Permit C ITY OF TIGARD' ELECTRICAL PERMIT
PERMIT #: ELC2006 -00601
DEVELOPMENT SERVICES DATE ISSUED: 10/23/2006
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 2S114AC -00400
SITE ADDRESS: 16545 SW 93RD AVE ZONING: R - 4.5
SUBDIVISION: CAFFALLS CORNER LOT : 004 JURISDICTION: TIG
Project Description: (1) branch circuit to re- connect furnace.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ADRIAN LETHBRIDGE BEN'S HEATING & A/C
16545 SW 93RD PO BOX 80607
TIGARD, OR 97224 PORTLAND, OR 97280
Phone: 503 - 352 -4597 Contact #: FAX 503 - 651 -3345
PRI 503 - 233 -1779
FEES
Description Date Amount Reg #: ELE 49LHR
[ELPRMT] ELC Permit 10/23/200( $46.85 LIC 64597
[TAX] 8% State Surcharge 10/23/200( $3.75
Total $50.60 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: �Ct�z� Permittee Signature: '
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'N: 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.
OCT -23 -2006 05:06 AM PENS HEATING 503 651 3345 P.03
l rv�
1 :1, " -1 i Olt lllltl'1 I 'I.O \I l
t n Deie/B ./ .� /f6 l ' Perm No,' ( ...r. , W s f 1
Received ,
City of Ti � alyd a � , 2 006
• 13125 SW Hall ;: Ivd., Tigard, OR 97223 01„,1 1, Plan Review other Runk
Phone: 503,639 • 171 Fax: 503.598,1960 Dme/B •
i i. I•I r
- Inspection Lino: 503.639,4175 l9s ' i.. Date' Ready/By Sae Page 1 for
1 Supplemental Information
Internet: www.t gird -orgov , i O'_ „Notlfi:d!Melhed:
R� e 9'. a � ktr' 3 ry "t. , a, PLAN REVIEW _
z ;;,,::;.T.1.1,. OF.. CVO :; `' .4:.!; . e.':5 ':; .' Sr r ; ".;.;e `''` ':,.. ;'z '. .
Please check all that apply:
■ New construction 1: Addition /altetation/repletcatnent ❑Service over 225 amps, comm'1 ['Hazardous location
❑ Demolition 0 Other: ❑Service over 320 amps - rating ❑Buildng over 10,000 sq, it.,
�� TEGORY OF CONSTRUCTION; . 4, • of 1 -and 2- family dwellings 4 or more new residential
12 System over 600 volts nominal units in one stru cture
1- and 2- family dwellins ■ Commercial/industrial ■ Accessory building ❑building over three stories ❑Feeders. 400 amps or more
(D Multi- family 0 Master builder 0 Other: °Occupant load over 99 persons ❑Manu factured structures or
", : t ''
? ?:r 0Eg ress/lighting plan
' JOB - INFORMA' 1' I( ?IY:AIVD °I.UCA7'�01�;;' t:,.; .. RV park
MINIEFE1111 ❑Health -care facility ❑(ltlter.
Job no.: .I. , b site address: ,e Submit I sets of plans with any of the above,
City /State/ZIP: ' l , Q r R - a - The above arc not applicable to temporary construction service.
.... • FEE* SCHEDULE
Suite/bldg./apt. no.: f Project name: Wserlptlen { Qty. { Fee. { Tote] { '.
— Cross street/directions to j. site: New residential single- or multi - family dwelling unit.
Includes attached Barest.
1,000 000 s ft. q, ft, or r less 145.15 4
Subdivision: Lot no.: Ea. addi 500 sq. ft or portion 33,40 l
Limited ener: , residential 75.00 2
Tax map/parcel no.: Limited energy, non - residential 75.00 2
: D r el • Er'['ION OF WORK ':. . .' `_,k :: ...''....':::.•=4;(,.....;,`
..' ' ::..... ':' ''' ;' Each manufactured or modular
dwellln:, service and/or feeder 90,90 2
e - CO 0 - 6 AI utfl/uhr Servtees or feeders installation, alteration, and/or relocation
200 amps or loss 80.30 2
201 amps to 400 amps 106.85 2
-
PROPERTY ,i wNER 1 . ' (] TFa�IANT 401 amps to 600 amps 160.60 2
Name; A ,� f t d / , 4 ei 601 amps to 1,000 amps 240.60 - 2
.. Over 1.000 amps or volts 454.65 _ 2
address: Ile i. Reconnect only 66.85 2
City / State/ZIP: --- I • g r r 9'2 a. A . Temporary services or feeders Installation, alteration, and /or
-1 _ relocation
Phone: ) �a S Fax; ) 200 amps or less 66.85 1
Owner installation: This nstallation Is being made on property that I own which is not 201 amps to 400 amps 100,30 2
intended for sale, lease, re t, or exchange. according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: _ Date: Branch circuits - new, alteration, or extension. per panel
A. Fee for branch circuits with
APIPLIC ��" t^ONTAGT.'.PERSON service or feeder fee, each
6,65 2
Business name: _ _
branch circuit
H. Fee for branch circuits rJ
Contact name: i 1 S . is i wfhoul service or feeder foe, 1 46.85 2
19 first branch circuit ,
Address: Each add'I branch circuit 6,65 2
City / State/ZlP: Miscellaneous (service or feeder not Included)
Pump or irrigation circle 53.40 2
Phone: Y Fax:: ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
CONTRA TOR' .: .' • '.' • .. .:•'''.1,: energy panel, alteration, or
Business name: C am. J ► .
4- A extension. Describe: Page 2 2
Address: ` . SO 6d7 Each additional Inspection over allowable in any of the above
o V (1 !� Per inspection 62,50
City / State/ZIP: Q t " ® ( 43 410 Investigation per hour (I hr min) T 62,50
p indus plant
Phone: (SO .. I 7 l [Fax: ( '�) 6 3 �4 per hour 73,75
CCB Lic.; r Electrical Lic.: e ; Suprv. Lic.: ELECTRICAL, PERMIT FEES Subtotal:
Suprv. Electrician signa ' e. required: "
Plan review (25% of permit fee):
a'r'int name: `ll I ' Date; State surcharge (8% of permit foe):
r . . TOTAL PERMIT FEE '> 6 O
Nil Authorized signatUro.` ,� • • 1 T his permit application osplros Ifs permll is not obtained within 184
1 a / / days after It has been accepted as complete
+ � 1 Date: Y Pee methodology sot by T ae s bee ty Buildi Industry Service Beard
"
Number of inspections per permit allowed.
I:\ euildmarpmnite v:LC.- PormItapp.d• . 03/).1!06 440.161ST(I I /OS/COM WEB
• CITY OF TIGARD
BUILDING DIVISION
A i PERMIT #: ELC2006-00601
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/23/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/30/2006 TIME: 7:05AM PAGE: 79
SITE ADDRESS: 16545 SW 93RD AVE CLASS OF WORK:
SUBDIVISION: CAFFALLS CORNER LOT #: 004 TYPE OF USE:
PROJECT NAME: LETHE3RIDGE
DESCRIPTION: (1) branch circuit to re-connect furnace.
OWNER: LETHBRIDGE, ADRIAN PHONE #: 503-352-4597 •
CONTRACTOR: BEN'S HEATING & NC PHONE #: 503 233 1779
Inspection Request Scheduled For: Date: '10/30/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 038643-01 503-233-1779
Corrections/Comments/Instructions:
p -ASS 0 PARTIAL APPROVAL fl CANCEL WCESS
FAIL CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector: ..--/ Date: 0 .0 Phone #: (503) 718- ZC9r