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Permit CITY OF TIGARD ELECTRICAL PERMIT f Permit #: ELC2010 -00276 COMMUNITY DEVELOPMENT �TICARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/09/2010 Parcel: 2S112BC09100 Jurisdiction: Tigard Site address: 14777 SW 80TH AVE Subdivision: RAZE MEADOWS Lot: 14 Project: Teyler Project Description: (1) branch circuit to reconnect gas furnace. Owner: FEES TEYLER, ELIN R Quantity Description Date Amount 14777 SW 80TH AVE TIGARD, OR 97224 1 crt Branch Circuits 06/09/2010 $56.18 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 06/09/2010 $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: Permittee Signature: S //1IP 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. Electrical Permit tio Applica ���f-'''')1��a CM/ 'h' , H � 1 o�v'1ktt , gmo , - ��w , }� ,�.�, r AJV 1 > $ yN ..,, , ,v, o - 14 , , , , ,,. 01ztw^r '. I I' ,� tI tl (, \�t11 p ant,c•91.i tS .4,iJy++l"st,' h �Y:S'" .- tk � r � duwa.a `,a�Qw „. 4,lAa "nYll2'•�I'5, lr$+•,� ;f'twi y4 City of Tigard Received It et 13125 SW Hall Blvd., Tigard, OR 972z� 0 8 2010 Pia R ° Al —� Plan Review 111 l'i Phone: 503,639,4171 Fax: 503.598.1960 Da,/8 te ; Oilier Permit: alp! to ,, 1, 0 �,i4t ,.''''f7:: Inspection Line, 503.639,4175 CITY OF TIGARD Date Ready/By: cv.i Internet: www.ti and -nr. ov N MI See PaRO2 for g 8 Notified/Method: Supplements! information ■ DIVI SION thd -- • TYPE OF • WORK PLAN REVIEW ❑ New con struction Addition /alteration/replacemcnt Please chock all that apply (submit a ;eta of plans w /items chocked below) ❑ Demolition ❑ Other: Service or feeder 400 amps or more ❑ Huilding over three stories . where the available fault current ❑ Marinas and boatyards CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. 1p dwelling leas to ground, or exceeds 14,000 ❑ Commerctul•use agricultural I • and 2—family Y g ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. [f Multi - family ❑ Master builder ry Other: ❑ F iro um _ �,,] p P- [] Inatatlauon of 75 KVA Or O Ernergency system. •• larger separately derived system. JOB SITE INFORMATION AND LOCATION' ❑ Addition of new motor load of ❑ "A ", "E ° I - ' 1.2 ', Job no._ Job site address: 1001 or more. occupancy. /SlAle /LIP: � ❑ Six nr more residential unit :. ❑ Recreational vehicle pail, . GIt y C Ji A •— ❑ Health-care facilities ❑ Supply voltage for more than J [] Hazardous locerions. 600 volts uum nnl Suite/bldg. /apt. no.: Project name: ❑ service or feeder bon amps or more, L. Cross street/directions to job site, FEE SCHEDULE Desert. 1• • Fee. Total I " New residential single• or multi- famlly dwelling unit, Includes attached garage. Subdivision; Lot no.: 1,000 sq. ft. Or less 168.54 4 fax map /parcel no.; E,a. add'! 500 sq (1. o_r portion 32.92 I Limited energy, residential 67.84 _, 2 CRIPTION OF WORK' with above s• ft. o �s Limited energy, multi- family II C r —1 a 4 .1r Ai A r residential with above a.. tl 67.84 2 Services or feeders Installation alteration and/or relocation 200 amps or less 100.70 :_ �U Ernwrism-smi ar- PROPERTY OWNER � T�NAN I' ( © 201 amps to 400 amps II. 133.5b 401 amps to 600 amps 200.34 E 1111 601 amps to 1,000 amps 301 _ 04 =1e Address: /` 7 4,-7 4,-7 � _ Over 1,000 amps or volts 11 • City /State /'LIP: I j a '^ J I ., dc. 4* - )o a 'L'cmporar services or feeders Installation, alteration, and /m' relocation Phonc:,)3 ) • 3a► _ i g f Fax: ( ) 200 amps or less 59.36 1 2 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I25.o8 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps t 68 54 branch circuits - new, alteration, or extension, per pallet Owner signature; Date: A. Fee for branch circuits with b'• APPLICANT ❑ CONTACT PERSON above service or feeder Ice 7 42 2 each branch circuit 13115111tlss ni1n1C; f3. fee for branch circuits without I Contact name t`� i • 0 ) servieo Or loader tee, first 1•.,] A IV branch circuit r 56.I d �p , I Address: Each add', branch circuit 7.43 2 Miscellane service or feeder not included City /State /211': Fach manufactured or modular G7 84 dwellin: service ond/or feeder Phone: (.;0.) 3 (, - - D Fax :: ( ) Reconnect only 67 84 2 Email: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 Signal circuits) or Limited- energy Business name S e1 f v ,•, 4 cl, alteration or oxtensIon, page Each additional inspection over allowable In an of the above _ Address; PQ 3O 8o 1 Addiiionel inspection (1 hr min) GG 25/ hr City /State /ZIP: T PO r , � ! oeL -7 ( ( 7 investigation (I hr min) 66 25/ hr �` Industrial plant ( I hr min) 78 1 8/ hr Phone: ) '7. -J7 Fax: Cl ) s .. 1 , ( 3 �7 ' � � / L Inspections for which no fee is 90. 001 hr f 1 0 • cificall listed 1 /3 hr min CCI3 Lic.;6 s '/ � 7. Electrical Lic,: ,`I` l�T Suprv. Lic.: y9 �r # ELECTRICAL, PERMIT FEES Suprv, Electrician s e, required: Iri m� Subtotal: j , 't " — • • '.•_ �' — A Plan reYfeW (25 °.o O�CITTIit tCC): .._� Print name: £ U r• , A i Date: 6 D /0 State surcharge (12 °/a of permit fee): ( 7 0 PERMIT TOTA Authorized si nature: L, FEE: CD a.• 61 R izrt a ` Thia permit application expires if a permit is not obtained within 180 Print name: 6 J (3 d ■re after r h hew pn accepted ■ coat plate, MTA r' • r-' bete: (V Number Of In9peCtiDna allOWed pet permjL 1 \Budding•PermtwELC- PcrmitApp••c IWUUUY 441- 46157(11 /0S /COM/waa T HIVr89NI,LVHH - SNai 2r CCT59C0S TVA 6C:80 0T0Z/L0/90