Permit wuriir
CITY OF TIGARD BUILDING PERMIT
il
xt; s COMMUNITY DEVELOPMENT Permit #: ELC2010 00254
T E
V.,'. Date Issued: 05/25/2010
G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S133DD16500
Jurisdiction: Tigard
Site address: 11994 SW 129TH PL
Subdivision: VILLAGE AT SUMMER LAKE NO. 5 Lot: 201
Project: Chin
Project Description: (2) branch circuits for furnace and heat pump.
Owner: FEES
CHIN FAMILY TRUST Description Date Amount
BY LAWRENCE D /ELAINE F CHIN TRS, 11994 Branch Circuits wo /Purchase Service or 05/25/2010 $63.60
SW 129TH PL Feeder
PHONE: 12% State Surcharge - Electrical 05/25/2010 $7.63
Contractor:
BEN'S HEATING & AIR CONDITIONING LLC
PO BOX 80607
PORTLAND, OR 97280
PHONE: 503 - 233 -1779
FAX: 503- 651 -3345
Specifics:
Type of Use: SF
Class of Work: ALT
Dwelling Units:
Stories: Height: ft
Bedrooms: Bathrooms:
Value: $0
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $71.23
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes an • di other - pplic: ble 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 ,I rk is spe • • ed for re the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted b the Oregon Utility Notification Center. Thos: 1 l-s -, = s- orth in OA!
952- 001 -0010 through OAR • 2- 001- 0100 -o• •r direct questions to OUNC by calling • 1 f 46 • • • = or 1.80' .
Issued By: Permittee Signature: , '`,fa
• al ,,,,dab 9.4175 by 7:00 a.m. for an inspection that business da
This permit car. 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 • n ,� .1 �� - 't `""c o ' II Ici ii ; Y
1
City of Tigard Date/B : t_ I U g 1 Permit No.: -/ i .
a • -.
13125 SW Hall Blvd., Tigard, OR 97223
:. Phone: 503.639.4171 Fax: 503.598.110c, Pl •
R ev i ew
t CEIV Date/By: , 1 Other Permit: r1 C 2. (0 �(,
FIG < A l I' Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov n^ V �� Notified/Method: Supplemental Information
TYPE OF WOR>Ct`t " 2 " U {� PLAN REVIEW
❑ New construction Addition /alteratiQA�Fo�t7��tJ��L Please check all that apply (submit 2 sets of plans w /items checked below):
1 v' DIN iS�O ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: BUILDING where the avai fault current ❑ Marinas and boatyards.
CATEGORY OF CON RUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
��[[ less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
- and 2-family dwelling ❑Commercial /industrial El Accessory building amps for all other installations. buildings.
{- Multi family ❑Master builder El Other: ❑Fire pump. ❑ Installation of 75 KVA or
. JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
Qnf T r - 1 ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: li / 7 4 `� /' t j / q � ( _ IOOH more rest occupancy.
/ vv �v 1 i ❑Six or more residential units. ❑ Recreational vehicle parks.
.�;
City /State /ZIP: f / ❑ Health - care facilities. Supply voltage for more than
Y (/ ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: "`Ill Project name: \ t ❑ Service or feeder 600 amps or more.
C� YV FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: -
Limited energy, esidential
� 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Re- Limited ,N ( `r A� deATUrvpr Limisid energy, mu s 67.84 2
/v ` /���►� 1 � 1! residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPER WNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: %
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without '
/ 56.18 service or feeder fee, first �
Contact name: 6 t4 r r„`i/ branch circuit �( 2
Each add'I branch circuit ` 7.42 * 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: /State /ZIP: Each manufactured or modular 67.84 2
Y dwelling, service and/or feeder
Phone: ( ) 3'? - 3CMO I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CO TRAQTOR de.- Signal circuits) or limited energy
Business name: �e� S �I of panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above •
Address: tt O OM 0 0 1 6: Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: :por-I- 1i es. L/ q .7d20 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: Inspections for which no fee is
90.00/ hr
�) �1Z3 �' 7 9 Fax: ( ) Pe
�G-� it specifically listed (%2 hr min)
CCB Lic.: 645177 II A l Electrical Lic.: ^I / I Lu rv. Lic.:
RICAL PERMIT FEES
Suprv. Electrician sd N'L,1Eequired: p o Subtotal: G 3 ,(
�J`G C/t il� Plan review (25% of permit fee):
Print name: el ( ie . _ r o Date: e r4) State surcharge (12% of permit fee): . 63
� �- TOTAL PERMIT FEE: -7 / )-3
Authorized signature: i l This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: a � �� ���= ,A-1 Date: �g.'"- 10 " Number of inspections allowed per permit.
I: 1 BuildinglPermits \ELC- PermitApp.doc 10/01/09 440- 4615T(1I/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \ Building \Permits\ELC- PermitApp.doc 10/01/09