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Permit CITY OF TIGARD ELECTRICAL PERMIT 111 COMMUNITY DEVELOPMENT Permit#: ELC2019-00530 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/06/2019 Parcel: 2S 111 BC01300 Jurisdiction: Tigard Site address: 10150 SW VIEW TER Project: Losli Subdivision: GREENBRIER Lot: 5 Project Description: (9)branch circuits for kitchen remodel. Contractor: NW ELECTRICAL SOLUTIONS Owner: CARMEN LOSLI PO BOX 805 10150 SW VIEW TER MOLALLA, OR 97038 TIGARD, OR 97224 PHONE: 503-539-7123 503-759-3952 FAX: FEES Quantity Description Date Amount 9 crt Branch Circuits wo/Purchase 08/06/2019 $115.54 Specifics: Service or Feeder 1 ea 12%State Surcharge- 08/06/2019 $13.86 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $129.40 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 ''r more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are -t forth in OAR 952-001-0010 through OA 952-001-0090. You may obtain rules or direct questions to OUNC by callin• _ . 32.1•. or 1.800 44. _ a -._ -- ----- ---r _—a Issued By: . permittee Signature: , — ��. A 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 - i'M # FOR OFFICE LSE()NIA City of Tigard Received ¢ j • 13125 SW Hall Blvd.,Tigard,OR 97223 (: qs i f,`C Date/B : t2�l �`/! ►1J� _ Phone: 503.718.2439 Fax: 503.598.1960 ` ' �" Plan Review Date/B : Related Permit#: i 1 ' -(✓�(y) )4L4 Inspection Line: 503.639.4175 ,r,, '? ,._ikeady Date/By: IMIIIII Bl See Page 2 for 1 I(i A R I) Internet: www.tigard-or.gov 'Notified/Method: Supplemental Information rx t.- ,'. . PE OF WOR PLAN REVIEW 1 ❑New constructionAddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. ID Demolition 12 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. -l-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or ,JOB ,SITEi :INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: / �-y- ❑Addition of new motor load of system. I�1 5 0 v/ 1c1 r 100HP or more. ❑<A„ `E> `1.2„ "1-3„ City/State/ZIP: l j d 0'� et-152-44- 0 Six or more residential units. occupancy. _ j / o Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 144� ®dfpi l -j , 00 HS locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE" CIIE E" Description I Qty. 1 Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK- Limited energy,residential J75.00 2 ^ (with above sq.ft.) I�t l "al IL-040:1d Limited energy,multi-family 75.00 2 residential(with above sq.ft.) PROPERTY OWNED ❑ TENANT Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Name: CAr nte,n 1.-os l r 200 amps or less 100.70 2 Address: r or i rb sv..) Y _ .c1 . -i- 201 amps to 400 amps 133.56 2 ( n iL p 401 amps to 600 amps 200.34 2 City/State/ZIP: ••T'((a(,rd 0 ell sa-Lc 601 amps to 1,000 amps 301.04 2 Phone:( x'02) P 7 '7(Z2, Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 APPLICANT 1 p CONTACT, PERSON Branch circuits-e new,alteration,or extension,per panel A.Fee for branch circuits with Business name: 0.4.41,6 lakito tVSabove service or feeder fee, 7.42 2 each branch circuit W . B. Contact name: Fee for branch circuits without — 'g Address: l p �O!/1 GrnCk service or feeder fee,first 56.18 `J 4. 2 �.�/L branch circuit ty N��h Q.�._ iia 1 Each add'l branch circuit 8 7.42 SiAltai 2 City/State/ZIP: © Zj Miscellaneous(service or feeder not included) Phone:(50 2)) 1'5( ,,,cif 50 Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: Reconnect only 67.84 2 ,..., CONTRACTOR Pump or irrigation circle 67.84 2 Bugtegs narne: M -t W-GS I tt a 1 t I hS Sign or"outline netting 67.84 • 2' Jr Zz /iC So �U �. Signal circuit(s)or limited-energy Address: 176 760 ' or,jar R panel,alteration,or extension. 0 See Page2 2 /do �� O p 1v t' Each additional inspection over allowable in any of the above City/State/ZIP: (f� / i1t b Additional inspection(1 hr min) 66.25/hr Phone:(563) 1 6 2,-3 ij ci Fax:( ) Investigation(1 hr min) 90.00/hr •� i+t.41 3i @ t " �-e C 0 M Industrial plant(1 hr min) 78.18/hr Email: �7,.A "/ Inspections for which no fee is CCB Lic.:2WC7 Z, Electrical Lic.:C 1451 Supry.LIc ,.5639 5 specifically listed('/hr min) 90.00/hr Suprv.Electrician signature,required: '• , �� -. ELECTRICAL. � " " " ,iii �. _ Subtotal: /�j Print name: r `{� '' q Plan Review Required(25%of permit fee): -- ii 101,- '"''', �� State surcharge(12%of permit fee): � Authorized signature: TOTAL PERMIT FEE: I {•ito jere4wA This permit application expires if a permit is not obt within 180 Print name: 0 SM 714Date:gifd/ days after it has been accepted as complete. ( * Number of inspections allowed per permit. I:\Buildng\Permits\ELC_PermitA _ LR_ERE.doc Rev 06/17/2015 440-46151(11/5/COM/WEB