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Permit r , CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 -00677 'TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2010 Parcel: 2S 111 DCO5100 Jurisdiction: Tigard Site address: 15683 SW SUMMERFIELD LN Project: Bates Subdivision: Lot: 0 Project Description: (1) service and (15) branch circuits. Contractor: TICE ELECTRIC Owner: BATES, LA MAE L & FRANK E 5405 N. LAGOON AVE. 15683 SW SUMMERFIELD LN PORTLAND, OR 97217 TIGARD, OR 97224 PHONE: 503 - 233 -8801 PHONE: FAX: 503 - 872 -8290 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 12/07/2010 $100.70 Specifics: amps or less 15 crt Branch Circuits w /Purchase 12/07/2010 $111.30 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 12/07/2010 $25.44 Electrical Type of Const: Occupancy Grp: Total $237.44 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 ae set forth in OAR 952- 001 -0010 through • • 2- 001 -0090. Y•u ma •. f t erect questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: L _ �_ �i Permittee Signature: AO 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 the next available inspection date. 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. 12/07/2010 13:34 503 -231 -3372 TICE ELECTRIC PAGE 02/03 Elect ical Application- l_�► Ol hl y r cr�� �.ii — co, V iil a Rea,ved - �. Pemtitrlo_ ,— - 1 City o Tigard T DaUJS . 1 1 — { 13125 SW Hell Blvd Tigard, O Plan Review Other Pamir, I ', Phone: 503.639.4171 . Fur 503.598.19A ��� Date!B . inspection Line: 503.639.4175 Date Ready/By:. la See Paze2 for 1 3 (; i Kr, ' Internet: wwy.tigard- or.gpv -r G 9D Notified/Mctlmd; Supplemental Information _. ,.... QT` 01i\I , ,v ` 1 ° ' Please c \f=a � PLAN REVIEW . beck all Mut app1Y (submit 2 sets of plans w /items ellecicedbelow); ❑ New construction AddiuOlt/SIL plaoemeni Q Service or fhedcr 400 amps or more © Building over three stories. U Demolition 0 Other: where the available fault currant ❑ Marinas and boatyards. - mmr• 10.000 amps at 150 volts or 0 Floating bui1dinv. . CATEGORY' OF C O N S T R U C T I O N lean to g n a w ] . or exceeds 14,000 ❑ Coromeseial use agricultural ►: 1- and 2 family dwelling 0 Corm art al mdustrial 0 Accessory building amps for all other installations_ buildings• 0 Multi- family 0 Master builder 0 Other: ❑ Fire pump. D Iusiallation of 75 KVA or in Emergency system. larger separately derived system: — . JOB Nuts INPOOR114ATION, AND LOCAT1ON. D Addition ()flew motor load of loc iP e s more. occupancy. Job no.: a5 , 2 3 Job site address 15 (13 S v , ) G(l w>,v , - r _ A ❑ six err mmx r e x i d e n t i a l wits. El Recreational vehicle parks. 0 Health -care facilities_ Supply voltage for more than City /State/ZIP: 11 � ' -^ " `/ [] Hazardous locations. 600 volts nominal. Suite/bldg.. /apt. no.; I Project narlte: C=l Service or feeder 600 amps or more- FEI; SCHEDULiE Cross street/directions to job site: ,...i, or). w . Per. Twat New residential single- or multi - family dwelling unit. Includes attached garage. — _ Lot no.: 1,004 sq. ft. or less 168.54 4 Subdivision: Lot add'I 500 sq. it or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 67.84 2 ..... :, ldTiSCRiF17fON.OF WORK, i ", i, (witch above sq. k. ) 1 ` Limited energy, mufti - family 67.84 2 r resid ential (with above sQ. ft 1 J Services or feeders installation :Mere on and/or relocation_ 200 amps or less 100.70 09/0 2 &PROPERTY OWNER �.: . • fl ;TENANT T 201 amps to 400 amps 133.56 2 • 401 amps to 600 amps 200.34 2 Flame: 0 - 1-tk r �ck 601 amps to 1,000 amps 301.04 2 Address: 56,.. Sr r V3 1 YI L-a n e Ow - O 1,000 amps AT volts 1. . 55226 2 Ci /Stafe/ZIP_ v � J G4.✓�' , p �- Temporary services or feeders installation, alteration, and/or ' relocation Phone: (S3) C�.1C _ 55 6r'',,, Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.03 2 Owner installation: This installation is being made on property that 1 own which is not 2 0I amps t4 599 am 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. P amps Branch circuits —new, ancratinn, or extension, per panel Owner signature: D A F ee for branch trcuits with ' ... above Service or feeder fee, ❑ APPLICANT ❑CONTACT PERSON .: 7.42 7 4.Z 2 each broach circuit Business name: B. Fee for branch circuits without service or feeder tee, 56.18 2 Contact name: fast branch circuit • Each add'1 branch circuit 14 J 7.42 10,3561 2 Address: • _ • Miscellaneous (service or feeder not included) Ci ty/ State /ZIP: Each nlanufaennred or modular 67.84 2 dweliin ' service and/or feeder . Phone ( ) Fat:: ( ) Reconnect only 67.84 , 2 Frmail: Pump or irrigation circle 67.84 2 Sign or ou tline lighting CONTRACTOI't - .. .,:. .:. 67.84 2 �s Signal circuits) or limited - Businessname: Tice Electric Company 0_01An .. awn panel, alteration, or Avenue � l extension. Describe; Page 2 2 Address: 5 0 N Lagoon 4 city /State/21P: Portland, Oregon 97217 Each additional inspection over allowable in any of the above . .� - Per inspection 66.25 Phone: (5 0 3) 233-8801 Fax ( 503) 872- ELI i Investigation per hour (1 hr men) 66.25 CCB Lic.' 1 6 6 electrical tic ; 26-126C Suprv, Lia_: 3651 S Industrial plant ELECTRICAL RERMYT 78_18 8 MI Suprv. Electrician signature, required: Le......, - Subtotal: .. _ v �-I Flan review (25% off permit fee)_ Print name: Doug Johnson T3at , — 1 d - State surcharge (12%of permit fee); D.5,, Authorized signature: - TOTAL PF.RMTT FEE: a, r 1 —) _, w This permit application as pires if a permit is not obtained within 19 Print name: Date: says au—tern has been accepted as curnpk t:. - . Number of inspections allowed per permit. ^ MuuntanelPmniuni- c- PcMitApp -doe ID/01109 440.46151(it/O51t'OMME6