Permit , CITY OF TIGARD ELECTRICAL PERMIT
'` r COMMUNI DEVELOPMENT Permit #: ELC2010 00337
131 25 SW Hall Blvd., Ti Date Issued: 07/06/2010
a1GARV . and OR 97223 503.639.4171 Tigard
Parcel: 2S103BD03400
Jurisdiction: Tigard
Site address: 12920 SW 121ST AVE
Subdivision: Lot: 0
Project: Sanchez
Project Description: (3) branch circuits for mini -split heat pump, GFI and condensation pump
Owner: FEES
SANCHEZ, RICARDO NAVA . Quantity Description Date Amount
12920 SW 121ST AVE
TIGARD, OR 97223 3 crt Branch Circuits 07/06/2010 $71.02
wo /Purchase Service or
PHONE: 503- 679 -7886 Feeder
1 ea 12% State Surcharge - 07/06/2010 $8.52
Electrical
Contractor:
SIMPSON. ELECTRICAL CONSTRUCTION
2145 NE MCDONALD LN # C
MCMINNVILLE', OR 97128
PHONE: 503 -472 -2530
FAX: 503 - 435 -0157 .
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 503.246.6699 or 1.800.332.2344. /
Issued By /�-�_ - Permittee OA 7 * / C /0 N
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.kep£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.
•
II
1
•
A-r ll-' , T0i iq Ir Iu 'tl n, h I�r > ""�urr�� � ' r ` 1 1 1
y 1 �
E
K I Rc ` � x r � h pl .. r ,, A , it , ,r, 117- 41 'A'4 r'-‘
.; �: City �ofTi ark lO�'1 r ..� 1 �ny � a . yY� �~;'y , �a�t ,,,.,. �', FORCFFIC � U '' �� ° �� �� �� � �
Electrical Permit A �eca� ,,
.z• rwe, a.� l � a r, "�
v \\ 1,..
p ti 10 .at�is, �7/ c) Esc. x0/0 001.E -r
a 13125 "SW Hall (31vd., Tigard, OR 97223. V� Plan Retie
R
J \ J Other Pemti ,�j
Phone: 503.G39,4 t71 Fax: 50 - 598.1960 3 (' A� A l Datus >! /.�'02(�/4 .--400 .--400 gC�
A''' Ins cctinn I inc 503.639.4175 r it t O \`. _Dare RcaJ i0 to rts. 0 See P m. 2 for
,Tj1GAILD, p 8 g 0� `�\ > >• �r/
w aN 1xYC� ' Inlcrilcl: www -li and -or. Ov 1 �� s �f! O,V Nntitied /Method: " t 6 '�ugdenrrnt:it Information
fonnaliurr
TYPE OF WOR ' PLAN REViEW
: ❑ New construction Addition/alteration/replacement Please'checkalit t apply (submit ? sets nfp{ :m em: checked l luxcl:
❑ Service or fee .. 400 amps or more ❑ Quddiimg over three stories.
9 Demolition ❑ Other: where the avai -dale fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,001 amps at 150 %olts or ❑neat tug buildings .
less to ground, or exceeds 14,000 ❑ Cuumtcnaal -use agricultural
r 1- El and 2- family clwctling ❑ Commercial /industrial Accessory building amps far all'ot,er installations. buildings
Multi- tinnily ❑ Master b El Other: ❑Fire pump, ❑ installation or75 KVA or
_ ❑ Em rgcocy s tem. Inner separately derived system.
.1013 SITE INFORMATION AND LOCATION ❑ Addition of nL • motor load of ❑' A" E' I -2 ' 1
!� /j 100HP or mo .. • occupancy.
:!017 :no.: Job site address: , f q !J'� 5 w � d�I /"'I - ❑ Recreational vehicle parks.
°c ave.. ❑ Sic or more r idential units. P
r ❑ 13 -car fa dines. ❑ Supply voltage fur more- than
City /State'% 1l : Q 600 oohs nominal.
� ��c^ 1 � �' ❑Hartrdous lo. lions.
Suitelhlde.lapt. no.: Project name: ❑ Service or fee. cr600.ampsormore.
• FEE SCHED
Cross street /directions to_ job site: Description rte. Fee. 1 c �l [ Trlr.ri ,
New residenti I.single- or ut fsmi)v c1w (lint, unit.
includes cd :garage_
Subdivision: Lot no.:
1,000'sq. ft. or css 168.54 4
; Ea. add'[ 500 s , : tL or portion 33.92 1
Tax map/parcel no.: Limited.ener_\ residential
67.:34 2
DESCRIPTION OF WORK (with abm. R -
: t— Limited en r3 multi- fttm G7 -R,1
rn;: li 101. E , ,, t F - - rr . - - residential ( '111 above sq. 11) l
Services or R ders installation, alteration, audlnr rclocatiritr
200 amps or I s 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2'
Name: 401 amps to 610 amps 200:34 2
601 amps to 1, l00 amps 301.04 2
Address:
Over 1,000 am s Or volts 552.26 ?
Cily'ISlatcLZI I': Temporary s ices or feeders installation, alterol .tlx and /nr
relocation
Phone: ( ) [ Fax: ( ) 200 amps or l�s 59.36 1
Owner installation: This installation is being made on property that.[ own which is not 201 amps lo4t0amiss 125.08 2
intended Itlr sale, lease, rent, or exchange, "according to ORS 447, 449, 670, and 701.
401 amps to 5'9 amps 1 168.54 2
Branch circui s — new, alteration, or cstension. Per pally!
Owner signature: _ Date: A. Fee for Mai eh circuits with
0 ,tPPLiCANT 1 ❑ CONTACT PERSON above servi.eor feeder lee. n 7.42
��� each bra circuit
L3usmess name: J 1 L3 Fee.furbr li cli' circuits
lrillronr sea ice or feeder fee.
Contact name: 56.18 2
first branch circuit k 1 j 5 � ��
Address: Each add'l branch; circuit ,P- 7.42 lu{, 2
i'.Iiscella (service or feeder pot inckrdcd)
City!S Lalc(ZiP : Each manufar wrcd or modular 67 .8.4 2
dwelling. sery ce and/or feeder- -.
Phone: (" ) Fax: : ( ) Reconnect only 67.114 _ 2
E-mail Pump or irrigation circle 67.84 2.
• . CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(,) or limited
F4uSincss name: S IA p . le c.2{ Ca t Con 5 L.& _4 o encrlit) panel. lltcmtion. or
A ddress: Ale-I.5 d1C a ad a , l Ln 5'±-e C — extension. De cribs: Page 2 2
City /State /ZIP: (VI l /)/ - n4 ur i , e r 0 a , 9' i Z3 E: eb additional inspection over allow: Isle in any of the above
w t Per inspection 66.25
('hone: (,93 )L{ 7a- 25 39/ Fax: (5)3 ) t{�, - U
l s � Investigation pe hour (1 lrr min) 66.25
C Lic.: (3-3 g gc, V Electrical Lie • 3o _ slge Suprv. Lie.: Sbc 3 S Industrial plat t per hour 73.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ' Subtotal: x) ( -O2.
Ilan review (25% of peanit Re): I
['ring name: Date: 1 10 OO.
I I/ ,Ii , S t f Sow State surcharge (i2 %of permit fee): . 5
-I l
I Authorized signature: TOTAL PERMIT FEE: r- I ,slf
1 Print Hanle: Date: This permit •rpplic:itiuir espires Outlined a perinit is no Outlined within 130
da after it has been accepted as cuaiplcie.
' Number of ilspeciioosallowed per penult.
1. 21.0441111.A',Waits \LI_C- Pcnni.App.doc 10/01109 440- 4615T(11IOSICOMAVEB
L L91.0 NOSdWI NIA )1 e} L L OL ZO Inf
11