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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2009 -00027 , "'COMMUNITY DEVELOPMENT DATE ISSUED: 1/20/2009 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S114BD -00900 SITE ADDRESS: 09950 SW RIVERWOOD LN ZONING: R -4.5 SUBDIVISION: PICKS LANDING NO.2 LOT : 070 JURISDICTION: TIG PROJECT: DINSMORE Project Description: Replace panel with 200 amp. 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: 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: SUZANNE DINSMORE WEST SIDE ELECTRIC CO INC 9950 SW RIVERWOOD LN 1834 SE 8TH AVE TIGARD, OR 97224 PORTLAND, OR 97214 Phone: Contact #: FAX 503 -231 -9987 PRI 503 -231 -1548 FEES Description Date Amount Reg #: ELF 26 -135c FELPRMT ELC Permit 1/20/2009 $80.30 LIC 13306 [TAX] 12% State Surchar 1/20/2009 $9.64 SUP 46545 Total $89.94 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 set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By: C`' b Permittee Signature: 4v9\ X O' 'r 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. electrical Permit Application FOROFFICEUSEONLY AtiE 3t" s� �t n �r. zr � s I iccervcd City of Tibard Petat,it No.: lir - CI " 13125 SW }Mall Blvd., Tigard, OR 9'/ Date /By: 1 - 2 Q • kJ I V� G C,7 l�• °(�' 0 7 b Plan Review Pho ne: 503.639.4171 Fax: 503.598.196 Other Permit: s � batclB} TIG%1R I nspection Line: 503.639.4175 JAN 2 d ( i:'i A Date Ready /By: L ,s /+ IZ See Page 2 for ; 1tgv,..5 „4.,,.,. Internet: www.tigard- or.gov 44gg,ff s a Notilied/Method: 1 (� Supplemental Information TYPE O EKOF T GARD PLAN REVIEW ❑ New construction A ddi tio@tattgakallIVISi ON Please check all that apply (submit 2 sets of plans w /iteins checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition 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 P' 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of KVA or ❑ Emergency system. larger separately derived system. .loll SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "ti "i -2 ", "1.3 ". Job no.: SL0zst.4Lr Job site address: C�Cj C© St--) A', a -,p g 1 v toot tro rmore. occupancy. j ! �� 1 ' ❑ S ix or more res units. ❑ Recreational vehicle parks. 1 City/State/ZIP: 4 (��" > > (�, ❑ hlealth•care facilities. ❑ Hazardous ❑Supply voltage for more than f��I'c� G�L` nrdous locations. 600 volts nominal. Suite /bldg. /apt, no.: Project name: ()r v),$ tvi,Q v -- .c - ?? to Z iii—,e, - ❑ Service or (ceder 600 amps or more. FEE SCHEDULE Cross Street /direct ions to job site: Description 1 Qty. I Fee. 1 Total I New residential single- or multi- fancily dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Fa. adcl'I 500 sq. ft or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. It.) /� Limited energy, multi - family 75,00 2 Q Clt/�.?; l C- L- v - residential (with above sq. ft.) Services or feeders installation, alteration, and /or relocation 200 amps or less l 80.300.- 2 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 r 2 Name: / c{ 0 ; Vt.S 1,1 4. O va 401 amps to 600 amps I60.60 � i(,C7. V�V�i 601 amps to 1,000 amps 240.60 2 Address: �j VVl_, Over 1,000 amps or volts 454.65 2 -i. City /State /ZIP: 'Temporary services or feeders installation, alteration, and /or relocation Phone: (43 ) c> 5 � (i s[[ '- — 6 `7 3 I Fax: ( ) 200 amps or less 66.85 H 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, each branch circuit 6.65 2 Business name: B. Fee for branch circuits Contact name: without service or feeder fcc, 46.85 first branch circuit Address: Each add'l branch circuit 6.65 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular dwelling, service and /or feeder 90.90 3 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E - mail: GLEN:NG tdWESTSIDEELECTRIC.COM Pump or irrigation circle 53.40 2 - CONTRACTOR Sign or outline lighting 53.40 2 Signal circuit(s) or limited - Business name: WEST SIDE ELECTRIC CO. energy panel, alteration, or Address: 1834 SE 8TII AVE. extension. Describes Page 2 2 City /State /ZIP: PORTLAND, OR 97214 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (503) 231 -1548 Fax: (503) 231 - 9987 Investigation per hour (I hr min} 62.50 CCB Lie.: 13306 Electrical Lie.: 26 -135C Suprv. Lic.: 4654S Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: p, 0, ' ' Print name: RANDALL ROBERTS Date: 1 (Z 1 p Plan review (25% of permit fee): /(' State surcharge (12% of permit fee): at ,(0 LI Authorized signature '�., yJ (_ "� e ./ T OTAL PERMIT P EE: �, (�' This permit application expires if a permit is not obtain will tt 180 Print flame: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. C\ 13uiidiueNermits \ELC- 1'ennitAnu.doc 05/23/06 440 - 461 STt t 1/05/COx1 /wain Z/ Z 6002 - 61 - 1.0 14' OZ £Z L966 l