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Permit CITY OF TIGARD ELECTRICAL PERMIT 11 1111 I , - COMMUNITY DEVELOPMEN Permit #: ELC2009 -00446 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/02/2009 TIGARD Parcel: 2S 104BC07900 Jurisdiction: Tigard Site address: 14125 SW MITCHELL CT Subdivision: Lot: 0 Project: Hindman Project Description: (2) branch circuits for A/C & GFCI. Owner: FEES HINDMAN, GAVIN D Quantity Description Date Amount 14125 SW MITCHELL CT TIGARD, OR 97223 2 crt Branch Circuits 09/02/2009 $53.50 wo /Purchase Service or PHONE: 503 - 521 -1390 Feeder 1 ea 12% State Surcharge - 09/02/2009 $6.42 Electrical Contractor: HILLSBORO ELECTRIC LLC 21185 NW EVERGREEN PKWY #110 HILLSBORO, OR 97124 PHONE: 503 -439 -9666 FAX: 503 -601 -3680 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $59.92 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 952 -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: 49/ Permittee Signature: U" / 9 - /% 4) 2. C-f9 � 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 603.639.4175 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. - 'From:Hillsboro Electric,LLC 5036013680 08/31/2009 02:43 #075 P.002/002 Electrical Permit ApPlicsii&r i; , , \ City of Tigard Received ._— 13125 SW Hell Blvd., Tigard, OR 9r 3 12009 r me : ge/ ' ....,1•W_ Permit No. ' � p y , Phone: 503.639.4171 Fax: 503.59 , DaodB Other Permit . , , , , Inspection line: 503.639.4175 C I T Y OF Ti Date Re ady/By: Internet: www.tigard ov TYPE OFD iiii' DIV4St!1t NobS`dRdethod , �p e w :mutation PLAN REVIEW New construction 74 Addition/alteration/replacement Phase cheep all that apply (submit! rates of plans wliteohe checked be/ow): ❑ Demolition 0 Service or feeder 400 amps or more CI Building over three stories. where the able huh wren El Mariam and b building. CATEGORY OF CONSTRUCTION exceeds 10,.000 000 amps at ISO yobs 13 bs or Floating Ell 1 -and 2- family dwelling ❑ Comm t'a cial/industrial Accessory k®to ground, or exceeds 14,000 ❑ + mat 0 Multi - family ❑ Master builder 0 Oilier building amps for all other installations. � 6 ❑ Otbex ❑ Fire pump. ❑ Installation of 7S KVA or JOB SITE INFORMATION AND LOCATION 13 Emergency system. severe* daivedsystem. ['Addition of DM motor load of ❑ - A ", "B", - I - 2", "1 -3 ", Job no.: I mai Job site address: I 10011P or more. City/StateJZIP:'t"' >I I/1f t / • 17 j I • , ❑pNaakh O Suppl onel vehicle n orethan perlo. U' ` N� ❑ �� Supply voltagefcrm Suite/bldg /apt no.: Project name: 600 volts "off• 11l I t I A.4 O Service or feeder 600 or more. Cross street/directions to job site: FEE SCHEDULE . New residential single- as lbw • Includes attached �, multi - family dwelling Wait Subdivision: Lot no.: 1,000 eq. R or less Tax map/parcel no.: Ee add'I 500 R or 145.15 II s4 portion 33.40 DESCRIPTION OF WORK C ove .. resideatiel 7 with above .. ti • `� L '. �', multi- family III residential with shove a. 75.00 - © Services or feeders imtallatb , alteration, and/or relontlon 200 amps or less . CI PROPERTY OWNER . ' • •. ..0 I TENMPR' •- : • . 201 80.30 2 amps 106.85 r Name: #1 Ni 'M �-/ �I � // A/ 401 amps to 600 amps III 160.60 — Address: 601 amps to 1,000 amps 240.60 2 Over 1,000 amps or volts 454.65 2 City/State/ZIP: ardoeat Temporary services or feeders installation, alteration, and/or Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1 T 1 Owner Installation: This installation is being made on property that I own which is not 201 to 400 amps 100.30 2 inter for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 13 3.7$ 2 Owner s ' . l]ete Laud Dew, attention, or e:tenden, ... - - .....:.C� 'APPIJCANT she for branch circuits with Dead ' . , : .CONTACT PERSON above service or feeder fee, Business name: each brands circuit 6.65 2 B. Fee for bra>rch circuits Contact name: without service or feeder ¢e, first branch circuit I 46.85 ' 2 Address: Each WW1 broth circuit ( 6.65 • lrs 2 City/State/VIP: Mlaeellaneow service or feeder not tad , ... . alar Phone: ( ) I Fax: : ( ) a mod III 90.90 - © P. -mail °�Y -` -El CON17tACTOR or irrigation circle - 53.40 _ SigrhoraWlioe - 53.40 _ Business mime: HILLSBORO ELECTRIC, LLC *dike)orlimited- Address: 2118 5 NW EVERGREEN PKWY # 110 Si t0. boa or extension. Describe: Page 2 2 City/State/ZIP: HILLSBORO, OR 97124 Each additional kw - 'onoverallowablein of the above Phone: ( 503) 439 -9666 I Fax: ( 503 > 1 -3680 III 62.50 - � CCB Lic.: 134481 � Lie.: 4 per hour (1 min) 62 50 34- 499 . '5' '/S industrial Plant Pa hour Suprv. Electrician signature, � ! required: l 1 -r ��. _ .!� ELECT PERMI FEES Print name: 4liT ��1► / 'i Date: i Plea review (2536 of , .. j ZY Authorized signature: State surcharge (12% of permit See): MM. Print name: TOTAL PERMIT FEE: Illffr I Date: MN pew app on aspires If a permit is not .. ■ . 'debt 180 1 Uhaad N6Pere tte�4FermfMs.doe osrtvos • Number of iaeoeetirm..and.a „� a eompkea