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Permit CITY OF TIGARD ELECTRICAL PERMIT - COMMUNITY DEVELOPMENT Permit #: ELC2012 -00029 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/18/2012 Parcel: 2S101AA08700 Jurisdiction: Tigard Site address: 12511 SW 68TH AVE Project: Heintzberger Payne Subdivision: WEST PORTLAND HEIGHTS Lot: 34 Project Description: Electrical for TI. Contractor: CANBY ELECTRIC INC Owner: BEVELAND BUILDING LLC 790 S IVY ST 12511 SW 68TH AVE CANBY, OR 97013 PORTLAND, OR 97223 PHONE: 503 - 597 -1600 HONE: 503 - 266 -7878 FAX: 503 - 266 -5543 FEES Quantity Description Date Amount 5 crt Branch Circuits wo /Purchase 01/18/2012 $85.86 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/18/2012 $10.30 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $96.16 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 • ' 952- 001 -0090. You may obtain a copy • e rue or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.. Issued By: ..46‘,A1/1r.s.. — _ ro " 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. ,•• a1+ar∎11 aa..aa J. %.a alale t'1: llGia an 25 of Tigard • Ci 4 , w, ' !P antes 1 M r` l ie : � A 71 • 13125 SW Hall Blvd„ Tigard, O' Plan Ravines Per Phone: 503.639.4171 Fax: 503.598.1960 ante8 ;' OthPermit: � 7A .P '` f Inspection Linn. 503.639.4175 � ` ��� p� 1 ' , t: I p JAN 17 2 012 D ate Ready/By: h ale: 14 see Page 2 tor. • Internet: www.tignrd ' or.gov � • t Notified/Method: 7}7 Suporameomihansemaliaa TYPE OF( `rR"OFTIGA D . . ;t ?,, .?,i .. t..': . °<':' : :,;;,'.,i. -;: ,i.' ;. : P1:AN > $EVIE�1!.a; ,;i;, % 6��. . , . ❑ New construction Additionetl i tts h +:tQ� B+h r+vl• 'tatr'�trt "`t:;' r`°i' l. i Please check all that apply (submit 2 seta of plan wlitema checked below):, . • �i ❑ Sarviceor Rater 400am 0 Demolition Other: p sO C] building over demo ataries. w t ava fault current IO Marinas and boatyards: CATEGORY OF CONSTRUCTION' meads 10,000 amps at ISO volts or ❑ Floating buildings. less to atenmet w exceed* 14,000 o Commerenti•use agricultural , . - 0: 1. and,2•fantiiy dwelling Commercial/industrial CI Accessory building ampatoratletheri.usitatio.. buildings, ' ❑ Multifamily II Master builder ❑ Other: °Fine pump. ID Installation of 75 KVA to ' . • JOE SITE IN)FORMA ANA LOCATION ❑Emergency system. larger saparately'tterived system. ..,. ❑ Addition of new motor load of ❑ "A " " E ", "1 - ". " 1.3 " Job no.: . "` lob site address: 12,51 I 51,/ t 4 ' ' _ 100HPor more. oeeapancy, . ❑ six or mote resadennsi units. Q Recreational vehicle parka. , • City /State/ZIP Z � � . CJ Health -care facilities 0 Supply voltage for more than , LI hazardous locations. 600 volts nominal. 'Su ite/bldgaapt,no„ Project name: ©Seivice feeder 600 amps ormore, ' t'i Y.i!��1 �'.t iy. aiC11VYa,,'. 6'..,',:4T; ::,, .. Cross st to job site: • _ oaartplbn — -- r Qtr, l Fee L Total • t New residential single -or multi-family dwelling unit. Includes attached garage. Subdivi§iori: __ 7 Lol no.: W 1,000 sq. ft. or less 168.54 Ea, a44'1500 sq. ti. or portion 33.92 . 1' • Tax: li�ap/parcei no.: Limited energy, residential °_y 2 . . • DESCRIPTION OP WORK ' `t`- ° '` (with above w. ft,)w 67,84 Limited energy, malti•fnmily 67.$4 2 . _ .. 1h '' , Il r r f i ✓ • . . residential (with above sq. a,) - Services or feeders installation alteration, and/or relocatio n ' 200 amps or l e s s 100.70 •: . • .. 2. . . 0 PROPERTY OWNER 1 ❑ ,TENANT. 201 amps to 400 amps —_ 133.56 . 2 ' Name: -, ,H P J/ l� 401 amps to 600 amps 200,34 2 601 amps to 1,000 amps 301.04 2 Address:.: ---561)42'"--- Over 1,000 amps or volts 552.26 2 ' ' City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation • 'P (• ) 71 Fax: ( ) 200 amps or less 59.36 1 ': Owner' installation: This installation is being made on property that I own'whicli is not 201 amps to 400 amps 125.08 ' . , - 2. . • . intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and.701 401 alrips to 599 amps 168.54 2 Owner signature: Dater Branch circuits -- new alteration, or extension, *Panel - . A. Fee fir branch circuits with . © A PPLICANT 1 ' :'; 0 CONTACT' PERSON ,;" - above service or feeder fee, 7.42 2 . each branch circuit ' . Business mune: B, Fee for branch circuits • without service or feeder fee, Contact name: first: branch circuit © 56.18 5'6, 2 • Address' Each add'I branch circuit 1 7.42 7..1 ,� 6 f 2 • Miscellaneous (service or feeder not includcdL City /State/ZIP: Each manufactured or modular 67,84 .. 2 . " dwellij service and/or feeder 'Phone. (:.. ) _ Y J Fax:: ( ) Reconnect only 67.84 • ' 2 . E-mail: Pump or irrigation circle — 67.84 .2. C ONTRACTOR Sign o r outline lighting 67.84 ' • • '2 Business name: /' Signal circuit(s) or limited- l ' ,,\ , � 61, bj (' Q r C j"Y7 ( , energy panel, alteration, or Addrtss: extension. Describe, Page 2 2 City /State /ZIP: C►� f �d Each additional Inspection over allowable in any of the above _ Per inspection 66.25 ' Phone:. (e ,) Z (,,.7� • Fax: (53 ) 1 • S54l3 Investigation per hour (1 Iv min) 66,25 • CCB Lic. 2p . Elect Lic. -5 Z Industrial pant per hour 78,18 o r ' 'tritl&C!'ItICAI;. PgRMI'1" FEES'.' ", s ;_, ;.:. ' !' �� t� Suprv. E , s it s t oic, r equired: f �- ' ` Suprv. Lic. /C7 ZfZ' _ Subk htal : , s `` '`v 111 ate: I ( D j ^ Plan review (25 %0 of permit fee). Print name: 0041 ,_G . - ,,,_U )1 r .(} Suite surcharge (12 %u of permit fee): in , SD Authorized signature: TOTAL Pt:RMPr FEE: c (, .1 6, _ • - - - - .- -- - - -• - - -'- This p {ftedwahin Print name: 1 Date: days itapphc after tiun ia t ha* been acc as com ..._... _ . - - -_... —_.. 440- 4615T(l 1105 /COMtwEB , Number of inspections allOwcd pe1 r�•nml. loiluildinglPermilFil t'•1'eimitApy doe I010!il) i Ed 14dS2:80 ETIDE LT •uef £bS899i'_2OS : 'ON dNOHd DNI 9Ia1991d AEN iJ : WOad