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Permit CITY OF TIGARD ELECTRICAL PERMIT n 1111111 • COMMUNITY DEVELOPMENT Permit#: ELC2015-00832 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/14/2015 Parcel: 1 S 136AA02100 Jurisdiction: Tigard Site address: 10310 SW 69TH AVE Project: Williamson Subdivision: FUR VALLEY Lot: 1 Project Description: Change 200amp service from overhead to underground.(House-Meter#1941106) Contractor: POWER LINE ELECTRIC INC Owner: WILLIAMSON, KRISTOPHER 8403 SE SHERRETT ST 10280 SW 69TH AVE PORTLAND, OR 97266 TIGARD, OR 97223 PHONE: 971-645-3807 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 10/14/2015 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 10/14/2015 $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 accordnck 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. ATT ION: Orego law re.uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001- 10 through OAR 952-6! 4090. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.232. •= .8111 2.2344. Issue By: Permittee Signature: X • oL _ • 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. 15-3C) 5 5 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. Electrical Permit APP li FOR OFFICE USE o�l.l City of Tigard �VEP Received /0 // �S Permit No.: el-e-�'t//S 60 a 3 13125 SW Hall Blvd.,Tigard,OR 97223 Plan R view! s Phone: 503.718.2439 Fax: 5 1 Date/ : Other Permit' p 2(115 1 I t i t R I Inspection Line: 503.639.4175 Date Ready By: lu is 0 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information I it), ,GARD PLAN REVIEW New construction A•t' • . '� ib�',t �It t nt Please check all that apply(submit 2 sets of plans w/items checked below): ❑ P 0 Service or feeder 400 amps or more 0 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 agncultural '1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings. ❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or ❑Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E","l-2", `I-3", f1 ��. 10OHP or more. occupancy. Job no.: Job site address: `� \c) �� G� Pie. ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than \\�('� \ O� ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 Tax map/parcel no.: i 5 / 34''4'4 C9 0-1 3C Limited ener gy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) \ Limited energy,multi-family C`, ? ;�1 \'> ���� C V�cY\rCLt ,� residential(with above sq.ft) 75.00 2 Q M trig- •� Renewable Energy ❑ See Page 2 \-kv\(LZc accr.)-vv),- ec.i ((+t.t t_5 ., l'`p a Services or feeders installation,alteration,and/or relocation fir P OPERTY OWNER ❑ TENANT 200 amps or less I 100.70 Mr.-70 2 I 201 amps to 400 amps 133.56 2 Name: .c\5 � • �Ak ,,,,LS0„ 401 amps to 600 amps 200.34 2 Address: \e-2....(6G Sw Gc1 i,. 1,4e., 601 amps to 1,000 amps 301.04 3 l Over 1,000 amps or volts 552.26 2 Cit}'/State/Z[P: `� ,‘ck` Temporary services or feeders installation,alteration,and/or Phone:( ) Fax:( ) relocation 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I 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 168.54 Owner signature: Date: Branch circuits-new,alteration,or extension,per panel APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7.42 Business name: 'a �\,∎C each branch circuit pVvC c v�� , B.Fee for branch circuits without Contact name: Vc.s,„ew� service or feeder fee,first c. c��� �� 56.18 2 c L branch circuit Address: ,al.tU 5 '-'c, �1_,c‘'E'kk Each add'l branch circuit 7.42 2 \ 1 Qa �r�/ Miscellaneous(service or feeder not included) City/State/ZIP: V(i,c\ciciv'\(i C� 11! Each manufactured or modular Phone: n �( q Fax:: dwelling,service and/or feeder 67.84 2 (v,�' ) —\ `� \ �� ` ( ) Reconnect only 67.84 2 E-mailAtN•1(c OU lec:Lci, 6 c��inio.Co*' Pump irrigation 2 Y Pum or irri anon circle 67.84 CONTRACTOR Sign or outline lighting 67.84 2 Business name:?0s, V.,„4.,C., \e Ckt,,..c.. ,- Signal circuit(s)or limited-energy See panel,alteration,or extension. Page 2 2 Address: QLQ', e - Each additional inspection over allowable in any of the above Additional inspection(l hr min) 66.25/hr City/State/ZIP: •Vock-VoiNck , Q (.�" (,y- Investigation(I hr min) 66.25/hr Phone:(cm) (c_-?,c '-T.7 T" `Fax::(( ) Industrial plant(1 hr min) 78.18/hr � ;�' I Inspections for which no fee is CCB Lic.:4V 1 6 Electrical Lie.: C ,® q Suprv^Lic.:5 -3O j ee specifically listed('/2 hr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: /cc). ''7 Print name:��,,G /2 ate:C3L� A. Plan review(25%of permit fee): rle� (` y Statesurcharge(12%of permit fee): /a g Authorized signature: ,U,� TOTAL PERMIT FEE: //A.•7 1 This permit application expires if a permit is not obtained within 180 Print name: e__,.,(.., \(U` v yc\1 Date: CL� V A.\S' days after it has been accepted as complete. V • Number of inspections allowed per permit. I.\BuildingWermits\ELC PermitApp_ELR_ERE doe Rev 05/21/2013 440-46t5T(11/05/COM/WFB