Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00416
�. 14., DEVELOPMENT SERVICES DATE ISSUED: 7/28/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 104DD -02700
SITE ADDRESS: 12859 SW RIDGEFIELD LN ZONING: R -4.5
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 2 LOT : 024 JURISDICTION: TIG
Project Description: Reconnect furnace & new A/C.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
MANDY MOCK A -1 AIR HEATING & COOLING
12859 SW RIDGEFIELD LN 2038 NW ALOCLEK DR #225
TIGARD, OR 97224 HILLSBORO, OR 97123
Phone: 503 - 524 - 3549 Contact #: FAX 503 - 648 -9824
PRI 503- 645 -5900
FEES
Description Date Amount Reg #: ELE 822LHR
[ELPRMT] ELC Permit 7/28/2006 $53.50 LIC 62102
[TAX] 8% State Surcharge 7/28/2006 $4.28
Total $57.78 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: - :� 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:
CONTRACTOR INSTALLATION ONLY
•
SIGNATURE OF SUPR. ELEC'N: 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.
Jul ,28 06 10:08a Denise (503)648 -3983 p.2
Electr Permit A 5 . 2 ,T r, . ,r �:
p t ( t ' � , i 3 k� i# + t a-� f'OR-;OFFIC USE ONLI
Ci of Tigard Received -1- Perm
N � Z � ��
�' g Date/Br / 4 t h u
13125 SW Hall Blvd.. Tigard, OR 97223 JUL 28 2001 Plan Review
k r.t t Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 7 4II ) 1 DateBy.
Inspection Line: 503.639.4175 ' Date Ready/By: r 0 Sec Page 2 for
Internet: www.ci.ugard.or.us (. j,1 sn9 Ut' 1. I' i Notificd!1ethod: � , Supplemental Information
�, N6i1K `. i / 1 y () ;\ PLAN REVIEW
❑ New construction ig3 Addition /alteration/replacement Please check all that apply:
E] Demolition ❑Other: ❑Service over225 amps, comm'I ❑Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRIICTION of 1- and 2- family dwellings 4 or more new residential
xi 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders. 400 amps or more
❑ Multi- family ❑ Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
Job no.: Job site address: / Z 8s' ...Se--(..) /2 I>G /E4 LA). ❑Health - care facility ❑Other:
Submit 2 sets of plans with any of the above.
City / State/ZIP: Ti G/* /L-D 02 7 - 7 Z Z - 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description 1 Qty. I Fee. 1 Total 1 **
Cross street/directions to job site: G ZE J,,= 1 G.t , l7� ., New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or Icss 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. R or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder _ _ 90.90 2
%Zi CG i(J.(J4 - C j GAS F fire A Lt )1 /?.a. /K) 4 Services or feeders installation, alteration, and/or relocation
.&.. x 1 57 1 AJG- e I2c d-i 1 % >i-O/L, .CJ, 4,J /. / 2 CC 'V-D. 200 amps or less 80.30 2
jin PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: X7",■5 CV NI O G/C 601 amps to 1,000 amps 240.60 2
Address: / Z gs S�v /Z 14--6-i: I Cp CiU, Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: 7 - y r���_i› Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 5 3S 9 Fax. ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I OWfl which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits wrth
service or feeder fee, each 6.65 2
Business name: /'l _ / /, G O Aj i> I t` , #,A 1 / �t J l,- branch circuit ,
B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 1
46.85 2
Address: Each add') branch circuit _ I 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: /.4.4 19 /2 G6�� t 7 - i Ovi.) 1L
Address: Each additional inspection over allowable in any of the above
z� /Vul ! q 4, / Z Z S Per inspection 62.50
City /State/ZIP: Ai , L L S e - O 2 e__ ) 0 /L c 7 / tr Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: ( ) , 4 /3 - S c jG 6 Fax: (5b3) C 4 7 ' — c l 6 a y ELECTRICAL PERMIT FEES*
CCB Lic.: co Z / O Z Electrical Lic.:S Z.6 / Suprv. Lic.: ZZL +Z Subtotal - 3
Suprv. Electrician signature, required: /2‘,a.: fri / _e_ Plan review (25% of permit fee)
State surcharge (8% of permit fee) 4/ z p
Print name: 7R O , /`-t L X 32 t b Date: 7 _ a 6., pd,,, TOTAL PERMIT FEE
S ?• - ?$
Authorized signature: 77.,..,_„_,,,, _ 7,7 , 2 T This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: -7 _ z g _ o • Fee methodology set by Tri-County Building Industry Service Board
•• Ntunbcr of inspections per permit allowed.
CITY OF TIGARD
BUILDING DIVISION 4 . PERMIT #: ELC2006-00416
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/213/2005
Phone: (503) 639 -4171 i k
Inspection Requests (24 Hrs.): (503) 639 -4175 - !�i '`�f1..
INSPECTION WORKSHEET FOR DATE: 9/28/2006 TIME: 7 :02AM PAGE: 59
SITE ADDRESS: 12859 SW RIDGEFIELD LN CLASS OF WORK:
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 2 LOT #: 024 TYPE OF USE:
PROJECT NAME: MOCK
DESCRIPTION: Reconnect. furnace & new A. /C.
OWNER: MOCK, MANDY PHONE #: 503-524-3549
CONTRACTOR: A - AIR HEATING & COOLING PHONE #: 503 -545 -5900
Inspection Request Scheduled For: Date: 9/28/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
14' — 7 _. .__ �,•, l unit circuit 037283 -02 503-524-3549 N
orrrctidns /Comments /Ifistruc ions:
' e2 ' a* p(, it s
''..-'-s-----
r PAS` n PARTIAL APPROVAL n CANCEL NO ACCESS
,4� - -- ,'CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
NZ
LE
-
Inspector: Da te: 4 t C Phone #: (503) 718-