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Permit CITY OF TIGARD ELECTRICAL PERMIT °�1 �: COMMUNITY DEVELOPMENT Permit #: ELC2011 -00010 TIG ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2011 Parcel: 1 S133DC15600 Jurisdiction: Tigard Site address: 12901 SW LAURMONT DR Project: Mumford Subdivision: VILLAGE AT SUMMER LAKE NO. 1 Lot: 11 Project Description: (1) branch circuit for garage and attic lights Contractor: A & J ELECTRIC Owner: MUMFORD, ANDY PO BOX 330 12901 SW LAURMONT DR FOREST GROVE, OR 97116 TIGARD, OR 97223 PHONE: 503 - 359 -5891 PHONE: 541 - 231 -3923 FAX: 503 - 359 -1981 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 01/05/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/05/2011 $6.74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 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 952 -0 - 090. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: Oi 6 /v/ e,4-77o4/ 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 603.639.4175 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. Jan 03 11 08:40a Leeann Greason 503 - 359 -1981 p.2 V % 4 a.n F1 ,r Electrical Permit Application - E ..'s" .11— I FOR OFFICE USE ONLY IN City of Tigard JAN Dar �e /© r � Perm Nu C • — �0 /a q 13125 SW Nail Bl vd., Tigard, OR 97223 0 2011 Plat Review �- Q: Phone. 503 639.4171 Fax: 503.598.1960 Dax/3 }: d t�Q P/`1 �herFennir. T CGARD Inspection Line 503.630.4175 CI Y O ff° f I Dar Ready ;By: lurir 0 See Poec 2 for Internet: unnwngardor.gov n J �l [ARD r NohtterJMethod �j� Supplemental Information •- .• I I n r S / R �7 , f - . . . . . r '4- L i '° 04;` t3 t' 4 tIr s , W: s _1,�,•( 7 ,4 F F : c , t :1x17- ''- ;::�1 IZVIEW .. . . = � ,..l.. ._ -' ,.. ,. !Y7 t!.LJ. te: ze u ..=,,, . •hc. „,...,....„ = SN . - . : n:St!. x L .._ . _ . .. - . .ate„.. �l . - 1 - 1 New construction Addition /alteration/replacement please check MI that apply ( 2 submit sets of plans sir/items checked below), ❑ Service or feeder 400 amps or more ❑ Building over t;•ree stories. ❑ Demolition ❑ Other: where the available fault curren: ❑ Marinas and boatyards. i. f - E• d l..vt-a,., exceeds lo,no0 omps al 150 volts er ❑ rloatino buildings. I less to tineund, or exceeds ;4,000 ❑Commercial -use a;riad;ural I tg I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building an for all oilier installations. builein ❑ Multi- Ihmily ❑ Masser builder D Other El Fire pump. ❑ Ingratiation of :5 KVA or ❑ Emergency system lalget sera rarely derived system s , ?g. T _. � ..It 01rt 451,, 'r ;'y.= e, r w ; ❑ :Addition of new motor load ❑ -. .. , l _�,.. 71:•\••• \ 1001 ur more. occupancy Job no.: Job silo address: ' �����\ \- •U \ \""rC El Six or more residential emits ❑ Recreational vehicle parks. CILytState /ZIP: ' c` r�� ❑ Health-ca c facilities. ❑ Supply voltage for more than ❑Hazsdous locauots. 600 volts manna' Suiteihldg.iapt, no.: Project name: ❑ Service or feeder 600 amps or more Cross streei.directions to job site: Dereriprion I qt.,. Fee i Total 1 • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: lot no.: 1,000 sq. ft or less 168,54 - - -- 4 - Ea. add'I 500 sq. ft or portion 33'12 1 Tax maprparcel no Y. residential n7 Limited energ ,.: -)E� > rmxxu- I r0 il ! /with above sq. ft.) 1 67.84 2 Limited energy, multi- family ! n `�a ,_ r— 7. 4a. t N C, residential (with above sq. II ) 1 67.81 i. Services or feeders installation. alteration, and/or relocation \�% 200 amps or less 100.70 2 R00#*' c $ , t.t ,r Z 0 *'tiA g , •201 amps to 400 amps 13356 2 C 401 amps to 600 arnps 200.34 2 Namc: �1 ___ 601 amps to :,000 amps 301.04 2 Address: Over 1.000 amps or volts 552.20 2 City /State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: (�J�) '�?��� •���� I Fax: ( ) 200 amps or less 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. 431 amps to 590 amps l68.54 2 Branch circa its - new, alteration, or extension, per panel _ Owner signature: Dale: A. Foe for branch circuits with 7,jel , -..- - , 1 x $ 4 , w �s” 5" iA f"! (}%(T - ';'r: above service or feeder fee, 7.42 each brunch circuit 2 Business name: B. Fee for branch citcwt; ivirhow service or fee fcc, Contact name: first branch circuit \ 56.18 ��� 2 Address: Each add'I branch circuit 7.42 2 Miscellaneous (service or feeder not included) City /State/Z1P: Each manufactured or modular • Phone: ( ) Fax : :( ) x dwelling, service and/or feeder ('T84 2 _ Ronncct only 67.84 2 E -mail: Pump or irrigation circle 67.84 2 . ; s ;`, ,'.. ,: ► A? F . u L ..-.. 1, h- %- v Sign or outline lighting • 67.84 2 Business name: Q� , i, \ Signal eircuirts) or limited- "+ ` �� , ��� r., . ,-,, ' : _ , 1 energy panel, alteration, or Address: '-' - -131 , .. ---?"-N-7 extension. Descrihe: Page 2 2 - City:IState. /%f[': r - '.``I- `. �y N ��� "���� Each additional inspection over allowable in any of the above Phone: ( )�So� ` � Fax: ( �j\ ` Per inspection _ 66.25 1 � �� Investigation per hour (I br .in ul 66.25 CCB Lie.: `�?� Electrical l,ic.:�y \tom 5 Suprv. Lic.: Industrial plant per hour r 78.18 F 7 t_,r Suprv. Electrician signature. requirlxl: -- Subtotal: .,d-- / - , �� Pr :nt name: ,Q , Date: Plan review (2i 'o of permit fee): — State surcharge (i 2 % of permit tee) Authorized signature: TOTAL PERMIT FEE: i �-?�- Print name: • Date: This permit application expires if a permit is not obtained miltrin 1811 days miter it has been accepted as complete. Number of inspections allowed per permit. I d:naVerx 110 FLC- 7eimrtApp.doc IWOI!09 ',49.4515T!!1,05:r.)M.N/EA