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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 00538 • Date Issued: 09/30/2011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Parcel: 2S102BC01808 Jurisdiction: Tigard Site address: 12535 SW WATKINS AVE Project: HERNANDEZ Subdivision: NORTH TIGARDVILLE ADDITION Lot: 26 Project Description: (2) branch circuits for home repair Contractor: SQUIRES ELECTRIC Owner: HERNANDEZ, MARIA DELUZ 1001 SE DIVISION STREET #1 12535 SW WATKINS AVE PORTLAND, OR 97202 TIGARD, OR 97223 PHONE: 503 - 252 -1609 PHONE FAX: 503 - 253 -5831 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 09/30/2011 $63 60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 09/30/2011 $7 63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71 23 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 - doptsd by the Oregon Utility Notification Center Those rules are set forth in OAR 9 52- 001 -0010 through %._ 2- 001 -0090 Yom . • = - copy o ' ",es or direct questions to OUNC by calking 50 98 or 1 800 332 2344 c Issued By� < —% � / . i Permittee Signature: - — 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. 08/28/2011 13.31 5032535831 SQUIRES ELECTRIC #0338 P 002/002 Elect l Per mit Ap FOR OFFICE, USE ONLY City of Tigard _ " 13125 SW Hall Blvd , Tigard, 0 , t\ ® \ i l a Permit No : LG — _ Phone: ,712439 Fax , 9 7[ 1111 = ;- I Phone: on 503 . 8 4 3 639Fax 5 5 Interact: www.ttgard- Or,gov %Y° %c\ \� x - S Sec Pane Z for � Sapplemeneal tnPormrttion s TYPE OF WORK P.l I R? W " El New Construction ® Addition/alteration/r1 . = ent Pl cheek all that a l . '(�, PP Y (submit Z sets of [skins w /items checked below): ❑ Demolition �Ther: V - ❑ Service or feeder 400 amps or mom 0 lSttilding over three ctorios, ". ' , . , rv a where the available fault current ❑ Marinas and boatyards. '., : - - ':RATE' CQRV', (.QNSCku - • cxaads 1 0,000 a.np. at 150 vole. or ❑ Floating butkiings. toss to ® I- and 2- lamilydwelling ❑Commercial/industrial ❑ Accessor building ground, or exceeds 0Conrmercial- useagrtcultumi y z= amps for all other installations building. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 K VA or JO i vS1K '> 'O1;i'i14.a N'D LO(:AT1O?V - T1C1N , Q Emergency sy larger separately derived uystcm. ❑ Addition or new motor load of ❑ "A^ "g" °I 2" "1 -3" Job no.: [Job site address: 12535 SW Watkins _ t0(IHP or more occupancy 4. D Sir or morn residential ungs ❑ Recreational vehicle parks, City /State /ZiP: Tigard, (717 0 l-care foeiiitics 10 Supply nonage for more than [] Hazardous locations 600 volts nominal Suite/bldg. /apt. no.: Project name: Horizon D Service or feeder 600 amps-or more Cross stree1/directions to job site; �� B EE S YY ntxrri lion K 1 alai III New residential s ingle- or multi- family dwelling unit. Subdivision: " Inc[ a ttache d garage, Lot no.: 1.000 so A. or less 1.11 168 54 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion IM 33 92 Limited energy, residential II. 'J) $CRIi'TIQN OF WORK 7S 00 . (with shove s R ) Rewire due to Car impact Limited energy, multi-family residential (with above ft.) 75 GO Services or feeders installation alteration /or relocation ]' PR'Op1�1t `Y (31VIV)u(t 200 amps or less 100 70 2 D T 201 amps to 400 amps 133.56 2 Name: 401 amps r0 600 amps Mil 200.34 2 - 601 amps to 1,000 amps Ell 301.04 I Address; - Over 1,000 amps or volts IM 552 26 City /Stan /Z if'; "Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less MI 59.36 1 Owner installation: fhis installation is being made on property that I own which is not 20 amps to 400 amps 125 08 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168,54 � © Fee for Owner sigltalure: A circuits — new, alteration, or extension, rer panel Date. A Fee f branch circuits with Ci AP�"1,1CANrJ 1:1 CONTACT PERSON above Service O r feede leg, 7 42 each branch circuit Business name: B Fee for branch circuits wuhout service or feeder fee- first 56 18 5618 Contact name: branch circuit 2 Address: Each add'I branch circuit ME 7 42 7 42 El MiscellancousIservice or feeder not included City /State/21P: t nets manufactured or modular dwelling, Service and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67 84 2 E - mail Pump or irrigation circle 67 84 2 GONT ,..___., Sign or outline lighting 67 84 Signal circuit(s) or limited- energy Business name: Squires Electric Inc panel, alteration, or extension. Page 2 Each additional ins teetion over allowable in an of the above Address: 1001 SE Division St., #I Additional inspection (1 hr min) -113M I City /SttltcJZiP: Portland, OR 97202 investigation (1 hr min) _ 6625/ hr - + Industrial plant (I hr min) illi 78 18/ hr EN Phone: (503) 252 - 1609 Fax: (503) 253 - 5831 Inspections for whidt no fee Is II - s• cttically listed ('/r hr shin) 90 OW hr CCB Lie.: 135085 Electrical Lie.: 26 -i I01C Suprv, Lic.: 4882S - - ' .,ECTRICAL , RMLT'FES Suprv. Electrician signature, requi Subtotal 63.60 Plan review (25% of permit fee) • Print name: Joe Squires Date: 9/29/2011 State surcharge (12 %ofpermit fee): 7.63 Authorized signature: TO I'AI PERMIT FEE 71,23 ___1 This permit application expires if a permit is not obtained within 180 Print name: Date: after it has been accepted as complet Date: • Number or inspections allowed per penult I \ xuitdmg \P(trimts\l3LC- PermitApp.doc OYIt)I /10 440 40157(1 I /1)1I(U1vUWE6