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Permit CITY OF TIGARD ELECTRICAL PERMIT ` COMMUNITY DEVELOPMENT Permit #: ELC2011 -00129 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/09/2011 Parcel: 25111 DB12000 Jurisdiction: Tigard Site address: 15225 SW 94TH AVE Project: GREENWOOD Subdivision: SUMMERFIELD NO.12 Lot: 647 Project Description: Temporary service with (1) branch circuit. Contractor: MCCOY ELECTRIC CO INC Owner: GREENWOOD, JO ANNE 2014 SE 9TH AVE 15225 SW 94TH PORTLAND, OR 97214 TIGARD, OR 97224 PHONE: 503 - 234 -7521 PHONE: FAX: 503 - 234 -9473 FEES Quantity Description Date Amount 1 ea Temp Services or Feeders - 03/09/2011 $59.36 Specifics: 200 amps or less 1 crt Branch Circuits w /Purchase 03/09/2011 $7.42 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 03/09/2011 $8.01 Electrical Type of Const: Occupancy Grp: Total $74.79 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 0 R 952 - 001 -0090. You ma - - .• • of the les :n &Not questions to OUNC by calling 51 2.1987 or 1.800.332.2344. Issued By• _ — Permittee Signature: c f 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. Mar. 8. 2011 1:39PM McCoy Electric Co. No. 3806 P. 1 Electrical remit Application.. i'Ui Orric'ic USE ONLY CFI C1 O T l BPfX i 4 �- / P ` 5 f 2 ° ' Date/ : Received 3 / 1 g T Permit No.: ✓�9v 11 — tx71 )1_ n 13125 SW Hall Blvd., Tigard, OR 97223 PtanRoview Phone: 503.718.2439 Fax: 503.598.1960M AR 8 2011 Date/0 : OlherPennnit: T IC .1 It fl Inspection Line; 503.639.175 Date Ready/By: /uric ® See Page 1 for Internet: www.tigard- or,goy Notified/Method: • Supplemental information a ` q 0 T b YPE : n"�'t1.i'. ': ` 1 y ■1 I.A z,4 � � 4a . ❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 1, acts of plans Wilms checked below): ['Service or feeder 400 amps or more ❑ Building over three stories. © Demolition CI Other: where the available fault current Marinas and boatyards. "by ! 0 ;_, , : ,L'A4 y�, �' CO " NSTRU F O P ` i ,!i;, 9 1 11 exceeds 10,000 amps at 150 volts or ❑ Floating buildings. ' less to ound, or exceeds 14,000 I- and 2-family dwelling sp ❑Commercial -use agriculnual ® y g ❑ CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings. Multi Multi-family CI Master builder El Other: ❑ Fire pump. ❑ Installation of 75 KVA or I ❑ Cmer syste larger separately derived system, 0 N. 'I -`L 4 OOATIOIV v ": �SfA'�A+�f..;�, FORl4IAT Ok__., s:x,..... ,: ,� °. . w , �l [] Addition of new motor toad of LI' A ", "13 ", "1- 2 ", "1 -3 ", Job no.: 05179 Job site address: 15225 SW 94 AVE toOHP or more. occupancy. ❑ Six or more residential units. ❑ Recreational Yeliicle parks. City /Slate /ZiP: TIGARD, OR ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: J Project name;..REST RATION ❑ Service or feeder 600 amps or more. NL.37`C� , ,PEES 1-1E11T1T.B r,ti ° 9 Cross street/directions to job site: Descnpiion I Qty. I Pea. I Told[ New residential single- or multi - fancily dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'/ 500 sq. R. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential „`• x ` . , _ "t, »ES[i� , ' ' .� tiVORit - '1 7 te a" x a ,:`;r ` k'^. with above = ft. 75.00 2 Limited energy, multi-family TEMP POWER FOR RESTORATION POWER AND SPIDER BOX residential (with above sq. tt.) 75.00 2 Services or feeders installation alteration and/or rcloegjlOn.— _ 200 amps or less v r I .: 100.70 2 " =..g? ;s HY OWNE.R . t" ;j t', . ' ❑ • TEjt0`,, ;x012 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200,34 2 Name: 601 amps to 1.000 amps 301.04 2 Address: / . - e-( ' - ' I Over 1,000 amps or volts 552.26 2 �1 Temporary services or feeders Installation, alteration, and/or City /State /ZIP. { relocation Phone; ( ) Fax — ) �' I 1, 200 amps or less I 59.36 , _ L I Owner installation: This installation is being made o roperty that which is not 201 amps 10400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to 0 , 49, 610, and 701. 401 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Pee for branch circuits Irish ? ' d ; abov service or f eeder fee 1 7,42 Y 1 a :.gyp„ _G`t'!T. 1�a, 1 CON7fACC : r ) )?sohl. 7.42 each branch circuit 2 Business name: B. Fee for branch circuits without service or feeder fire, first 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 1 2 Address: Miscellaneous (service or feeder not included) City /S(ale /ZIP: Each manufactured Or modular 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: Sign or outline lighting 67.84 2 . ' O . xlliACrOR �9 it n % • , • Signal circuit(s) or limited-energy Business name: McCoy Electric Co. Inc. panel, alteration, or extension. Paget 2 Each additional Inspection over allowable In any of the above Address: 2014 SE 9 AVENUE Additional inspection (1 hr min) 66.25/ hr City /State/ZIP: PORTLAND, OR 97214 Investigation (1 hr min) 66251 hr Industrial plant (I hr min) 78.18/ hr Phone: (503) 2347521 I Fax: (503) 2349473 Inspections for which no fee is 90.00 / hr specifically listed (S hr min) CCB Lie.: 8277 { Electrical Lia: 26 -82C [ Suprv, Lic.: 21'75S , i , :, ?,. Ek.1RG . 1 R,i7 1/0 st}* 1. Suprv. Electrician signature, required: Subtotal: 108.12 ! ' rte .. r Plan review (25% of permit fee): Print name: JIM HALL fiff Date: 03/08/2011 State surcharge (12% of pernut fee): 12.97 TOTAL PERMIT FEE: 121.09 Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: FRONTDESK MCCOYELECTRIC.COM Date: • days after It has been accepted as complete. A'umbcr of inspections allowed per permit. L'. Building \Permiis\ELC- PermilApp,doc 07/01/10 410-1615T(iI /05 /COMWEB