Permit h t ��
CITY OF TIGARD
r-' ELECTRICAL PERMIT
11
2 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00669
TIGARD` 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/22/2009
Parcel: 2S 104BD02500
Jurisdiction: Tigard
Site address: 13570 SW FERN ST
Subdivision: Lot: 0
Project: Viestenz
Project Description: (3) branch circuits for new furnace and A/C.
Owner: FEES
VIESTENZ, KERRY Quantity Description Date Amount
13570 SW FERN ST
TIGARD, OR 97223 3 crt Branch Circuits 12/22/2009 $71.02
wo /Purchase Service or
PHONE: 503 - 524 -1502 Feeder
1 ea 12% State Surcharge - 12/22/2009 $8.52
Electrical
Contractor:
SUNSET HEATING & COOLING
0607 SW IDAHO ST
PORTLAND, OR 97239
PHONE: 503 - 234 -0611
FAX: 503 - 234 -0439
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 4 7 � Arde Permittee Signature: (i> /7'/ (1 )
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 an inspection that business day.
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.
,, RECEIVE 0 _ rr y;y�, a r ar
S � Mf".� b 9 " ��
Electrical Permit Application : a Y ' n ^Fo F LAS A : a ;> ?'* * :, w
a City of Tigard DE C 1 1 8 200' D cep y / 4/ , °9 Permit CC Z °67 - C7fr')(�r°/
• 1 Phone: 550 Hell Blvd., Tigard, OR 97223 Plan Review Other Permit:
Phone 503.639.4171 Fax: 503.598.1960 CITY OF TIGAR I Date/ y: turf Q) See Page 2 for
Internet:
¢llky►-��• Inspection 503.639.4175 . - teReadyeBy:
Til "'".° p BUILDING DIVISI 1 tt /Metho 16 Supplemental Information ,?
www.tigard-or.gov gov le
s 4 . " "^n+ T, ( , S ' .. ,, '' f., t * --.4.0 ` v.7 s #„ . .t -e s a t. 4 ' ' +- ' �� i L;,r - . • M � ac� • ; t6 , ����, ..a .• �.& .� - � 1 . .i. •
Please check nil that apply (sub
sets of plans whtc.ms checked below): New construction ® Addition /alterationlreplacemenl ❑ Scrvice or feeder 400 amps or more ❑ Building over three stories.
D Demolition ❑ Other: where the available fault current ❑ Manilas and boatyards.
r ;..:; M re:: -..,, , :. �, .r ; � 'y�i � '1 3 p ; exceeds 10,000 am ground, s at 150 volts or ❑ Floating buildings.
�.: � • Nvr °` less to ound, or exceeds 14,000 ❑ Commercial-use agricultural
l o . , �az
® 1- and 2- family dwelling ❑ Commercial/industrial � Accessory building amps for all oilier installations. ❑ buildings.
of 75 KVA or 0
Multi ". 1 0 asYe but y 6 ❑ .. r� '' , ' 0 Emergency of uew m larger sepatalely derived system.
> � '�w�' ' `' " +� � ❑ motor load of ❑ ., A .:.. E ... t _ Z „ ..
5 x ti k. ., . u 4 ❑
I OOHP or more. occupancy
Job no.: S - 1 t;, Job site address: r- (^� \ }, Yi1 S4 ❑ Recreations{ vehicle packs.
t �� C f ❑ Six or more residential writs.
y ❑ Health -care facilities. ❑ Supply voltage for more than City /State /ZIP: �) l k al 7 ❑ Hazardous locations 600 volts nnal.
� ID Service or feeder 600 amps or more
Suite/bldg./apt. no.: Project name: ,v I -)-e '0 ;r �r tsl:450 , 0`'V1i ' is a ` r .� YAN .
di ) Ott rteah 1
Description i (icy. I Fee. 1 Total I •
Cross street directions to job site:
New residential single- or multi - family dwelling unit.
. includes attached garage.
Subdivision: 1 Lot no.:
1,000 sq. if or less 145.15 4
Ea. add'1 500 sq. ft. or portion 33.40 t
Tax map /parcel no L imited energy, residential 75 00 2
.„ ti t -•rl�r' . ryy? x ` 11 " ' (with above sq. ft.)
r �,. • .,
" s - .a 7, -sat c «4 m 4'Z k s w
` Limited energy, multi - family 75.00 2
residential (with above sq. ft.) .-
>L Services or feeders installation, alteration. and /or relocation
200 amps or less 80.30 2
+' le �' 201 amps to 400 amps 106.85
•e, + -+ 1.. 401 amps to 600 amps 160.60 2
Name: K .e► -t'VJ \,) , C_ 601 amps to 1,000 amps 240.60 2
` r- f Over 1,000 amps or volts 454.65 2
Address: � "7 v h„>:l . l',i 41
Over
services or feeders installation, alteration, and /or
City/State /ZIP: .-1-'1 0 t"Jr1 � } _ relocation -
200 amps or less 66.85 1
Phone: ( ) j) 4 - I Fax: ( ) 201 amps to 400 amps I 100.30 2
Owner installation: This installation is being made on property that 1 own which is not 401 amps to 599 amps 133.75 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel
Owner signature Date: A. Fee for branch circuits with
yrr f ,� 9 a l Chi above service or feeder fee, 6.65 2 •
4., r .'" . .as -'xis, :_ ,.,. .... t� .. .:: each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, ' 46.85 , D� 2
Contact name: first branch circuit
Each add'l branch circuit 9 6.65 15 • 2
Address: - Miscellaneous (service or feeder not included)
Each manufactured or modular 90.90 7
City/State/ZIP: dwelling, service and/or feeder
Fax :: ( ) Reconnect only 66.85
2
Phone: ( ) 2
53.40
E-mail: or irrigation circle ,,� 53.40 2
aawc x �� �' s Sig o outline lightin
"w 'a a4. � T ,.
`�.�e ri'�� Via, ?� a , Signal circuit(s) or limited -
Business name: Sunset Heating and Cooling energy panel, alteration, or
extension. Describe: Page 2 2
' Address: 0607 SW Idaho Street l
City /State/ZIP: Portland,
OR 9 7239 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 234 F ax: (503) 503 234 -0439 Investigation per hour (1 hr min) 62.50
73 75
Suprv. Lic.: 4638S Industrial plant per hour •
CCB Lic.: 161085 .-.. ^ ,P 1, ; .t. ' „ ' 1 •' t MV. „ a.. q, " ;,
. Subtotal: Wit_;. t J x71 r�
Suprv. Electrician signature, required: 7 1-
Date:
i` � l Plan review (25% trf permit fcc): y
Print name: Randy Ess State surcharge (12% of perm tee): � 1 <� t
TOTAL PERMIT FIT: k.7.3)-1 ,,,,.../.'..--- Authorized signature
{ 1 This permit application expires if a permit is not obtained within 180
Print name: Shauna D'Am rosia 1 .
I Date: I days after it has been accepted as complete. ^�
+ Number of iuspeetions allowed per permit. ,/
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