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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2006 -10067 f � , DEVELOPMENT SERVICES ` � DATE ISSUED: 3/23/2006 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 S 135AD -02300 SITE ADDRESS: 10915 SW HALL BLVD 18 ZONING: R -12 SUBDIVISION: METZGER ACRE TRACTS LOT : 002 JURISDICTION: TIG Project Description: Move panel and junction box. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: PAM BENSON OWNER 10915 SW HALL BLVD #18 • TIGARD, OR 97223 Phone: 503 - 314 -2955 Contact #: FEES Description Date Amount Reg #: [ELPRMT] ELC Permit 4/5/2006 $80.30 [TAX] 8% State Surcharge 4/5/2006 $6.96 Total $87.26 REQUIRED ITEMS AND REPORTS This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are h -in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of the2 or direct questions to OUNC at : ►� , 503-246 699 or 1 344. Issued 61-4(A)41-4 Permittee SignaturC 4 j %._ia.__ i' Y 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'N: 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. , Elec. limit Application FOR OFFICE USE ONLY City O . ?d Received permit No.: - /a) t3' Date'B . 1i, ' �.. / / I�! 13125 SW . /vd., Tigard, OR 97223 Plan Review 0 r Phone: 503.639.4171 Fax: 503.598.1960 /4%. 1 J' Ir?ilii I4" Date /By Other Permit: Inspection Line: 503.639.4175 4 ■ ='..L Date Ready/By: Ju. ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: tif Supplemental Information TYPE OF WORK PLAN REVIEW / ❑ New construction ❑ A ition /alteration/replacement Please check all that apply: 0 Demolition Other: ❑Service over 225 amps, comm'I 0 Hazardous location ❑ Service over 320 amps - rating ['Bulldog over 10,000 sq. ft., ' CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ❑ 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑ Master builder ther ❑Building over three stories ['Feeders, 400 amps or more ['Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park q 4/ ❑Health -care facility ❑Other: Job no.: Job site address: '0 1 iJ S f I b��vv Ar Submit 2 sets of plans with any of the above. City/State/ZIP: /d -/ 9 7Z Z .7 ppicable to temporary The above are not applicable construction service. y �, y /n �/ t�` f Suite/bldg. /apt. no.: ( , Project name: FEE* SCHEDULE Description I Qty. I Fee. J Total J *• Cross street/directions to job site: "-- P Fr' rpz, 0 / � New residential single- or multi-family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF O 7,240/e..._ RK • Each manufactured or modula 7 , 240/e..._ ehC / �L� L ( tI d ( d /f dwelling, service and/or feeder 90.90 2 Services or feeders installation, alteration, and /or relocation A I vh G i oki b y `/ 200 amps or less r 80.30 2 J IN PROPERTY OWNER , ❑ TENANT 201 amps to 400 amps 106.85 2 • 401 amps to 600 amps 160.60 2 Name: J r Q n j 1 c LJ ? i--, 601 amps to 1,000 amps 240.60 2 Address: / D f`J 1/4 / ) e / ��` - `!gD Over 1,000 amps or volts 454.65 2 ` I �' Reconnect only 66.85 2 l / City /State /ZIP: - t✓," Z/ /2 2-2-c7 Lj Temporary services or feeders installation, alteration, and /or v Phone: ( J �/y 2 "fit Fax: (`jai 60 2.2 relocation 200 amps or less 66.85 1 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, ase, r t, or excha , cording to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: 0/f"--- Date: Branch circuits - new, alteration, or extension, per panel RAPPIICANT - CINTACT PERSON A. Fee for branch circuits with service or feeder fee, each p 6.65 2 Business name: branch circuit / . Contact name: B. Fee for branch circuits YYL G r�V d without service or feeder fee, 46.85 2 Address: C, ) / / 6,/ first branch circuit l� !�� �� li(/ ni (�` (� -7 Each add'I branch circuit 6.65 2 City /State /ZIP: eD L v O / / 7i 2--,7 Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 . Phone( ) Fax::( ) Sign or outline lighting 53.40 2 E -mail: / f7-►� LA , G', e tP 7# 's41L /J � Gb ( f etkial circuit(s) or limited- ' CONTRACTOR energy panel, alteration, or lJ� . " extension. Describe: Page 2 2 Business name: Address: v Iv Lk—, Each additional inspection over allowable in any of the above Per inspection 62.50 City /State/ZIP: Investigation per hour (t hr min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES *1 -•■ t^ CCB Lie.: Electrical Lie.: Suprv. Lie.: Subtotal ©,:;(� Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) CO . 9 ' TOTAL PERMIT FEE C 7, Authorized signature: This permit application expires if a permit is not obtained within 1 0 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. l:\ Building\Permits\ELC- PermitApp.doc 12/30/05 440- 4615T(10 /02/COM/WEB Electrical Permit Application - City of Tigard Page 2 . Supplemiental Information • LIMITED ENERGY PERMIT FEES: RESIDENTIAL'WORK, ONLY: , Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* • ❑ Heating, Ventilation and Air Conditioning System* . • ❑ Vacuum Systems* ❑ Other: COM1VIE12.CIAL WORK ONLY: , ._._ Fee for each commercial system $75.00 • • (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ B oiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ F ire Alarm Installation ❑ HVAC ❑ Instrumentation • ❑ Intercom and Paging Systems • ❑ Landscape Irrigation Control* • • . • ❑ Medical - El N urse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ,❑ Other r , ,Total "number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\ Building \Permits\ELC- PermitApp.doc 12/30/05 CITY OF TIGARD • BUILDING DIVISION P ERMIT #: TVj2 N 1�;�A 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSU --- ' • " � / Phone: (503) 639 -4171 l t � Inspection Requests (24 Hrs.): (503) 639 -4175 .�, ;1J �.1 , INSPECTION WORKSHEET FOR DATE: 4 / Q TIME: • PAGE: 0 \ SITE ADDRESS: / / / S �� CLASS OF ORK: SUBDIVISION: - LOT #: TYP. OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message c/ kcii9MA/-6--- 0 2 Corrections /Comments /Instructions: i Ar _A Ae A I I L M _ _A 1.E_ gL__ oilk/ ._ / - ar" / - , ..4_e✓.s -- geoe: , c_s i kt, elOn76- ,..,...L A77)- - P4 S, 1 c- / 4-tie,— i \/:u -/vial. I 1 I C;111°14 z 14rL ©A// 7D e ,G✓. x / 6, j: L_� vier ter' — A e't.,9 4l ArAr t ' / 0 ■ 47 C— ' A g..' : i. /It; trE- , ____,0 cr,--t_____NO .--- / I- eE,t4otv3.1,_ / Pl.„ i I PASS 2 PART • L APPROVAL n CANCEL NO ACCESS FAIL ! I •.% = LL F•R ∎S ION P . ITION • L FEES ASSESSED Inspector: _ // Date: - Phone #: (503) 71