Permit f ,'! CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00294
T1GARb. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/16/2010
Parcel: 2S111CC19200
Jurisdiction: Tigard
Site address: 10335 SW GREENLEAF TER
Subdivision: Lot: 0
Project: Kilkenny
Project Description: (2) branch circuits to reconnect gas furnace and A/C.
Owner: FEES
KILKENNY, JULIE R Quantity Description Date Amount
10335 SW GREENLEAF TER
TIGARD, OR 97224 2 crt Branch Circuits 06/16/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/16/2010 $7.63
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 $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 OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2446.6699 or 1.800.332.2344. ,, /
Issued By: �-- Permittee Signature: OW / . ' - C� �
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.
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Electrical Permit A,_pplicati ti � �. -, y, �,,' � � I i l( 1 t'itiI ll� \1 1 P i� py � "D� iL5
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a 4 i 'ni J 15 2010 Reoetved / stuns ,
x , City o Ti gar d (U
Pe r mit No.:
' t • 13125 SW Hall Blvd„ Tigard, OR 97223 p,un R . / %/� /` / — ! / '�
- 3 8 , g Plan Review
�" ' Nei � a inspection Line 503'03.598. 639.4175 Diilo/B , Other Permi(/y /
I 1 T 'JI Ti A
BUILDING y D,
141 ( 1. 11! P Date Ready/By: ) uri 6d See Pa
444 " ^+ Internet: www,tlgafd•or.gov BING DIVISION Notitied/Method: J' nt 2 for
ht Supplements! informailon
__ W TYPE OF WORK • � PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply (submit j sets of plans w /items checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or mole ❑ Building over three stories .
where the available Fault current CI Marinas and buety:wits
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ floating buildings,
less to ground, or exceeds 14,000 ❑ Commerciol•ose attricultural
'r,,
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. bulldulg3.
Multi - family ❑Master builder p Other ❑ Fire pump. ❑ Instahatiun of 75 K or
• JOB SITE INFORMATION AND LOCATION' 0 Emergency system. • larger separately derived system
❑ Addition anew motor load of ❑ "A ", "E I.2", " I -3 ",
I00HP or more.
Job no.: ... 1 lob site address: /O ? . ( 4r � 7 occupancy,
_ 1• 5.1 ❑ Six or more residential
sidentiel units. ❑ Recreational vehicle parks.
City /State /ZIP: /AT& ,n'2 en "S
e�► ❑ Health -care facilities, ❑Supply voltage for n wre than
OR Jt ❑Hazardous lucatienx. bt) volts nominal.
Suite/bldg. /apt. no.: [ name; ❑ Service or feeder 600 amps or more.
Cross street/directions to job site FEE SCHEDULE
_ _ Demi• . at . F , Total 0
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. 10. or portion 33, i
Tax map /parcel no.: Limited energy, residential
2
DESCRIPTION OF WORK' : . . _. , , •, with above s.. ft 67.84
�'"� ,/� Q, /� Limited energy, multi-flu-114 6 c Y �._ '� I -r J V 67.84 II
2e, residentia wi th above s . n.
Services or feeders Installation and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER 1 . "'. 0 TENANT; • ' . • • 201 amps to 400 amps • 133 56 2
{Name: • f LA I1 e �i 1 // e/1/ 401 amps to 600 amps 200 14 2
[ r I 601 amps [0 1,000 amps 301.04 2
Address_ /0 G � _ Over 1,000 _amps or voItS 552. G
f r
City /state /7.IP; ��� (� Temporary services or feeders Installation, alteration, a nd /nr
relocation
Phone: az 624 - 3 1 0 1 Fax: ( ) 200 amps or less 59, 36 i
400
Owner Installation: This installation is being made on property that 1 own which is riot 201 amps to 599 amps — 125.58 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 54
Branch circuits - new, alteration, or extension, per panel
Owner signature: • Date: A Fee for branch circuits with
E ' , APPLICAN'C [] CONTACT
ONTACT' PERSON above service o r feeder fee 7,42
each branch circuit 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: tA r ar branch circuit 56.18 1
J v Each add' I branch circuit / 7,42 2
Address: _ Miscellaneous (service or feeder not included)
City /Slide /Z,11'; Filch manufactured or modular 67 84 ,
dwelling, service and/or feeder
Phone; SD3 ) 3j3 • Fax:: ( ) Reconnect only 67,84 ,
Pump or or irrigation circ 67 B4 "
Email: ___
' — ' Sign or outline lighting 67 ,
' CONTRACTOR • • _ Signal circuit(s) or limited- energy
Bus iness name: ' NeitkII y „ e. /c anal alteration, or extension. Pa e 2 _ , 2
Each additional inspection over allowable in any of the above
Address: Po cog go 6 1 1 _Additional inspection (1 hr min) . 66.25/ hr
City/State /ZIP: pet �- {-� ,� 06:: Q d� 7 ago
_Investigetian (1 hr min) • 66 25/ hr
I lndustnal plant (I hr min) 78.18 / hr
Phone: ) S.- M 7 Fax: (, )3) bs /- 33 4,5"
'l Inspections for which no fee is
7 � � seeifically listed (' /a hr min) 70.00/ hr
C:CI3 Lie,; Electrical Lie,; 1 Suprv. Lic.: 7 i , ��, ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required. . * ! � Subtotal; ,
��
Print name; - State surcharge (12 %of permit tee): f P lan review (25% of permit fee):
r, Ut �' . J./ • Date: f Q L3
Iv 7,
Authorized signature: r i f fOfAL PERMIT' FEE: 7/ �
/ This permit application expires if a permit is not obtained within 180
Print name: �( ► �••� GG�� Ar r Dwel i ji„` +0 • Numbe of inspect days aions fter It has been accepted as comptete,
V allowed per permit.
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