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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2012 -00044 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2012 Parcel: 2S102CB00700 Jurisdiction: Tigard Site address: 13048 SW GRANT AVE Project: MY FINANCIAL WORKOUT LLC Subdivision: NORTH TIGARDVILLE ADDITION Lot: Project Description: (1) service and (2) branch circuits for panel grounding. Contractor: CONDUIT ELECTRIC Owner: MY FINANCIAL WORKOUT LLC 19461 SW 89TH AVE 4636 SW KELLY AVE TUALATIN, OR 97062 PORTLAND, OR 97239 PHONE: 503 - 692 -1428 PHONE: FAX: 503 - 692 -3652 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 01/26/2012 $100.70 Specifics: amps or less 2 crt Branch Circuits w /Purchase 01/26/2012 $14.84 Type of Use: SFA Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 01/26/2012 $13.86 Electrical Type of Const: Occupancy Grp: Total $129.40 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 OA: • - 001- 0090.Youu may obtain a c• • • lie rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: .1 1 1 1 1 - 1 / 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. Electrical Permit Application 1-;,) FOR O Flcl USE ONLY City of Tigard �� Date /B : ��i Permit No.: . 13125 SW Hall Blvd., Tigard, OR 9 ,. �°I< C - Phone • 503.639.4171 Fax: 503.59 .. i r Date/B Other Permit: T I G A R D inspection Line: 503.639.4175 �6 Date Ready/By: ® See Page 2 for Internet: www.tigard or.gov \..'," r:�� Notified/Method: ` Supplemental Information �� • TYPE OF WORK SI ∎ - , \ s PLAN REVIEW ddit ion /alteratiot /r plment Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction [ ',NOV- ❑ Service or feeder 400 amps or more ❑ Building over three stories. 1=1 Demolition CI Other: where the available fault current ❑ Marinas and boatyards CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 1l- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: aPt 7 / 3 C( �r q � � 100HP or more. occupancy. Job site address: © Sir 's /�i"'� ❑ Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: 7--- 12 7 / ' �/n. /« 0 /i'_ G 3 ❑ Health -care facilities. ❑ Supply voltage for more than a f ta—� ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more FEE SCHEDULE • Cross street/directions to job site: Description I Qty. I Fee. I Total New residential single- or multi - family dwelling unit. • Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less ' 168.54 4 Ea. add'l 500 sq ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPT ON OF WORK (with above sq. ft.) 67.84 2 /� / Limited energy, multi- family 67.84 2 P Et �:>v Q, /N -t 41e-. keit..s ( - //V) residential (with above sq. ft) Services or feeders installation, alteration, and /or relocation / N,Ai...' i`"$ S' / CC e 4-#.1 v/l U U - CJ GJ t t(t rt 200 amps or less ( 100.70 /t'.10 t 2 V PROPERTY OWNER 1/ ❑ TENANT. 201 amps to 400 amps 133.56 2 Name: N. F w L L-� E i r vt N C l Pty V t Lk.--e 401 amps to 600 amps 200.34 2 /� r 601 amps to 1,000 amps 301.04 2 Address: • y (A 3 Y' S¼_)3, K E l l.'y iA 1 / 4 -1(e._ Over 1,000 amps or volts 552.26 2 r� Temporary services or feeders installation, alteration, and /or City /State /ZIP: 1 �2iz -f 1� ....V1.- 2 3 ? relocation Phone: ( tJ) ( Sr - "`Z Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that i own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT • ❑ CONTACT PERSON above service or feeder fee 7 42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first ! Contact name: branch circuit 56.18 B ;1 2 Each add'l branch circuit 7.42 / t / / 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 ty dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 /� CONTRACTOR Signal circuit(s) or limited - energy Business name: VEtN('1iT C L-eC -lC panel, alteration, or extension. Paget 2 Kr, E. c Each additional inspection over allowable in any of the above Ll S fr Address: / ? i , , O / h , /� i" Ut Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: 'TO (4 '/N Cif 1,7 Investigation (1 hr min) 66.25/ hr Industrial plant (I hr min) 78.18/ hr Phone: ( 5"z13 C. C(Z ---i 4 Z Fax: ( 3" 4a F 7 - 3 So S Z Inspections for which no fee is 90.00 / hr �^ P �,� specifically listed (V2 hr min) CCB Lie.: r0 I C Electrical Lic.: Z Cp '/i=$ iprv. Lie.: ySo f , ELECTRICAL PERMIT 'FEES Suprv. Electrician signature, required: C 5L-2Y e Subtotal: l � �� Plan review (25% of permit fee): r Print name: . C, tiz4tct -CS PA (t ("r---11_ Date: / /21//� L.. State surcharge (12% of permit fee): /3 I! TOTAL PERMIT FEE: / 2? t Authorized signature: C/ / / This permit application expires if a permit is not obtained within 180 Print name: `-' �,s Date: �/2 y / / days after it has been accepted as complete. i - / ' N u mb er of inspections allowed per permit. 1.\ Budding \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB