Permit CITY OF TIGARD ELECTRICAL PERMIT
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: . II ;;- COMMUNITY DEVELOPMENT Permit #: ELC2009-00637
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/01/2009
Parcel: 1S133DA03700
Jurisdiction: Tigard
Site address: 12545 SW GLACIER LILY CIR
Subdivision: Lot: 0
Project: McClure
Project Description: Add /alter (1) branch circuit to replace gas furnace.
Owner: FEES
MCCLURE, KEITH E AND Quantity Description Date Amount
PATRICIA E, 12545 SW GLACIER LILY, CIRCLE
TIGARD, OR 97223 1 crt Branch Circuits 12/01/2009 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 12/01/2009 $6.74
Electrical
Contractor:
BEN'S HEATING & AIR CONDITIONING LLC
PO BOX 80607
PORTLAND, OR 97280
PHONE: 503 - 233 -1779
FAX: 503 - 651 -3345
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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. At 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: ` \ •'. A ! ., l j 1 . 1 Permittee Signature:
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:
1 CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' (t ` Date:
LICENSE NO. Q.
4
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.
. . ., /-* '-
rical Permit Application �i =)51 ('' . rc;IC of i ic:l•: IJsi•: ()NIA'
City f Tigard ce
25 NOV 0 V Z �A Permit No.; � 7
ate / BV.
• 13125 5W Hall Blvd., Tigard, OR 97223 Plan Review rn M
Phone' 503.639.4171 Fax: 503.598.1960 Date/By; other Permit " `teaC I ?3F
T I G A RD Inspection Line: 503.639.4175 (;';"V ° :. `pate tteady/Hy ? l� a s Page 2 for "L �
Internet: www.tigard- or.gov is , t , •,•,- - 1'fot hod ` ,
• t ( ^:' i . Suyplementallnfurmntinn l
. • ! i T., f., 9 p iir C 4 .,. , n1'I' 1 40 ' r P PLAN REVIEW
❑ New construction tgr Addition /alteration /replacement Please check all that apply (submit 1 sets of plans w /terns checked bcluH I -
❑ Service or feeder 400 Amps or more 0 Building over three stories
❑ Demolition ❑ Other: whore the available fault current ❑ Marina, and boatyards
• CATEGORY pit. C NSTRUI'I(*ib1', , g , , er A : + ;r`', exceeds 10.000 amps al 150 volts or ❑ Floating buildings.
r '' ' '` less to round, or exceeds 14,000
a ❑ Commercial-use ngcicuitwsl
gj 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder 0 Other: ❑ Fire pump. ❑ Inat;,Ii :Ilion of 75 K VA or
t . . ❑ Emergency system. larger separately deri,ed wystcnl
JOB 36' E%1NIfORM AND 'I:i�ATICI
OI!� ,r .:';:�' , �a t M1
. • n .., . . is • ❑ Addition of new motor load of ❑ "A" "li" "I •:" I • }' .
.10h no.: Job site address: / //S„Sa IC er l� � 10011P or more. occupancy.
/v ❑ S ix or more residential unirs. ❑ Recreational vehicle Or 1s
City /Stale /'LIP: 7 ' ?f ^ Ste• ate- 77/23 ❑ Health-care facilities. 171 Supply voltage for more Mall ` ' �JJ ��� fffrrr��� t / 17L pC ❑ I IAiArdoua locations. 600 volts nominal
Suitc /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
- -- -- 4;t'h' »r,,a,:^; • ' • - FEE 'SCHEDULE
Cross street /directions to job site: Descrlplion _ 1 Qty. 1 pre. 1 'total 1 -
New residential single- or multi - family dwelling nnit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 1 145,15 4
Ea. add'I 500 sq. R. or portion 33.40 1
Mix rasp /parcel n0.: Limited energy, residential
. D vri4 uv ^`�arvt:url : ?!i . . (with witha .ft 75.00 2
F.§CR1P'1'IOI1(.t ' �'` W ,RK: I t ; ( �a • )
cork) Limited energy, multi - family 75.00 2
rvlVf� -rl v t(.u'rt/t ei residential (with above sq. a.)
Services or feeders installation, alteration, and /or relocation ,
200 amps or less 80,30 2
I PROPERTY OWNER ' L ' Q'+ r
, r r° N ` w" "', `� 201 amps to 400 amps 106 85 12
Nuiiw; e' , & C / d� 401 amps to 600 amps 160.60 2
�/ 601 amps to 1,000 amps 240.60 I 2
'ldress: l rl S 0 (y /j i' L � y a, Over 1,000 amps or volts 454.65 2
'- •-: tty /State /ZIP: i41; •4rS- v 9, R,01.3 Temporary services or feeders installation. alteration. and /ur
relocation
Phone:ga l ) tit • 7 .- . 00 Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30
intended for sale, lease. rent, or exchange, according to ORS 447, 449, 670, and 70 I, 401 amps to 599 amps _ 133.75 2
()weer signature: Date: Branch circuits - new, alteration, or extenslott, perpancl
A. Fee for branch Circuits with
- a A.MLCAIYT;. ( :COiV:4 l"PERSON above scrvicc or feeder fbe.
each branch circuit 6.65 2
Business name: 1 1 1 4- eh L 4- Air CAA d t o - r, Iii LL C B. Fee for branch circuits
Contact name: C i , . e,4
rya fi rst br anch circuit service or feeder fee, 2
first branch
46.85
Address: Each add'l branch clrcult w 6,61
Mlaccllaneoua (service or feeder not included)
City /State /ZIP: Each manufactured or nodular 90,90 I 2
Phone: dwelling, service and /or feeder
f hone: (5713 ) 31.3— _79k0 Fax ( s -o) ) d >1 _ g3 y f- Reconnect only 6G.85 2
E -mail: Pump or irrigation circle - 53.40 2 • CONTRACTOR Sign or outline lighting 53.4u 2
Business name: '"B e , � � x Signal circuits) or limited-
A) Caa , ,s / 1_4C- energy panel, alteration, or
Address: e 0 (3 , 7 extension. Describe: Page 2 2
(.'ity /State /ZIP: t o , �� at 9 7,2 5 Each additional Inspection o allowable in any of the above
Per inspection 62.50
Phone: (3 ) al ? _ /7 ? 9 Fax: (S1 3 ) (pry" 33 '.5 Investigation per hour 11 hr min) 62,50
CCI3 LiC.: 4 7 Electrical Lic.: yq L #, Suprv. Lie.: /TES Industrial plant per hour 73.75
-j, ` � �� ELEC TRICAL PERMIT PIES
•
Suprv. Electrician signature, requi - .
Subtotal
int name: � ate:
Plan review (25 %of'permit fee):
j State surcharge (I 2% of pemtit fee): �j
Authorized signature: W
TOTAL PERMIT FEE' 2" 'IZ
Print name: ei t� Q I Date: r ll 3i O`7 This permit application expires If a permit Is not obtained within 1x0
,--" e L' r +0 p_ / 11 Jaya after it has been accepted ea complete
j • Number of inspections allowed Der permit.
I Mal ldmall'enninlELC. Permit App doe 05/2) /06 440 -4e I Fr( I I/OS /COM /WEB
2000 HIVVONI.Lv3H - SN3(3 217CCT99CO2 XVJ 6C :TT 6002 /OC /TT