Permit rt CITY OF TIGARD ELECTRICAL PERMIT
•r1 r COMMUNITY DEVELOPMENT Permit #: ELC2010 -00053
Date Issued: 02/03/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S104AA03400 •
• Jurisdiction: Tigard
Site address: 12200 SW 126TH AVE
Subdivision: BELLWOOD Lot: 32
Project: Coats
Project Description: (1) 200 amp service and (1) branch circuit for exhaust fan
Owner: FEES
COATS, MICHAEL Quantity Description Date Amount
12200 SW 126TH AVE 1 ea Services or Feeders - 200 02/03/2010 $100.70
TIGARD, OR 97223 amps or less
PHONE: 1 crt Branch Circuits w /Purchase 02/03/2010 $7.42
Service or Feeder
1 ea 12% State Surcharge - 02/03/2010 $12.9
Contractor: Electrical
SQUIRES ELECTRIC
PO BOX 16851
PORTLAND, OR 97292
PHONE: 503 - 252 -1609
FAX: 503 - 253 -5831
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $121.09
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: Permittee Signature: 0 `� 69 2 " / e ��c' ^ .
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 603.639.4176 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 ��1� FOR OFFICE 12SE ONLY •
City of Tigard . / p i PamitNo tC WO -
23
13125 SW Hall Blvd., Tigard, OR 23 Q 10 Plan Review
Phone: 503.639.4171 Fax: 503.598.1V 0 i' Dates : Other Pamir
TI C: A R n Inspection Line: 503.639.4175 p Q) Data Rear. r 0 See Page 2 for
Internet www.tigard-Or•gov `clGn Netifie dy /B hod: ` Suppteroenml Information
kS T.- l= ti .^r:r i.g4 t, e _ Y'? 7 'L'g:�: L'f'a-. ''1'.: �,..�y� `�1 ,;_. g
'W� :, %�L -. . ' `,::� :�. . } .� .�} 4:';' fir,. � .c �- �- ;.. - '.l :.: �r�` :: =p �' ,75•... ter., +� , .... ..s.�: - •':•. �.rfi'._.t:f- =-. :' .1._: �r -k: ,; ti <L�4 f ��17V.''y"K M. .• � .• _��..... ❑ New construction I'Addition/alteplacement mist cltwk an that apply (submit 3 sets or plans w /hams checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
; "; ..: . ", : .- ` :. - :. 'aF _-, . e 0 •.• : -(f '''_-; : a"Y >`x: "'� "" exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
•' � `' legs to round, or exceeds 14,000 ❑ Commercial -use erg :culturni
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for alt other installations. buildings.
Multi - family ID Master builder El Other: ❑ Fire pump. 0 Installation of 75 KV•A or
=1 qrpi ' ❑ Emergency system. largo Separately derived system.
o,, % ' = :- , t .. .K'K�,u��! _ ,,I�j � : r ".? - �.. .,r -� �i :c:� n- 1?+ ❑ Addition or new motor load of ❑ ..A -. •, _t.2 _3 ",
Job no.: Job site address: / ,), j)(j OLD j) 4.1 A e 10011P or mote. occuconcy.
❑ six or more residential units. ❑ Reere:16,m l vehicle parks.
City /Statt/ZTPT 'C ; C (p_y-( ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: Project name: .d I ; &t out.. I ('53 ❑ Service or feeder 6W amps or more.
ATIIE: :`..air.'; :gti ;" :' .. " -.. 1.... ':' tiWO... .f, .
Cross street/directions to job site: Ikscrlpdon 1 Qty, i Fen. i Tntat •
'" - New residential single- or multi - family dwelling unit..
includes attached garage.
-
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Tux map /parcel no.: Ea. add'] 500 sq. ft. or portion 33.92 1 -
Limited energy. residential 6 7. 2
+
``, �� s ��� < . ,,, ,,,,,r.�, - y ,-- .... ::x'l"": � �_ - ; s.
,5 ...,...;, _ ti ny i ` ' ; *.V.) . •A ' (`� : . 11.1•= ' t1== . ` o «rs ; (with above Sq. Al . �Pi+rd3'..a�;.V: : ;.. ,. - . � ;-C - : _•., r . .... _ liF� }...- : , .. .F"�3 "� : "' �i ; ' I ° %�
iimited energy, multi - family 67.84 2
I) ; EJL- 4 L ► 1 r ; + 'rah' e(i g , residential (with above sq. R)
Seniccs or feeders installation, alteration, and /or relocation
200 amps or less ._ __ _7 100.70 1 O.7Z) 2
r_= 9=7,1 r nsrw }' -4' : w1 - � ,... _• i .
- . -• .c5 '.�`� � � �_ �F`�iElt.- ' r?: h r .`'.; =�' t �� �i�4'I;`-
i I 201 amps to 400 amps 133.56 2
Name: ri / /f,4 CO t 7:5". 441 snips to 600 amps 20034 1 2
601 amps to 1.000 amps 301.04 1 2
Address: Over Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration. and /or
I relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 own which 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 amps to 599 amps j 168.54 2
Branch circuits - new, alteration, or extension, per panel j
Owner si _.. Date: A. Fee for branch circuits with
. �.' .' , -: '4:. 477: 1 ,, • '+"` •. '�- r r✓ above service or feeder fee, : g-fr : :=r 1 . ,.. 8 :141g.7404,0.! ' .0 '1 '; -.. ; .r � [ 1 ; �'' 5 j f 742 7 r, 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or fender fcc, 56.18 2
first branch circuit
Address: Each add'1 branch circuit 1 7.42 � 2
Miscellaneous (service or feeder not included) l
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.$4 2
Phone: ( ) Fax: : ( ) , Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
D .� ,,p� :,,•. :M :- _ riT ; ` ,;. M ;7 % r ."_ ...: 3. :,.,; Sign or outline lighting 67.84 2 .. e 1 iE 1 " : Signal p a n ui, a) or limited-
Business nam or
Lt-4 Yew Y i t �u-�. energy panel, alteration, or 1
Address: t '- C am
f.g extension. Describe: P-4e 2 2
City /State /ZIP7pc DR. 9' .. 9 <1... • Each additional inspection over allowable in any of the above
_ Per inpectton 66.25
Phone: (5D3 ,....A5 I P7 Fax: (603) ,3 -5 .0,l v / Investigation per hour (I hr min) , 6625
11 �!/ CCB Lie.: 1,g5 0 Electrical Lic. b -i /D / el Suprv. Lic.: ,6 I p per hour M` i 78.18
��Vll gi' _ s� ! '• c gic �, �'` ��'�E�*i3�:jZ:�S; : :' : :r,<
Suprv. Electrician signature, rtxluir :
Subtotal: 1 f(} ).
Print name: 6 pie: : /02 • _ Plan review (25% of permit fee):
e Q I i re`, a 1 Stare surcharge (12 %ofpermit fee): y 7
Authorized signature: TOTAL PERMIT FEE U1 . b 9
This permit application expires if a permit u not obtained within 180
Print name: Date: days after it ham been accepted as complete.
• Number of inspections sh owed per permit.
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