Permit CITY OF TIGARD ELECTRICAL PERMIT
°'1 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00050
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/20/2011
Parcel: 2S114BB03000
Jurisdiction: Tigard
Site address: 10065 SW KENT PL
Project: EDMONDS Subdivision: PICKS LANDING NO. 1 Lot: 44
Project Description: Reconnect only.
Contractor: MCCOY ELECTRIC CO INC Owner: EDMONDS, STANLEY T /CHRISTINA J
2014 SE 9TH AVE 10065 SW KENT PL
PORTLAND, OR 97214 TIGARD, OR 97224
PHONE: 503 - 234 -7521 PHONE:
FAX: 503 - 234 -9473
FEES
Quantity Description Date Amount
1 ea Reconnect Only 01/20/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 01/20/2011 $8.14
Electrical
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 OA' •52- 001 -0090. You - • • - o.y of th- es o ..rect questions to OUNC by calling 503.232.1987 or 1.800.332.2344,
6 -7 � — �
Issued By: �' is ! _ h� Permittee Signature: P� � -z� `^
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.
t XPJa,n. 20. 2011 10:12RM Mc y E ' e '4t � r l rtltt bar USE 3 9 v P 2
Elect rermit Application L �_
2 0
City T J AN 2011 Received
IN �1 Of Tigard Ol'(� Date/B : I L/ to Pennil No.. - 8 - 000 •
" 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
s Phone: 503.718.2439 Fax: 503.59�p1Qj ®F TIGARD Date/BY: Other Permit:
i'1CiAIt1) Inspection lire: 503.539.4175 DateRRadyBy: 7uds la SeePage2for
Internet: www.tigard-or.gov BUILDING DIVISION NotificdMelhod: . A L Supplemental Information
M- - x„ ; tai " l t t. , .O k z" :;4'- "2 ' . E �Sx '
❑ New construction ® Addition/alteration/repIacemcnt
Please check oil that apply (submit 1 sets of plans w /ileros checked below);
❑ Service or fbeder400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Ot her: where the available fault current ❑Marinas Ind boalyatds,
i iy" "` 2 1 a i_ A. ' , exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
, , . , ....:4,...... c. '" , OATR�'0}4Y, Q � ��i � tl ; ,'' , '' . z P g
less to ground, or exceeds 14,000 ❑ Commercial -use ogrieahural
X I - and 2- family dwelling ❑ Commercial industrial ❑ Accessory building amps for all other installations. buildings.
Multi-family ❑ Master builder ❑Ot ❑Fire pump 9 Installation of 75 KVA or
uW� rr . + r �����y p,� /�n ❑ Emergency system. larger separately derived system.
°.w, .i ,. � b I . ' -,?k N. _ ', . .: 1' !.., t „ i, in ii ❑ Addition of new motor load of El "A-, „E„ "1-2 "1-3
Job no.: D4938 Job site address: 10065 SW KENT PLACE 1001 or more, occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: TIGARD, OR ❑ Health•care facilities. ❑ Supply voltage for more than
['Hazardous locations. 600 volts nominal.
Suite/bidg /apt. no.: Project name: RECONNECT ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Delcr f Qd. I Pee, I Total I
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'1500 sq. R. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
7
i ..g r? 1 I N 0' QAK ` i n ted above sq I.) n 5.00 2
—. . „ ...t:.w .. r.:_ ..- .'. .- „� .,.,.-.3}',l' .. , .... . ; . `t, ' . {(with
.-
Limited energy, tat, ”- fhmily 75.00 2
RECONNECT residential (with above sq. ft.)
Services or feeders installation, alteration, anti/or relocation
200 amps or less 100.70 2
>?" r ' 8P Ai�irck m �''.�. " "_C Q [%`1 �� ' F 201 amps to400amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders in0fellation, alteration, and /or
t3 relocation
Phone: ( ) 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.
401 amps to 599 amps 168.54 2
13ranch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Pee for branch circuits with
7' `"7 6" "��"` _ � above se rvice or feeder fee,
nrrr,IC�r c4?Po� 7.42 2
each branch circuit
Business name: B. Fee for branch circuits withour
service or feeder fee, first 56.18 2
Contact name: branch circuit
— Each add'I branch circuit 7.42 1
Address: Miscellaneous (service or feeder not Included)
Etch City /State /ZIP: dwelling serv n d/or fe eder 67.84 2
Phone: ( ) Tax: : ( ) Reconnect only . X 67.84 60151 2
' Pump or irrigation circle 67.84 2
E -mail. Sign or outline lighting 67.84 2
':a, � %:r f��: �`' CO' sTIt40- O : , 5 . , ,'' i ' , ,tom
S�.�t`' , � Nr - * ^ !h� Si cironil(s) or limited - energy
Business name: McCoy Electric CO. Inc, panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: 2014 SE 9 T11 AVENUE Additional inspection (1 hr ruin) 66.25/hr
City /Stale /ZIP: PORTLAND, OR 91214 Investigation (1 hr min) 66.25/hr
Industrial plant (I hr min) 78,18 /hr
Phone: (503) 234 -7521 Fax: (503) 234 -9473 Inspections for which no fee is 90.00 / hr
--w - • specifically listed eh hr min)
con Lic.: 8277 Electrical Lic.: 26 - 82C Suprv. Lic.: 21755 -
.!:�Eh' 1 t p -;. R,S .3' ??gP3r'' ;:: ;,:; '''' :''
Suprv. Electrician signature, requ \ \ Subtotal: 67.84
r— w , �., _ Plan review (25% of permit foe ):
Print name: JIM HALL 1 1111110 Date: 1 -20 -2011 State surcharge (12% of permit fee): 8,14
TOTAL PERMIT FEE: 75.98
Authorized signature: This permit application expires ICn permit is not obtained , nithin 180
Print name: Date: ; days after it has been prcepted AS complete.
Number of inspections allowed per permit.
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