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Permit CITY OF TIGARD ELECTRICAL PERMIT ' COMMUNITY DEVELOPMENT Permit#: ELC2013-00574 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/26/2013 Parcel: 25111 CC05900 Jurisdiction: Tigard Site address: 9980 SW CENTURY OAK DR Project: Bell Subdivision: SUMMERFIELD Lot: 82 Project Description: (1)new service. Contractor: THE POWER WORKS Owner: BELL,JOHN D 4233 SE 182ND#202 9980 SW CENTURY OAK DR GRESHAM, OR 97030 TIGARD,OR 97224 PHONE: 503-310-9745 PHONE: FAX: 503-622-6612 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 09/26/2013 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 09/26/2013 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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 952-001-0090. You ma • • - _ • of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued =•. rr Permittee Signature: rSow 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. SANDY RIVER ACCTG PAGE 02102 09/25/2013 15:38. 5036226612 FOR(.)FF)('i:. 1 st,O\l,l ,,! seas 11 Crinli ApptlCat�ion �} City of"Tigard e Ream I i� Permit Na.: 2u .. •S 7 e1 • 13 125 SW Ball Blvd.,Ti D�' Q�� plan R view .2� ' E- ' Phone: 503-718.2439 Fax; r:., •60 Datdg : Other Permit: T i r.,,`/..1-) indiction Line: 503.639.4175 t�Q �®��, luris ® See Page 2 for Internet: www,tigard-or.guv , ',�'r ,�\` Supplemental information "TYPE,iO1H'W t 1 �v. ❑New construction 7 Addition/alt !,cement Please check all that apply(submit 2 sets ot plans*items checked below): ❑Demolition 1::1 Other d Service or feeder 400 amps or more D Building over three stories. where the available fault mm ant ❑Meuse and boatyards. and 2-family dwelling y pjp,;, ONOTIS V •'-: .. . '. pcceeds 10,000 amps at 150 volts or ❑Floating buildings.• - - wellin - .. less to 1pvuna,or exceeds 14,000 ❑Commercial-use agricultural $ 1 0 Accessory building amps for all other installations. buildings. 0 Multi-family 0 Master builder ❑Other: ❑Fire pinup. ❑installation of 150 K VA or system. larger separately derived system, ' daft.SIT INFORMATION AIND,LOCATION Emergency �K -; • 0 Addition of new motor load of ©"A","1 "1-2••,"I-I" Job.no.: Job site address:CIO SC), .U)(, OA lo— 100141,nr r El Six or more residential units. cuynuOy.n ecreationa 0 Recreational vehicle parks. City/State/ZiP: '' °'' r 0 Hazardous facilities. ❑600 volts nominal. more than \� ❑Har.Orrdou,locations. Suitc/bldg_/apt.no.: Project name: _ D Service or fader 600 strips or more. i,R!ai 16Ct:* :A FEE SCHEDULE Cross street/directions to job site: na ,,,ri,ion - PeG w,t tp New rcaldcntlil stogie-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.R.or less MI 168.54 4 Tax map/parcel no.: Be,add-I 50U sq,It.or portion 33,92 �El Limited energy,residcmial 75 00 El DESCRIPTION OF•WORK.. with above s•.R. Limited matey,multi Family 75.00 e _ OP ,:, _. .-. '(✓,e., residential with above •.ft. Renewable Ene a 0 See Page 2 Services or feeders installation alteration,and/or rclocativu . D',PROPER:rv,oWNIIFR:. .' - tr 1:'.TENAPrr 200 amps or leas NMI 100.70 a. 0 2 201 amps to 400 amps ism 133.56 El Name: �f 6bN 401 emus to 600 amps 200.34 11111111110 Address: 601 snips to 1,000 amps 11.1 301,(14 MEND City/Slate/ZIP Over 1,000 amps or volts 552,26 Q Temporary acrvices or feeders installation,alteration,and/or — Phone:( ) Fax:( ) relocation 200 amps or less d Owner installation:This installation is being made on property that I own which is not 201 amps to 400;imps 125,08 d intended for sale,lease,rent.or exchange,according to ORS 447,449,670,and 701. 401 d,Itt,to 599 amt's ; _© Owner signature: Date: Branch circuits–new alteration or extension • r ,suet A.tee fo,branch circuits with 0 APPLICANT ..1� CiDI!tT.ltT.PEft90N°' above service or feeder fee, Business name: each branch circuit 1-42 B.Fee for branch circuits without Contact name: service or feeder fee.first 56,18 branch circuit Address: itch add-I branch circuit 7.42 misceuaneous(service or feeder not included City/State/;LIP; _ Each manufactured or modular III awefin: service and/er feeder 67.84 Phone:( ) Fax_:( ) _ Reconnaet only IIIIIII 67.84 E-mail: Pump or irrigation citete MIrd •ONTRACTOR sign or outline lighting 67 84 Business name:The Power Works Sigrrnr druit(s)or lintite -e See .,el,alteration or extension. Page 2 Address:4233 SE 182nd Ave,#202 Each additional ins•action over allowable in an of the above City/State/ZIP:Gresham,OR 970311 Additional inspection(1 hr nu n) 66251 hr investigation(1 hr min) 66.25/hr IN Phone:(503)310-9745 Fax:(503)622-6612 1 .•usnia!plant(1brmin) . — i.- Beall rot wnee:h no in i9 90 00/hr �� CCB Lie.: 1$4278 ��Suprv.Lic,: 5389$ firc11 listed 'h hr min ELEC"IRICAL'PERM1T FEES. Suprv.Electrician signature,required: d,/ _ J+ Subtotal: `Cr),"t(� Plan review(25%of permit fee): Print uamc: Eric C.Martin Date: 9/251�j State surcharge(12%of permit fee): ; WA Authorized signature: TOTAL PERMIT FEE: r Print riamC; 1JaLC: This permit appliartlon expires if a permit is trot obtained within 180 day,after It has been accepted as cotapiete- • Nmuber of invct;tiun5 snowed per permit. 3uiiditrg\Pamits1ELC PrrmltApp_6LR ERE.doc a. n5/21/2013 446-t15T(IlIosicomWP.R