Permit �' "': ELECTRICAL PERMIT
1: CITY OF TIGARD
13 COMMUNITY DEVELOPMENT Permit #: ELC2010 00260
T(GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/27/2010
Parcel: 2S104CD03400
Jurisdiction: Tigard
Site address: 13506 SW HILLSHIRE DR
Subdivision: HILLSHIRE ESTATES Lot: 34
Project: Le
Project Description: (2) branch circuits for A/C.
Owner: FEES
LE, PAULINA Q Quantity Description Date Amount
12254 SW 114TH TER
TIGARD, OR 97223 2 crt Branch Circuits 05/27/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/27/2010 $7.63
Electrical
Contractor:
ROTH HEATING & COOLING
PO BOX 1265
CANBY, OR 97013
PHONE: 503 - 266 -1249
FAX: 503 - 266 -3478
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 0 952- 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:/ Permittee Signature: $2e f�� .►r
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.
MAY -27 -2010 THU 08:09 AM ROTH HEATING FAX NO 5032663478 P. 01
• Lt# 1 A \+
Electrical Permit Application "" MR I)'.I'I(:'I''. U5L; ONLY C' r � - lc; eaivod
City of Tigard L, " "� " " ' ontc/s : A J- � Permit No.; `! 2, lv -- D
i llil ' 13125 SW Hall 13Ivd , Tigard, OR 97223 Plan Rcvin Other Permit: 4.0 i --(x.. �S
Phone: 503.639.4171 Fax: 503.598.1060 MAY M I .0 10 DBIC/B :
r ": ® See Page z for
'I' 1 1. A It 1'r Inspection Line: 503.639.4175 Date Road y (B y' )u '� Supplement/it Information www.tigard- or.gov t^y CF TIGARD Notified/Method; I i �D pP
TYPE' o!..woriii.JILDING Di`` l3IQ' J . ; , Pii"Ahi REYI '
tt��lt Addition/alteration/replacement Please check oil drat apply (submit 2 acts or plans w /items chucked below);
❑ New construction Ipl ❑ Service or feeder 400 amps or more ❑ Buiklink over three stories.
❑ Demolition ❑Other: where the available fault current Q Marinas and boatyards.
CATEGORY' OF CON exceeds 10,000 amps at 150 volts or ❑ Fleeing buildings.
less to ground, or exceeds 14.000 p Commercial -use agricultural
it 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings,
❑ Muiti- famil ❑ Master builder ❑ Other: ❑ In pump. ❑ Installation of 75 KVA or
❑ Entcrgency system Forger separately der_vud system.
'JOB' SITE INFORMATION AND LOCATION
,. 9 Addition of new motor load of Q "A" "L" "1-2" ''1 -3 "
100HP or more. occupancy,
Job no.: - 1 1 5 , Job site address: 13 0\.0 5 ' - \ i 1\ Stn VC '. 9 Six or mare residential unite. ❑Recreational vehicle parks.
City /State /ZIP: 7 l ❑ 1.1mido facilities. ❑ Supply voltage for mum than
OX d , 0 - 6 J `T try Z7 600 volts nominal.
J L ❑ Iltuardous locntinna.
Suite /bldg. /apt. no.: Project name: Lei _ ❑ Service or feeder 60U amps or more.
FEE 'SCHEDULE •
Cross street/directions to job site: Da scdptton r . I`c T ot al
New residential single- or multi - family dwelling unit.
Includes attached garage. _
Subdivision: Lot no.: _ I ,000 sq. II. or legs 168.54 4
Ea. add'1500 sq. I3. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 67.84 2
DISSCRiPTIQN OF WOR1G, _ (with above aq. (1)
*e I,, Limited energy, multi - Family 6 .84 2
" / t J l , \V ad/ c Y ` C, 1 rc,L. s r esidential (with above s 11.) J .�
L ` Services or feeders installation, alteration, and/or relocation _
_ 200 Amps or less 100.70 2
201 to 100 amps 133.56 2
ig 'PROPERTY OWNER : i:. E 1. TENANT : amps
401 amps to 600 amps 200,34 2
- Name: p Q.0 `,1 tnok. l , ,- 601 amps to 1,000 atnpe - 301.04 2
Address: r: rA rn t✓ Over 1,000 amps or volts 552.26 I 2
Temporary services or feeders installation, alteration, and/o
City /State/ZIP: relcitioo _..
Phone: (q 71) i et g $,g 71 Fax: ( ) 200 amps or Tess I 59.36 I
201 amps to 400 amps 135,08 '-
Owner Installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 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
CONTACT PERSON above service or feeder Ice, 7 42 2
APPLICANT Q each b ranch circuit
Business name: ti 13. Fee for branch circuits whiter/
service or feeder fee, first 1
56.18 � t 2
Contact name:
brunch circuit l
i
- Each udd'1 branch circuit i 7.42 ] - . 1 2 -
2
Address: Miscellaneous (service or feeder not inchided) -
Eaeh manufactured or modular 67.01 2
City / State/ZIP: dwelling, service and /or feeder _
Phone: ( ) Fax: : ( )
Reconnect only 67.04 2 _
_ 67.84
Pump or irrigation circle
E-mail: Sign or outline lighting 67.84 '
. , ' '.CONTRACTOR' .. ' - Signal circuit(s) or limited energy
peach nhemtion, ar extension, [rape 2 ' -
Business name: g � <v t C Q �_h Each additional Inspection over allowable in any of the above ,
Address: 0 6(v 1 -2-.' _ Addition__ inspection (1 hr min) 66.25 /hr
Investigation (1 hr min) • 66.251 hr
City/State/ZIP: . t , 2 �� ` Industrial plant (1 brmin) 78.18 / hr
Phone: (5133) ,. .....113\f,_ 12, / ' Fax: ( Le 3L/7? rnspeationa for which no fee is 90.00 / hr
. •eciticull listed ('h hr min)
CCR Lie.: ' LI Electrica t Lic.: , S , Suprv. Lic.: 55 5 s'S _ . ELECTRICAL PERMIT FEES:, - •
t ��I Subtotal: 7 UJ� 7 - v p 0
Suprv. Electr t1 gt c requ Plan review (25% o permit fee):
Print name: _ State surcharge (12 "/0 of permit fec):
SQ.,(-3 eG o V l C. Date: ,D.:1, TOTAL PERMIT FEE: 1 1 . 23
Authorized signature tc,_,� ��
L Thls permit application expires If a permit is not uhptined within 180
� C ' � ^^ dnys utter It hna been accepted as complete.
Print name: A -IRri.2 la "tC O Q,h `8,v- Date: 5 -1 l ( `,1 • Number or inspections aliowud per permit-
NAY -27 -2010 THU 08:09 All ROTH HEATING FAX NO 5032663478 P. 02
Electrical Perinit 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:
❑ Audio and Stereo Systems'
El Burglar Alarm
❑ Garage Door Opener"
Heating, Ventilation and Air Conditioning System"
❑ Vacuum Systems'
❑ Other.
COMMERCIAL WORK ONI:Y
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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control''
❑ Medical
[] Nurse Calls
❑ Outdoor Landscape Lighting"
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are requited. Licenses are required
for all other installations