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Permit a CITY OF TIGARD ELECTRICAL PERMIT s. COMMUNITY DEVELOPMENT Permit#: ELC2016-00433 T f GARD D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/25/2016 G Parcel: 2S110BA05600 Jurisdiction: Tigard Site address: 11865 SW WILDWOOD ST Project: ANDERSON Subdivision: SHADOW HILLS Lot: 9 Project Description: (2)branch circuits for heat pump and remodel. Contractor: POLARIS ELECTRIC LLC Owner: ANDERSON, KELCIE L 22380 NW SELLERS RD 11865 SW WILDWOOD ST BANKS, OR 97106 TIGARD, OR 97224 PHONE: 503-681-8013 PHONE: FAX: 503-647-9099 FEES Quantity Description Date Amount 2 crt Branch Circuits wo/Purchase 05/25/2016 $63.60 Specifics:, Service or Feeder 1 ea 12%State Surcharge- 05/25/2016 $7.63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 AR 952-001-0010 through••R 952-001-0090. You •.•o•tainin-•r or direct questions to OUNC by calling 50 32.1987 or 1.800.332.2344. Issued By: .r! Permittee Signature: l �" j �// 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. Electrical Permit ApplieaWn City of Tigard ECE►VE[ ms 5 l(e -�r ,-t#; L.Go l(o`fit 3 11,4 , 13125 SW}fall Blvd.,Tigard,OR 917.23 y 2 Plan Review X ' Phone: 503.7181439 Far 503.54 c/B. - Related Permit kin 57 O/,'" t5. InspectionH i line: 503.639.4175 2016 Ready Date/By ha See Page 2 for T 1 t, -D Internet tvt4roi tigard-or.gov CITi�E Notifies kkthod Supplemental taforiaatina tlPlane check all that apply(st tai}?sets of plans iv/items chucked): Q New construction 0 Addition/alteration/replace I V_ . 0 Servicv or feeder 400 amps or more 0 Building over three stories. Q Demolition 0 Other: where the acaiMabk tach current ©l+Aarinas and boatyards. colTEGORY OF • e****I0,000 amps st l50*Ali* 0 Floating buildings- jiC : less1-and 2-family dwelling 0 Commercialfindustrial 0 Accessory building to g*� ►.Oftx 14,01X1 0 t a nmercial Lae igricu►niral amps for all other installations buildings. 0 Multi-family 0 Master builder 0 Other 0 Fite pump 0 Installation of 150 K.VA or t ;'JOB;, IN TH MID Aiti ❑Emerg v system. larger separately derived O limon of new motor i of system. Job#: Joh site address 2 • Lb '�� lnnliP'rxiEH�rC. A z" C iCyr'StAt sj7 TD. 0 Six or more residential traits. occupy. 0 Heahh»care facilities, 0 Recreational vehicle parks. Suitefbldgiapt.#: 1 Project name: 1 0flazanhous locations la supply voltage Remote than 600 flail Cross strcet/directions lo job site: 0 Service or feeder 600 amps or more a nominal > 1 Qty. 1 ray ) rot>ri j ,� iNew residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached rage. l,titlfl sq,ft.or loss Tax.map/parcel ti: ,,, „ F-a-add'i 500 sq tt-or portion M nN OF W i Limited ener residential (with atoveSq.ft.) 7S.f1(1 i�- 8,,,,...„1„... L 1 n c,w . .,,.m.,.-.,,.ter ......m. i �, Limited /� ` tom-inuhi fatnil5 # ; AA GC 1 Lf/t-c:- -- /-J AT 17,,,,,,t, residential(withabove sy t 1 35.Qr'i _ �` PROPERTY �1 E' 13 T�1 - Renewable Energy 1 © See Page 2 � Services or fetders installation.alteration,and/or relocation Name: ape or less 1 100.70 2 { c M >�nl i ZS :J r 201 in 40(1 amps { 133.56 _ Address; % i K t S- StA) i/� l LU ik/;;v SI rt-t_t_r 401 align to 600 amps 200 34 2 (it �iwt ?TCl': r i -�-� } r r G A,L,J O rZ y 7 z -L"> fi{i1 amps ro 1.000 amps _3})1.}34 I Phone:(5,c3 ) -)a Z - `•)(.)i./-7 Fax:( ) Over 000 amps or volts 1 ! 552.26 Temporary services or feeders installation,alteration.andltir 1 mail: -f.s Cq7 vi L.a t'a>�, 2eincatitrn Owner nstallation: his installation is being made on property that I own which isnot 200 arras ur kis ! 59.3G I intended for sale,Iease��,xen or exchange,according to ORS447,449,670,and 701. 201 amps to amps 125.})8 2 IOwner signature: i O 4"- 14.•,Q.L-vs--___. Date: S.-- 2-`-/ - 401 aims to 599 amps j 168_54 E Ar1 iC iT' 1 1: lrACT,PERSON Branch circuits- new,alteration,or extension, r yianel A.Tee far brranch circuits wrth Business name: above service or(Coact fee, i 4., - Contact name; chit branchcircuit B I Fee for branch circuits wirhoie - ! ._,..,..�,,,. service or feeder fee,first i 's7 2 1 5' ,. t {i Address: branch circuit 1 1 56 f 8 City 1 Stale/ZlP: Each add'►branch circuit j I I 7.42 7,41-2 # �— afiscelianmtuc(service or feeder not included) .„ Phone:( ) Fax::( 1 Each manufactured or modular 1-'.$4 dwelling service andior feeler 1 Email: i Reconnectinch 67.84 " . C#1 AC� Pump or irrigation circle ] I 07.84 7.M 2 Business name: /' tj/Air`,_i I e.c �°.fi e j Sign Of outline lighting 1 1( 67.84 2 Address: a yl r fit' i~S �( Simi circuitl s)or limited-energy I 0 Sec Page 2 2 + panel,alteration.lir extension. i ri } Each additional inspection over allmf. in as ►f tits above City/StaleiZ 1, ti j _ tit,_ /j °_E : , 51 hr Phone::(co 3) 6 / C-)i_? 1 Fax:( ,-) et/7- `i (' € nvcssttigatitin(I hrinrin l h I 9000/hr i r minEmail: ) ...{.- Industrial plant(l hr min) t8 1It far . // Inspections for winch no fee is i 90,00/hr CCB Lie.;f 1 f Q,r s Electrical Lie.: C._ .,a Suprv.Lic.:53/tU 1 , ►`f 'listed'4_hr mai p f /`� 'a CTA1,.I`Ii. +u r4.Electrician trician signature,required: (' ! "'-'e '1., ___ Subtotal" 6 3�' j / Print name: ''�i t(?. f l t, e... _ j Date: �t3`Ar, ,11 C Plan Review Required(25"o of perm}fee): State surcharge(12"ii',of permit fry): I- _Authorized signature: OTAl.P1 RMIT Fes: 7 s� a This permit application expires ifs permit is ret obtained within 180 I Print name: Date: i days after it has been actepttd as complete. ' Number of inspections allowed per permit 1'43w:dny,ll'etmiu1-1,C.PennitY r, ILA 1111 dor kcy 06,17,201" 444-4t I VI:1 1,t)i'CoMw4'r1