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Permit CITY OF TIGARD ELECTRICAL PERMIT III Permit #: ELC2009 -00276 2 COMMUNITY DEVELOPMENT Date Issued: 06/05/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103CC00800 Jurisdiction: Tigard Site address: 12055 SW ROSE VISTA DR Subdivision: Lot: 0 Project: McPherson Project Description: Install (2) 200 amp sub - panels and (3) branch circuits Owner: FEES MCPHERSON, LORIN & BRENDA _ Quantity Description Date Amount 12055 SW ROSE VISTA DR 2 ea Services or Feeders - 200 06/05/2009 $160.60 TIGARD, OR 97223 amps or less PHONE 503 590 - 3993 3 crt . Branch Circuits w!Purchase 06/05/2009 $19.95 Service or Feeder 1 ea 12% State Surcharge - 06/05/2009 $21.67 Contractor: • Electrical BOONES FERRY ELECTRIC INC PO BOX 628 WILSONVILLE, OR 97070 PHONE: 503 - 682 -4936 FAX: 503 -682 -7946 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $202.22 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through A 52 -001- 100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By f Permittee Signature: eAr-� /9Ue� -76," ^ " / OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 603.639.4175 by 7:00 a.m. for an Inspection that business day. This permit card shall be kept in a conspicuous place on the Job site until completion of the project. Approved plans are required on the Job site at the time of each inspection. ;. 1 0 : 1 1 m i H$AM lieation No. 1159 P. 1 —Pp FOR OFFICE 1ltili ONL1' City of Tigard I; ' Received !3125 SW Hell Blvd., Tigard, OR i` ' • I CF D a„in : , 5 - / r !J4! ' No.: _, 0 2 .e / t r Q Phone: 503.639.4171 Fax: 503_''' 961 Plan te ew Other Permit W T IC \ R Ll Inspection Line: 503.639.4175 J U N U 4 2009 Internet tvww h -Or v Date Ready/By. ® See Paga 2 for said g° Notsfred/Method �� Supplem�tak lnfoirorahoa b ❑New construction Add itioNa ` - =y' - �' ", 3 >• _,. Z .. x , r �� :�- �, ,a ,� � �, . Ol) �ep�e�t�s�o Pleas check all that apply (submit S sat of pleas whams cheelred ttelaw). Q Service or feeds 400 amp, emote ❑ Buildin8 over mree stories. ❑ Demolition ❑ Other i e l r where the available fault current ��,.t� 1 f ir f y tN 1! r ra ^ C7 ( ' l r ,, 1 � r .: `n T : _ ❑ Foanngbui dp :�_...... ....,_ .....;,. r. , _ :.. >.. ..: ,_..c � ...._:: s..._a. � :. � _: � � _ a x# exceeds 10,000 amps at ISO w or ❑ Floating buildings. .,r less to al- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all �O °C exceeds 14,000 q Commercial agricultural ❑ Multifamily ❑ Master builder um other installation buildings. sea i � � r v r _ ❑ Other ❑ Fire pump. tram! of 75 KVA or t `: r c :1tl ' ..,..,' c '� ',, ^,10 li ;` P4�i :. 11 S T . a,✓ ' ❑Emtrgencysystem. ❑ rgerspaz 11:!II e1 sysrem. __.._ , r ❑ Add ifioa OF new motor toad of ❑ Ia A " , " E c" . " 1 - r " L3 " , lob no.: /5z7C2 Job site address: � J . O s sn,. Rose V,' ,1 _ s Hr r or more. ox,r ❑Six or mo re resi deat i el em ❑ Reccea tiorul vehicle parks. City /State/ZIP: lljar d O Q ❑ Health -taro facilities. ❑ Supply whose for more than SUitdbld J CI Hazardous �IQ 600 volts oomin i. 8 � no Project name: I l c f) rsa v't 4 services or feeder 600 amps or more. Cross street/directions to job site: :` f , .- `,_ r! c '..''':',•`3.:?..',:"-"ti.:".,-2:-.;.'1`''''‘'''''-'::.'t;'-': , - • , ;.. J, Ilt°'L'll Fm Total lia New residential single- or multi- family dwelling nail. Includes attached garage. Subdivision: 1 Lot no,: 1,000 sq. It or less 1111 145.15 4 — Tax map/parcel no E& add'! 500 sq. ft. or portion 33.40 W s r s s r , Limited energy, residential .... ,. .. .... am; c , ,. . _. . . .: f L g4- �, . r,... c S t ; , with above . ft. 75.00 J l 1' Limited energy, multi - family III Si, 4 , / a rs & / s ' i Cie' F '1' s T t , /.O 1t d S co, • residential with above . , • (t 75.00 1/ . / 1 k 5 r1 Services or feeders installation alteration and/or relocation a d r 200 amps or less EN $0 30 60 6 • 2 L :,- ' '' .,,. , t . ,. . : M` ! . .`,,' . � _.�. 4 ; �. , .. . . , t, o , 201 amps to 400 snips 106.85 �© Name: _, . /N /j ' � � , 401 amps to 600 amps 160.60 �© / ,e...401-0- �d/�� / V�LI / 1 - 601 amps to 1,000 a r . IDps 240.60 !dress: �t 55 S 4779 �� Over 1.000 amps or volts III 454.65 El City/State/ZIP: 77G-.2.d . 0 , 2 9 701 a 3 Temporary services or feeders installation, alteration, and/or relocation : Phone :45.1o3i coo _' 993 Fax; ( ) 200 amps or less r 66.85 • - Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 © intended for salt, 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, panel J. A Fee for branch circuits with '. f ; ' _..__.. r.. ! ._. Gf F� r . n : °< , �1'.. . t .: , r , , r ', above service Of feeder fee, 6.65 )9.9 f 2 Business name: oath branch circuit B. Fee for branch circuits II COnffict name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'I branch circuit ii. 6.65 2 • City/State/ZIP: Miscellaneous service or feeder not included Each manufactured or modular MI 2 Phone: dwelling, service and/or feeder IME ( ) Fax: Reconnect only = 66.85 2 E-mail; s Pump or irrigation circle Mi 53.40 2 ,, .. :. - ,W .Z::' 3 ,i ,.? .., _ ' ',.:7'...::: - : - ..7.:;!::' - ',:://.:7:.:‘;' ... f S n i a _ k y « wv . ' . 1 ' ?.. _.., ' . � . l -' ` i !,.•_r,_ � ..� .,,.. Sign or outline lighting 53,40 2 Business name: Boones Ferry Electric Signal circuit(s) or limited- energy Address: P.O. Boa 628 extension. Describe Page 2 • 2 alteration, or City/State/ZIP: Wilsonville OR 97070 Each additional ins. ;on over allowable in as of the above Phone; (503) 682-4936 Fax: (503) 682 -7946 Per inspection 62.50 _IM Investigation per hour (t hr min) r 62_50 El CCB Lic.: 88482 Electrical Lic_: 3 -2 C Suprv. Lie.: 5t 9l B r Industrial plant per hour 73.75 Suprv. Electrician signature, required: �' ` , - x ° . - ,,,r i,: r ',.!, -r _ -. •s ' o',� ...\ .:> !,r r Subtotal: (a_Q , 5- 1 • int name' S e r1 1-1r,-0 +'► • Date: Plan review (25% of permit fee): �� A State surcharge (12% of permit fee): Z I . 6 ( I r �0_/ Authorized Signature: TOTAL PERMIT FEE: let 2, , 2,./ "da. a. Print name: Date: This permit application expires it a permit is not obtained withla 180 1 days atter it bas been accepted as complete. • Numbs of inspections allowed pa permit LV3vih 'irVennitAELC -Pami App.da 052 i 3/06 4404615TO tios/COM i;