 7.42 2 • each branch circuit
Business name: B. Fee for branch circuits without (/�
- service or feeder fee, first 56,18 V 2
Contact name: branch circuit q
Each ndd'l bmnch circuit ( ma y . , 7.42 , l('-t 2
Address: ;Miscellaneous (service or feeder not included)
City/State/ZIP: /State /2IP: Each manuthctured or [nodular 67,84 2
�' dwelling, service and/or feeder
Phone: ( ) I Fax: - ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: _ Signor outline lighting 67.84 2
.. f COTYfIir#t,TOR Signal circuits) oriimited�nergy
Business name: C I e ~O panel, alteration, or extension. Page 2 _ 2
�� l � f5 � _ 1 ' ave., Each additional Inspection over allowable in any of the abov
Address: Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: p -' d cgZ1(,� Investigation : hr min) 66.25/ hr
78.18/ hr
Phone: ) p, i
� _ 4 1 sa4 Fax: ( j) 61(-11 Industrial plant (1 hr min) 90.00 / hr
1, �� t! , 72 inspections for which no fee is
specifically listed (S5 hr min)
/CCB Lic.: C 6 ri ` l Electrical Lic.: _ sae S uprv. Lic.: 2, 11 55 • :..ELE(TRICAI: PERIIIIT.FEE3 ;': • -
ot
`6V Suprv. Electrician signature, required: \4 �Q // j/� plan review (2$% of pem bt feeal): : 1(, �a
Print name: f MPl 1 k LA / Date: tO -2S ..10 S tate surcharge (l2 %ofpermit fee): Yto /
✓ ✓
TOTAL PERMIT FEE: ri
Authorized Signature: This permit application expires it s permit is not obtained ' mit t In 180
dais after it ms been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit.
1;\ Building +PermilaLC- PermitApp.doe 07/01/10 44O4615T(11/05 /COMI EB