Permit _ q CITY OF TIGARD ELECTRICAL PERMIT
:�' ' COMMUNITY DEVELOPMENT Permit #: ELC2009-00124
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/16/2009
Parcel: 2S 111 AB08600
Jurisdiction: Tigard
Site address: 14425 SW 94TH CT
Subdivision: PENROSE TERRACE Lot: 31
Project: Ferguson
Project Description: Reconnect gas furnace.
Owner: FEES
FERGUSON, DONALD W Quantity Description Date Amount
JULIE A, 14425 SW 94TH CT
TIGARD, OR 97223 1 crt Branch Circuits 03/16/2009 $46.85
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/16/2009 $5.62
Electrical
Contractor:
BEN'S HEATING & A/C
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: VB
Occupancy Grp: R -3 •
Total $52.47
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTI : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -001 rough O • ' 952-011-0100. You � may obtain a copy of the rules or direct questions to OUNC by calling 503 246.6699 or 1.800.332.2344.
Issued • & A/IA —Q- Permittee Signature: CL
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' D Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
.> s rieal Per A fleet( CE�ED FOR OFFICE USE ONL
City of Tigard Received ¢
g Dato /B : d /6" Pcnnit Ni .' i640
l.4,49
L. t 13125 SW 11911 Blvd., Tigard, OR 972�� pp 16 2p09 Plan Review
Phone: 503.639.4171 Fax 503.598 111610 DatciB Other Prrmil
'fl(aAR1,1
inspection Line: 503.639.417$ .� G �QII Date Ready /13y: lulr ®SeePu>c2to
Internet: www.tigard•or.gov c of � 1 s[O N otified/Method;
Stjp )Ir insane
�NG. ,/± 1 Information
4 y I f nt,t
a, TYPE QA j .. PLAN REVIEW
New construction i7,41 addition /alteration /replaeemenl Please check all that apply (submit 1 sets of plaits whlnntx tacked beloal:'�
0 Service or feeder 400 ;Imps or more ❑ Buildin over three stories
❑ Demolition ❑ Other: wt.,/ o avai1a1)16 limll mT4111 e ❑ Marinas and boaiya
' CATEGORY OF CONSTRUCTION .. .. • • exceeds 10,000 amps at 150 calm in [] Filming buildings,
less to ground, or exceeds 14,000 Q Commercial—use u I Icuh,n'al
54 • and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for ail otter Instullaiions. buildings.
❑ Multi - family 0 Master builder ❑ Other: ❑ Fire ;hum C1 Iltsu 01'75 KVA or
_ ...
J OII• SITE INFORMATION AND LOCATION . 0 Mdii gn)cy stem I;u•> sepraveiy derived iysavl,
[� / r, ❑ Additi: of n uu nu, nl'
Job no.: Job site address: /1/141 to / y t4 d 10011P or more. occupancy.
J
Sis or more residential cais. ❑ Reere;u,,,n,d vellIde parks,
City /State /ZIP: 77 Health -care facilities, ❑ Supply vohape fur inure than
�' ❑ Hazardous locations. a(10 cult, nr nim,l
Spite /bldg, /apt. no.: Project name: ['Service or feeder 600 amps or inure
— � - FEE SCHEDULE
Cross street/directions to job site: Dntriplion 7 Qty, 1 Rt. 1 mud 1 •
New residential single- or multi- famth' dwelling unit,
_" Includes attached garage,
Subdivision; Lot no,: 1.000 set, ft. or less -.w., 145,15 .p
- Ea add'I 500 sq. 11. or portion 33.40 I
Fax map /parcel no - �--W. , _ ,
Limited energy, residential 75.00
DESCRIPTION OF WORK ... _ (with above sq. f1 1
Limited energy. multi- family
(� e - cotov6e- 6 rs ire.VV14,e/ residential (with above vy (1.) 7 8,00 — )
f�
n
Services or feeders installation, alteration, and /or relocatio
200 amps or less 80.30 E : 2
ttir PROPERTY OWNER 1 • ❑ .TENANT 201 amps to 400 amps 106.8. . 2
Ntmle: 4 U 1 amps l0 600 amps 160.60 2
___ -d faSO� 601 amps to 1,000 amps 240.60
' rldress: /I S .-- 44.) g ,/ - _ Over 1,000 amps or v0)15 454.69 2
..ay/State/ZIP: '7' ,..dt, V f `77 , Temporary services or feeders installation. alteration, Rut) /rn
/ t rl relocation
Phone: (e ,.i) 6 - o ? ii Q F., ( ) 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 C)RS 447, 449, 670. and 701. 401 amps to 599 amps 133,73 2
Owner 3iQnalurC: Dale: Branch circuits- new, a lteration, or extension, per pullet -
°' ° -° A, Foe for branch circuits with
0 APPLICANT CONTACT PERSO above service or feeder fee,
• each branch circuit O
1.3usiness name: 1 I' - --
J Fr ea Fr r 4 ( pv,,( io,t II,S LL C B Fee for branch circuits
✓ u•Nhnrrr service or fee. /
C �( 8-
ontact name: 1
� � i.a � r-) first brunch circuit -
Address; Each add'I brunch circuit 6.65 -, 2
Miscellaneous (service or feeder not included)
Cat)' /Statc/ZI P: Each mnnufuctured or modular 9090 2
? (� dwelling, service and /or lectdcl
Phone: (S713 ) 3).3- 9 'o Fax:: (1 ) G s J - S J / i Reconnect only 66.85
r.Iiittill Pump or irrigation circle 53.411 _ _ ?
CONTRACTOR Sign or outline lighting _ 5.; .111
Business name: r � , Signal circult(s) or limited-
n S 1-1 @4' ; n t r (rah ! / energy panel, alteration. or
Address: to, 0. a,, 4.. 4 7 r extension. Describe: Page 2
City /State /ZIP: Y? e_4(Pr,v` o 9 7 Each additional Inspection over allowable in any of the alto :c
Per inspection 62,5(1
Phone:; (so 7 ) Fax: y
� 3 .... /7 7 9 ( S 3 ) 6.17_ 3 /f.i Investigation per hour (I fir mini 62.50
CCB Lie.: 4ySgi 7 Electrical Lic.: 4/ L./' Suprv. Lic.: Industrial plant per hour - _.. 73.75
Suprv. Electrician signature, requi . r: / �S4NW ,. ,t;��' ELECTRICAL PERMIT FEES
Subtotal: 4„. $5
inn nflme:
if i rdl 1 6 0?- Plan review (2sgoof permit Ice). le
r 0? State surcharge (12"./0 of permil ,ire): S r (0�
Authorized signature: . 6 : I 17 I /r l O t AI. f'f::RMI l' 1 1 1 5a `�
Print name; ! jii / •1 hi s permi uppllcntion expires if a permit is nut n d „hhin I I) 6tnine) C c ( d 61, ,--1L0 f {�k 11C; I/ dnyY after it line been accepted as complete.
' Number of inspections sdlowed pep Nino!
I 'Building 1l 'ennitel/'LC•PermitApp.dnc 05/23/06 440.4615TI11/05/COM/WLD
Z 0 0 Z HIHVONIZXHH - SNHH ST7CCi XYI TZ :LO 6002/9T/E0