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Permit (47) „I CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2016-00683 T[ ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/08/2016 Parcel: 1S136CA08100 Jurisdiction: Tigard Site address: 11036 SW LEGACY OAK WAY Project: PAN Subdivision: WHITE OAK VILLAGE Lot: 2 Project Description: Reconnect only. Contractor: Owner: PAN,ZHIHENG ZHU, CHUNHUA 11036 SW LEGACY OAK WAY TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Reconnect Only 09/08/2016 $67.84 Specifics: 1 ea 12%State Surcharge- 09/08/2016 $8.14 Electrical Type of Use: SF Class of Work: OTR Type of Const: Occupancy Grp: Total $75.98 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 accor 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. ATTE ON: Or:e.g.-Oh,law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0 0 through OAR 952-++ -$0.0. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: 4a ./jA--tJ Permittee Signature. ' • -.. :i'ZLL/.�1_L •' ' 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 Application =� , -., F0I4 01.1:114: I Sl.0\1.1.`City of Tigard ,"` $ ''; Retxuved joy Harem : �,/fi/; ‘'imp, Pmmitft: .. 13125 SW Hall Blvd„Tigard,OR 97223 •i Plan Review Phone: 503.718.2439 Fax: 503.598 1960 ',-- 2 11 h lIato/i1y: Related Permit#: i't c.A tt t� Inspection Line: 503.639.4175 to Ready Date/By: tun.. 0 See Page 2 for Internet: www.tigard•or.gov 'DI , 0), , ; Non 0edlMetturd: Supptrwurrullrforrtatlott TYPE OF `WOR ' PLAN REVIEW ©New construction 0 Addition/a1t o d : I cr cnt ' ', '' Please chock all chat apply(submit seta of plans w/items checked): �_ �cp.8 i itioR Other: ❑ its or!cedar 400 amps or more ❑Budding over three stories. where the available fault current 17 Mannas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or 0 Floating buildings. LP I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commeretal-use agricultural ❑Multi-fatuity 0Master builderamps for all other istallations. buildings. �rf.�. 0 Other: ❑Fire pump. ❑1nsu11atian of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job H. y Job site address: /4136 �� ! ) / ❑AdditGon of new motor load of system. C,1i tri 100Ni or more. 0»A" F "1-2","1-3" City/State/ZIP: IL,' / dep G 7 3 [�Six or more residential units. uWncy. Suite/bld L ✓ [ ❑Health-care facilities. ❑Recreatiorui vehicle parks. g✓ap 4: i Project name: 0 Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Crass street/dfrtions to job site: FEE SCHEDULE Descriotioa I Qty. I rant I Total New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea add'!500 sq.li or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential Re-- iv. Q (with above sq.ft:) 75.00 2 Limited energy,multi-family 7500 2 / residential(with above sq.ft.) ivl PROPERTY OWNER I 0 TENANT Renewable Energy 0 See Page 2 J � �J1 Q Services or feeders installation,alteration,and/or relocation Name: i /A7 4, 200 amps or less 100.70 2 Address: //0.46 �JrJ W1 Q VL 201 amps to 400 amps • 133.56 2 City/State/ZIP: ) 401 amps to 600 amps 200:34 2 i fiz_‘-, /Z�T� t?2- 601 amps to I,D00 amps 301.04 2Phone:(( ) 7(�— _I4. J Fax:( ) Over 1,000 amps or volts 552.26 2 Email: `� C� j. ,-._, `4;7,4 Temporary services or feeders installation,alteration,and/or lw mc.0relocation Owner installsAeA :This installation is being made on property that I own which is not 200 amps or less 59.36 I intended for sale,lease,j t, . chant according to ORS 447,449,670,and a701. 201 amps to 400 amps 125.08 2 r Date: 6(/`'t 4 401 amps to 599 amps 168.54 2 Owner signature: 44 V — CI APPLICANT (_ P ' 45 ,) ( !7 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel Business name: A Fee for branch circuits with above service or feeder fee, Contact name: '�; each branch circuit 7.42 2 (I' j t'J. ri,,Mt B.Fee for branch circuits without Addtt~as: C! service or feeder fee,first branch circuit 56.18 2 City/State/ZIP: Each add'I branch circuit 7,42 2 Miscellaneous(service or feeder not included) Phone:(5t0) 2(s-1? iFax::( ) t Each manufactured or modular Email: �cy dwelling.service and/or feeder 67.84 2 � " ` Reconnect only 1 67.84 CONTRACTOR _ ♦ i" 2 F � Pump or irrigation circle 67,84 2 Business name: Sign or outline lighting 67:84 2 Signal circuit(s)or limited-eenergy Address: 0 See Page panel,alteration,or extension. g 2 2 of City/State/ZIP: Each additional inspection over allowable in any.1.4 the above Additional inspection(I hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Entail; Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(Ys hr min) m' rELECTRICAL ERMIFEES `•Suprv.Electrician signature,required: rt_ ^-- Subtotal: , Print name: Date: 0 Plan Review Required(25%of permit tbe): 11.;41111**—� State xttrch • (12%of - it fee): Authorized signature: TOTAL PERMIT FEE x This resit a J- Prfttt name: pe ppReiaHaa aspires if a permit b sat :�ff*! wroth,18t1 [ 3-ivit�rti , I Date: 9('6/ (-� 1 days atter it L•.• tempted as eoatptsta t pikum pPgmitsun-c srmitAce„uk,EIREMic Rev 001112 tl} • Number of inspections allowed per paw. I40.eat 51(1 ilOSICO Mlwg.5' Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11036 SW LEGACY OAK WAY, TIGARD, OR, 97223 Residential - Electrical 199 Electrical final PASS - No C of O ELC2016-00683 Herb Stabenow Violation Summary: Inspector Contractor