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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2009 -00189 Date Issued: 04/29/2009 T [CARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1 S1346D10300 Jurisdiction: Tigard Site address: 10846 SW 118TH CT Subdivision: PENN LAWN ESTATES NO.2 Lot: 31 Project: White Project Description: Replace gas furnace. Owner: FEES WHITE, PHILIP S SR & CAROL J Quantity Description Date Amount 32391 SW LAKE DR 1 crt Branch Circuits 04/29/2009 $46.85 WILSONVILLE, OR 97070 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 04/29/2009 $5.62 Contractor: Electrical 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: Occupancy Grp: 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95 Issued By: Ot oug A Y � may obtain l a copy ^ or�e rules or direct P ermittee Si lure calling ) 503.246.6699 or 1.800.332.2344. 1 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. — a.g till t -Electrical Permit Application FOR OFFICE (ISE UNIX • f Rece ived City of Tigard 2 7 2009 oela/B : - 7 • •C Permit No . €, ET . ii 6 tto t a 13125 SW 110 Blvd. Tigard, OR 97223 A PR plan Review W h _ I Phone: 503.639.4171 Fax: 503,598,1960 Data /B : *A ' 4k Z Inspection Line: 503,639,41 '11uAttll 75 CITY ®r Ts rs' Wm Permit: r ate Ready /By: nuns 0 See rage 1 for Internet: www.tigard- or-gov �i otltlecUMetll C5 S upldcmcn Is! lnrn rmrlinn W BUILDING DIVISI " _ . TYPE OF'WORK ,.. ••'.'. • . PLAN REVIEW E1 New construction jAddition /alteration /replacement Plcpxe cheek all that apply (submit 2 •,celx of plaun ■ide,lr, clmcked Lehr,, , 0 Service or feeder 400 amps or more Ca tlnddnrp aver !line MarICs © Demolition ❑ Other: where t h e available Peel' currant ❑ Marinas and bo,ty:nts CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 vitas nr ❑ I'IOannp 1)1611.1 6 I 10 $I•UIIII(t, Or C. \CCULIs 14.0 o C „,„111 Il•u.1.a g8i 1culluud r, 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building al,gs roe »n othm installations I Multi-family ❑ Mastcrbulkier ❑Other: ❑lIre pump. 01irl;lll;;toaul' ❑ Emergency system. larger separately cloned system. JOB SITE INFORMATION AND LOCATION ❑ Addition anew motor load of ❑ ' >� , "1. °I - ". ' 1 " „” ' � � 100111 of tore. oceepane■ -- lob no.: Job site address: / ry g • ' ❑ Six or more residdnlial units ❑ Ree ealionut t chicic parks Cllr /Staff /ZIP: 1v 0 G 7 � 0 ir pHealth-eare an io n s . ❑ Sunny ,ohapr liar more Mao iaa;udnux !minions. (Al vahs nominal Suite /bldg, /apt. no.: Project name: ❑ Service or feeder ow ;uupu to more. -•. FEE SCHEDULE Cross street /directions to job site: oescripilon � Ul,, ( rte. 1 Tool • -- New residential single- or multi - fancily dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq, ti. or loss 145.15 4 Ea. add] 500 sq. IL or portion 33.40 I Tax map /parcel no - _ Limited energy, residential -- - , DESCRIPTION OF WORI: (with above ad;,tlj 7- 00 i LI ` W vVA-L o Limited energy, muovmily 75.00 .__ ., ,,.,,. � residential (with above sq. fi.) Services or feeders installation, alterntion,,lnd /or 1 200 amps or less 110.30 -' PROPERTY OWNER 1 • ❑ TENANT . • 201 amps to 400 amps ._.� I06.8S _' Name: FIB 1 Vtl h;4e,. 401 amps to 600 amps '01).60 - - -- 601 amps to 1,000 amps _40.60 _ ddrc � � ss: ��/ ,� � , Over 1,000 amps or volts 454.65 —_ : - ' „IL) /StItdc /Zll WA/044 d i_ Temporary Services or feeders Iristaltation, alteration. It ed /ur • rcIUCa11011 1 iSiq 1 4 q 4 -, S`a`0 fax: ( ) 200 amps or less 66.85 1 201 amps to 400 amps 100.30 2 Owner installation: This instullution is being made on property that I own which is not --- - - 401 m to 599 amps 13 75 2 intended for sale. lease. rent, or exchange. according to ORS 447, 449, 670, and 701- p h Branch circuits - new alteration, or e>;tenslnn, r•r panel Owner signature: ate; A. Fee for branch circuits Lruh 0 APPLICANT a- CONTACT PERSON above service Of feeder foci 6.65 each branch circuit Business name; I/ E - tPp+} , !-:) T. ( i( rl'P,,r ( LC C 13. Fee for branch circuits Contact name: without service or fader fee- 46,85 2 C I / &�c r+'er _ first branch circuit _ Address: Each ode branch circuit 6.65 - - Nllscellaneous (service or feeder not Included) City /butte /l1 P: Each manufactured ur modular 90.90 ', - - - -- dwelling„ service and /or feeder Phone: 1S eJ ) 3/3_ 3 9 k 6 ) Fax:: (5-0 ) ) 6 5 %, 33 Y. S Reconnect only 66.85 2 F-main: Pump or irrigation circle 53,40 , CONTRACTOR - Sign or outline lighting 53 40 1 _ BLISIIlcss name: .- ame: 3 Signal circuitts) or limited - �-)� `s N 1,x l; �+ Y i r Co x �r i l., energy panel, alteration, or • extension. Describe; Page 2 2 Address: f:), n, 4> _ 2 0 _ City/State/ZIP: E ach a Inspection over allowable in any of the above �0 2� � kr+� � �'� , � - PCr inspection 62.50 Phone; (Sb 3 ) 01.3 3 . , I 2 7 7 Pax: (5 3 ) 4.57 3393y Investigation per hour ( hr mini 62.50 C C B Lie.: 6 t./3 2 Electrical l.,ie,: i L.1 Suprv. L.ic.: Industrial plant per hour 7 - ELECTRICAL PERMIT rEES Suprv. Electrician signature. rcqui ••: V ..�,._- .. -... Subtotal. I ate: .., Plan review (25% of permit tee) _ 1 r - . InI namZ: 01 ; Stale surcharge (12% of permit toe): Authorized signature: 0+ T ► TOTAl. P1 -1RMrr IT.1:: 52' 7 _ - 1 This permit a pplieetien expires if a Ixvmll to 001 nAmine(' n ilhin ISO Prilnt name: C i 4 L l e sc., r + I l)Htc; / IM ii. ant's otter 11 11110 been nccrpuvl us cunlpletr. Y • Number of i i Peclion;: adored per permit I ni ,ildolnl.enniu't)I.C-Pennnp ;qr dill 0515..900 440.161ST(11 , 5ICOMIWr.a T00 V31 HIV ONI,L63H - SNafi SfiCCT X113 9Z :IT 6002 /LZ /fi0