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Permit F q CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00662 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2011 Parcel: 1S 134DA01904 Jurisdiction: Tigard Site address: 11105 SW 108TH AVE Project: Worrell Subdivision: NORTHERN PINE Lot: 6 Project Description: (2) branch circuits for HVAC Contractor: SUNLIGHT ELECTRIC INC Owner: WORRELL, STUART 2800 NE 65TH AVE SUITE B 11105 SW 108TH AVE VANCOUVER, WA 98661 TIGARD, OR 97223 PHONE: 360 - 772 -3877 PHONE: 503 - 430 -8977 FAX: 360- 694 -9728 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 11/30/2011 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 11/30/2011 $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 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 9 ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ' /ail/ /9--/°/ / L' "}- / l� Issued By: r Permiftee 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. • C4 F F D El ectrical Permit Application. t .. FOR OF FICE USE ONLY City of Tigard ,NOV 9 2011 Dat %/ EGC 2 / — DD - ermit No.: II • 13125 SW Hall Blvd., Tigard, OR 97 23 plan Revi i Oth F er m i s: / 1 7 zo // -ea 99S Phone: 503.639.4171 Fax: 503.5 8 1 9 6/0 TIGARD .� D ate /B y: �t" TIGARD Inspection Line: 503.639.4175 l.0 � 1 ur i tai 1'1® DateReady/By: 1uris: ®SeePage2for Internet: www.ti and or. ov BUILDING Notified/Method. ILG" Supplemental Information g g BUILDIt iG please check all that apply (submit 2 sets of plans w /items checked below): ❑ New constructionAdditionlalteration /replacement 0 Service or feeder 400 amps or more E7 Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. • . .. , � y .g � OIZ � (;2'I ❑ , ' ry ; ;' : ;: � '' � " ' exceeds 10,000 amps at ISO volts or Floating buildings. l - and 2 dwelling EO Corn erc� ia l /4n I ON Accessory building - • • :' • : lcss to ground, or exceeds 14,000 ❑Commercial -use agricultural amps for all other installations. buildings. ❑ Multi - family ❑ Master ❑ Other: installation of KVA or aSte[ bUll Cher: _ ❑ larger separately derived system. ..<.: JOB S`IT.E. :'INFORM A'I AND..pet,O ew m rre pump. ❑Emergency s .. ❑ A o new motor load of ❑ "A", "E', "1 -2 ", "I -3 ", 1 i yt 5- S t, 1 1 O Q'4'a. �tiC.e_ 100HP or more. occupancy. Job no.: Job site address: ii i05 I/V 6 (j r ��((�� {� ? 7 0 Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: ('© jctvl t) (9 !Z.. G � 2 3 ❑ Health -care facilities ❑Supply voltage for more than • ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. Cross street/directions to job site: Description I qq.. Fee. i ' Total I • X New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145,15 4 Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential — .. B�SCRfk!'ITON.OT: �OI�K::,.. . (with above sq. ft.) 2 K „ ^ n t V , 2 n Limited energy, multi- family UYt #1.,k)..) #1.,k)..) ✓ ! 0 - 11 Ct iat I residential (with above sq. ft.) 75.00 2 r 14 w9 •i Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 : ;JQ-$R'bPE Name: A) 'I Y: *$ ❑'`Td `Ta 201 amps to 400 amps 106.85 2 9 0 2 �t /J . G 401 amps to 600 amps 160.60 2 �_ 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 Temporary services or feeders installation, alteration, and /or City / State/ZIP: relocation Phone: ( ) l Fax: ( ) 200 amps or less 66.85 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133,75 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with : - - °' f Ak`PY A ''_ [ , corer hFI3.£(llii` above service or feeder fee, 6.65 2 each branch circuit Business name: 72. ccfa9r'ee s (Orep A ,4lr. -) B. Fee for branch circuits _ �� Contact name: • without service or feeder fee, 46.85 .S r 2 - rsr /d" first branch circuit !,-� �r b� 02 Each add'{ branch circuit 6.65 , 2 Address: Miscellaneous (service or feeder not included) / City /State /ZIP: Each manufactured or modular 80.90 _ dwelling, service and/or feeder 2 Phone: ( ) I Fax: : (. ) Reconnect only _ 66,85 2 E -mail: Pump or irrigation circle 53.40 2 ;: „ ,. . „ :COITRACTOR • .._:. ::', ;.. _ Sign or outline lighting 53.40 2 Su 1 r r f ' c f r Signal circuit(s) or limited - Business name: t� ee ('. . ! . 0 6 energy panel, alteration, or Address: S 00 6 ' f-ii 4 5u /4-e 8 extension. Describe: Page 2 2 City /State /ZIP: V fri 6 p if..e- r, k/4 t y'g 6 6 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (360) S( 8 - -t. 89 Fax: (360) 32 .x'60 Investigation per hour (1 hr ntin) 62.50 6 2CB Lie.: l Z 9 Electrical Lie.: C 2_30 Suprv. Lie.: f 3s Industrial plant per hour 73.75 - eia. Suprv. Electrici ig t required: ,! i �� lo 1' Subtotal: 5 3 / • Plan review (25% of permit fee): 9' �3 / s ��� /��` ' z f f 7 � 'J s Date: f 2 9/ l �� State surcharge (l2% of permit fee): Print nam f, Authorized signature: TOTAL PERMIT FEE: ' / /. This permit application expires if a permit is not obtai ed within 180 Print name: Date: days after it has been accepted as complete. s Number of inspections allowed per permit. / ∎I I:\ Building \Perrnits\ELC- Pcrm 05/21/06 440- 4615TQ IPo5iCOM/wan