Permit CITY OF TIGARD ELECTRICAL PERMIT
" COMMUNITY DEVELOPMENT Permit #: ELC2009 -00452
Date Issued: 09/04/2009
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112CB00403
Jurisdiction: Tigard
Site address: 15200 SW 81ST AVE
Subdivision: Lot: 0
Project: Janes
Project Description: Reconnect furnace and air conditioner
Owner: FEES
JANES, KEN Quantity Description Date Amount
PO BOX 23399 2 crt Branch Circuits 09/04/2009 $53.50
TIGARD, OR 97281 wo /Purchase Service or
PHONE: 503 - 624 -7133 Feeder
1 ea 12% State Surcharge - 09/04/2009 $6.42
Electrical
Contractor:
TRI- COUNTY TEMP CONTROL
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 557 -2220
FAX: 503 - 557 -0919
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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. 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 503.246.66999 Y or 1.800.332.2344.
Issued By: — Permittee Signature: et./ ` - /-,o �-i e'g
/-
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.
EP -2 -2089 10:23A FROM: t " 't ' TO:5035981960 P.2
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Electrical Permit Application SEP 0 2 [� ,(,li t„ , If ,. l SI „�,.,
City of Tigard ,el� ) ` ) Datem `, Q - Permit No.: .•••• tr - (f() 4-.S'. 13125 SW Hall Blvd., Tigard, OR y ,,, n e 19C,, ` i
114 "I �"''''' tJ A' '�' [[� Plan Revie
.7--' v 1 � Other Permit: 503.639.4171 Fax: 503. � I� Date/13
1 I C 11% It Inspection line: 503 - 639.4175 Date Ready/By: I �IIL�� ® See Page 2 for
Internet: www.tigard- or.gov .:ds
Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other: where the available fault current ❑ Marinas and boatyards.
CA'T'EGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. • buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
O 6 �� � r p ytt pr Six or or more r es, occupancy.
Job no.: Job site address: (�� W T , y � j 111�,J ❑ Six or mart residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, q1224 ❑ Health - care facilities. ❑ Supply voltage for more than
��, www��� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt, no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. f Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no,: 1,000 sq. R. or less 145.15 4
Ea add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with sq. ) 75.00 2
with above s R. • Limited energy, multi- family
• n TO -�,ln, ec, q ai r core .i er residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Ken ski ill-/ 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: GJI.Ir rj Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
n relocation
Phone: (617) 1eZ4 1Ib) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own 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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Dale: A. Fee for branch circuits with
l' APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Same as Contractor B. Fee for branch circuits '
Contact name: Diane Mason
without branch service or feeder fee, 46.85 14 -gb 2
first branch circuit
Address: Each add'l branch circuit } 6.65 ee 4's 2
- Miscellaneous (service or feeder not included) ,
City/State /ZIP: Each manufactured or modular 90.90 2
- dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Temp Control energy panel, or limited- o
Business name: Tri County or
tY P energy panel, alteration, or
Address: 13150 S. Clackamas River Drive extension. Describe: Page 2 2
City/State /ZIP: Oregon City, 97045 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 557.2220 Fax: (503) 557.0919 Investigation per hour (1 hr min) 62.50
CCB Lie.: 72623 ,/ Electrical Lie.: 527L1 -IR Suprv. Lic.: 2567LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv, Electrician signature, required: Subtotal: 5 r5 0
Print name: Dave Salholm ® J Date: alioq Plan review (25% of permit fee): -e
S tate surcharge (12% of permit fee): i t' -
Authorized signature: ,Ala/fL,, a4Q. TOTAL PERMIT FEE: -'may 57,42
This permit application expires if a permit Is not obtained within 180
Print name: Diane Mason Date: � /„ f 11T o /t M/ days after It has been accepted as complete.
• Number of inspections allowed per permit.
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ctrical Permit Application - City of Tigard
:e 2 - Supplemental Information
.:..IMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: •
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stcreo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ I
❑ Intercom and Paging Systems
O Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: —
*No licenses are required. Licenses are required
for all other installations
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