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Permit 1• Ili CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2009 -00311 TIGARD 13125 SW Hall Blvd Tigard OR 97223 503.639.4171 Date Issued: 06/24/2009 _ Parcel: 1S134ACO2607 Jurisdiction: Tigard Site address: 11345 SW COTTONWOOD LN Subdivision: Lot: 0 Project: Cook Project Description: Service change Owner: FEES COOK, JAMES S & KATHLEEN M Quantity Description Date Amount 11345 SW COTTONWOOD LN TIGARD, OR 97223 1 ea Services or Feeders - 200 06/24/2009 $80.30 amps or less PHONE: 1 ea 12% State Surcharge - 06/24/2009 $9.64 Electrical Contractor: JD MILLER CONSTRUCTION CO 11070 SW ALLEN BLVD BEAVERTON, OR 97005 PHONE: 503 - 649 -6991 FAX: 503 - 641 -1902 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $89.94 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 OAR 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: __i 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 an inspection that business day. 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. `Se;nt 8y: MIKE'S ELECTRIC; 591 7847; Jun -19 -09 13:33; Page 1/2 To TIGARD At : 503598196 �� EIVE . Electrical Permit Application REC I OROt t ', (1st': U)NI v • ' City 4 City of Tigard JUN 1 9 2009 Dato/By: 4,rs Permit No.:- J ZV C 7 -coif/ 13125 SW Hall Blvd„ Tigard, OR 97227 Plan Review '' ti " Phnnc: 507639,4171 Fnx: 503.598.1960 Date /13y OrherPermit: inspection Line: 503.639.4175 CITY OF TIGARD mare RaadylBy: +ur„- 1 0 Set PaKe 2 for — Tl (:; Akii Internet: www.tigerd- or.gov BUILDING DIVISI•ij ■ Not`fiert Mctl'ad SnPPlementat Information _ TYPE nF'' O .,.. _ '''. - . t , ❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit i acts of plans w /items checked below) ❑ Demolition El Service or reader 400 amp Or mere ❑ Building over three skit ies. ❑ Others where the available fault current CAT VN3' : ''�?j(71V ' ';:,;',.;.;:,'u n�. Marinas and diugs. �l . exceeds 10,000 amps ar 1.5o vntlq or El flowing buildings. I I and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building m§ tq ground, or exc eeds t4,an ❑ Commercial-09C eftticnttural !? amps for all other in9lallptions. buildings. ❑ Multi - family © Master builde ❑ Other: [1 Fite pump ❑ Installation of 75 KVA or l JOB' 17 p ..ap r :' ❑ Brnergeucy syvren' ar er separately y RNFt:iItt1TA'�Ili3N, •A'> 1,�'l�iA1 , .,� , ti g P Y derived system. —" w, c�.. ; ....), ., • ,{ ❑ Ammar, dr.., motor load of l] ^A" '1:" "1 -2 - ,' 1.1' , 'Intl no: 26426 Job site address' 11345 SW Cottonwo ]d Ln. I09HPni more. occupancy, r .•.. • [] Six Or more residential malls. ❑ Recreational vehicle parks (.iI >'SluIeLil: Tigard, QR 97223 ©liaalth•carefacilities. ❑Supply voltage far Iola n t bbrprdoua locations. 600 volts nominal. Suite /bldg. /apt- no.: I Project name; J ❑ Sci vicu cn fee(Iet' 600 Mpg 01 more, (( slrect.'dirccltons to job site; :. .., t� ..., yy t? T l :'; • ., • - -• - -- - -._ n Uercnt,60,. 1 Vty, I Fee � +,1y T'ure - ! New residential single- or multi - family dwelling unit. ...4 __. - . nc o es attached garage. Subdivision: Et no.: 1,000sq. ft. nr less 195,15 4 Tax map /parcel nos! '°`- Ea. add'1 500 sq. ft, or portion 33.40 1 - .,.�,,. energy, re + I b E5 CR[P TIG i i.'.OP ' tJTt'IC.:,; Limited ene en to 75.00 2 Limi sid • — ..,..... ( with above $q. (1 1.„ Service change Limited energy, multi - family ,. residential (widr above sq. a.) 75 2 0' RN _Services or feeders installation, alteration, a ad /u relocation 200 amps or less 1 " 80,30 �SU • it 2 ❑ PROPERTY OWNER i E tN. 201 amps to 400 amps 106,85 - 2 • B me: _J Cook I 401 amps to 600 amps 160.60 2 Address: 11345 SW Cottonwood Ln. 601 amps to 1,000 amps 240.60 2 Over 1,000 amps or volts 454.65 2 Cils /5tatc /ZIP: Tigard OR 97223 Temporary services or feeders installation, alteration, and /or ,,. _..., ,_,,., _ relocation Phone: 1 503) 590.6049 Fax: ( ) 200 amps or less 66.85 1 Ow ner installation: - 1"hi5 installation is tieing made on property that I ow t which is not w 7.01 amps to 400 amps 1110.30 2 intended for sale. lease, rent, or exchange. according to ORS 947, 449, 670, and 701. 401 amps to 599 amps 133,75 2 Owner Signature: _ Date: Branch circuits - new, alteration, ur extension, per panel A. Fee fbr branch circuits With . . ..0. APPLfCyNJr' • . , ' , 44•:6 pi,. "R 4 1 ' ,41 ,r 00 above set vita ur reader ftc, " `` i, each bra c ircuit 6.65 2 Business mime; D. Fee f ur y b ranch circuits _� wirhour service or feeder fee, Contact name: I 46,85 2 -- - first branch circuit Address: Each add') branch circuit 6 6s 2 "" "- Miscellaneous (service or feeder not incttld ed) Cit) /State /ZIP: Each manufactured or modular — 90.90 2 Phone; ( ) l Fax:: ( ) - dwelling, service end /or feeder Reconnect only 6b.85 2 E- mail: Pump or irrigation'cirele 53,40 2 - . ` ;1 OINOV 'p Et, 1 , •I M !±,: );`;'i' n a , Sign or outline lighting 5340 2 . ' ( \ ,...., .. L •r +•!�. 4 n Business name: JD Miller Construction URA Mike's Electric Signal circnit(s) or limited - energy panel, alteration, or Address: 11070 SW Allen Blvd. extension. Describe: Page 2 2 _ additional inspection over Allowable in any of the above C ttv /Stet _ - .._ c1Z1P; Renverton, OR 97005 Each • ""- Per inspection ` 62.50 Phone (((3) 649.6991 Fax: (503) 641.191)2 Investigation per hour (I hr min) 62 50 C'CR t,ic.:'050209 i Electrical Lie.: 34 - 18C Suprv, Lic.: 4230S industrial plant per hour 73,75 Suprv. Electricia i i required: q!/ /// 1 v I „, ,,, Y ; [ . afit E' , . ,(� i�.X k,: {t>r 1t .' lull . - ' Submit': -0. b Prim name: Douglas ,I, Miller 1 Date: 06 19.09 Plan revie (Z59(, of permit f t W. State surcharge (12 %ofpermit fee): 9.64 A uthorized signature: j� —'" rf,. L TOTAL PfHMI'i' • '.9�+ Print torn,.: Dole, rhl§ p. rmit applies expires If perrni( is not nbtalned within 180 Joys after It has been accepted as complete. I ‘. , ELG-rxoairApp. doe 0:02:000 ' Number of Inspections allowed per MIAMI. -1,1 0.4 t5T(IlrmQslcomiwita •