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Permit ill v CITY OF TIGARD ELECTRICAL PERMIT .' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00144 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/02/2009 Parcel: 1S133DD12800 Jurisdiction: Tigard Site address: 11881 SW 126TH PL Subdivision: VILLAGE AT SUMMER LAKE PARK 4 Lot: 165 Project: Jimerson Project Description: Replace gas furnace, and a/c unit. Owner: FEES JIMERSON, DAVID A Quantity Description Date Amount 11881 SW 126TH PL TIGARD, OR 97223 2 crt Branch Circuits 04/02/2009 $53.50 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 04/02/2009 $6.42 Contractor: Electrical HEBERLE ELECTRIC 29012 SW EGGER RD. HILLSBORO, OR 97123 PHONE: 503 - 628 -2095 FAX: 503 - 628 -3076 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. 2- 001- 01 � Q/ l>s-+ 00. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800,332.2344. By: WMCO...V1r\S f Permittee Si n ature: 9 � � I � w , y nU* O Issued B ` AK) ( OWNER INSTALLATION ONLY 1 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. - 03/31,/2009 16:34 5036283076 HEBERLE ELECTRIC INC PAGE 02 e • 1 Electrical Permit ApplicatiollECEIVED i tilt OPtlt I. li,Nl' (1■1,) 1 Received t I C City f Tigard netwl}y, " � 1 x( Permit 140,; E ( 04 • Q Q 4 lig , ' w 13125 SW Hail Blvd., Tigard, O R 9722A R Flan Review ,M �2 d * • . • • I Z Phone: 503.639 -4171 Fax: 503.598.1960 D� Dare/5 : Other Parma . r r Inspection Lino: 503,639.4175 CrrV OF TIGARD Date Ready/Hy: 121 See Page 2 air Tntomet wwav 4gerd rn gov 1 111 1S1ON NatHicdfl4admd l 8u mr'•tnllnrmmatton I 5 fa , ll iil " rV 1 '`.1i M A.. 77 . ' ,. i 4 w ° .wlr .,, ; i i �l�u ', �tluuiit�ia : ., rh ,t .� �. f„v lu�.c all © New construction N: ' ddition /alteration /replacement Plante check n1 that apply (submit Z rota of pleura w /home .hooked below)' ❑ Service or feeder 400 amps or more 01311041ft over three stories. ❑ Demolition 0 Other, where t available fault current CI Marinas and boatyards. i ,1 ,,,,, , 7 1 1 ' ,I l , ,�, 4 i ry . j 1 , r R r .,9 " .... , , 4l� r " j 1 "r . 'r 0x0.„,,9 10,000 d at i50 rants or In Floating buildings, a , .. lux• rid A9.ii.e A , : u �.: '' ul u+7iai 1 '''I ' 41 j- -- ¢ less to ground. or exceeds 14,000 © Commerciet•usa agricultural - and 2- family dwelling ❑ Commercial/industrial 0 Accessory building am ps for all other installation., buildings. 0 Multi family 0 Master builder 0 puler © Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. '- ' ,,.,, o f ,ei { , y ;. ', {,q���„u „ ��3' � ,! �i�4 i " l . El A ddition of new m otor load o f ❑ "A", "r, "1-2", .. _ ya „ / •,'. :a +J �t rJW'��i, wu�, r L a +. � ,,i+ xxa � - 43 .3, w.Lwd �,, Job no.: Job site address: C I { �l f � � ' T� six op or o occupancy. v 1 ❑ Six o r more residont sn ❑ Recreational vehicle parka - City/State/ZIP: y .r c 9' "z.. 7. Q Health-care r WO.. ❑ Supply voltage for more than ID Hazardous locations, 600 unite nominal Suite/bldg. /apt. no.: Project name: I i1 ,S ( ❑ Service or feeder 600 amps or MOM. �' i '',./ i y fi i 0 , w ({ -e , ,r _ y . :: "',. al..i 11 S f 1I, ,. 9 4 r . Cross street/directions to ,job site: (v 4 5 - 5 - -g pesertpttaa Rb , P•r • Total New residential abigle- or nniltl -family dwelling unit. - Includes attached garage. - Subdivision' Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map/parcel no.: Ira. add'l 500 sq, ft. or portion - 33.40 1 a 'P P 7 Limited energy, residential ',;..:.':':. 75.00 2 r i i) o 1 (witA ebovc eq. ft.) — ( Limited energy, multi - family 75,00 2 [�C�o [ �, — c444• -r residential (tith shove Sq. ft.) . r y -- _ . f cp 4"4,7-".' Services or feederu lnatallathnj alteration and/or relocation y� ([� 1 ) 200 amps or lees 80.30 • ; ,� ,�i,o. }' ,I,,2rr, ,, j7.. li k.,.,.,;0 , :, , l .' :1 r> ,:,,:,;;.5r,,.-4"::,,!::.,-,,-.:•.4.,:..,, i , a :k ... .............. � _ J.. � ! a 201 amps to 400 amps II 106.85 Name: � ' 'L.Y` 1 1 'T' l 401 ,, .: to 600 , el 160,60 601 amps to 1,000 amps 240,60 - ® Address: Over 1,000 am.s or volts 454,65 City /State/ZIP: Temporary service. or Peeden krataltat1on, alteration, andlar relocation Phone: ( ) c5 2J r - g Fax: ( ) 200 sups or less 66.85 1 Owner installation: This installation is being made on property that I own which is not __201 amps m 4o0_atnps _ __ - 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 Owner signature Date: - �� llraneh circuits - new, alteration, or eatenalon, per panel Jo; , , '• r w a. r r - r A. Fee for branch circuits with y!. 1� ' . l x n �" �' e9 n'� 4 n + P , ; ',9 WI I I ri,' $ pr abOV1R1UVt000r feeder fee, n� yea 6.G5 2 each branch circuit Business name: add'1 branch ronit - -- .... -- - _ B. Fee for branch o �j � Contact caste: N- IfiraCEYPI . )15 without service or feeder fee, (.�.1 j 2 rC first branch circuit 46.85 Address: - - Q f 1• 4Q i C 2 Each add') 6.65 Miscellaneous (service or 'ceder not included) _ City/State/ZIP: Each manufactured or modular 90,90 - 2 dwe service and/or feeder Phone: ( ) Fax:: ( ) __ Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 n.:. = .4:'4 , . "/ " - — _v. '. . . , � .�•,,,a , a ,If 1 ' , . , , ,a' " Signoroutlm 53.40 2 Business name: signal citcuit(e) or limited - Heberle Electric, Inc. energy panel, alteration, or Address; extension,1accribe: Page 2 2 City/State/ZIP: He le Each additional Ins . cation over allowable hr any of the above Phone ( ) r ' r S S . - S : • , X ( ) - - Per inspection 62.50 OH QQ7� . Investigation per hour (1 hr min) 6250 CCB Lie.: I1. �: ca Li 12 Suprv. Lice Tndu4tnal plant per hour 73.75 Suprv. Electrician signature, required: ` "'" ' "."� i""'"a z,a" Subtotal: I' Print name r r , i s p . 0 Date 3_-_,....0 Plan rcviow (25% of permit foe): J Siete surcharge (12% of permit fee)' 4.'-f . ' y - Authorized signature: TOTAL PERMIT err Print name: p - rlrt+ rwrmlt alrpllcatlnn eTpawe irn permit I. not obtained within IAA dsyl idler it has been .roepted no complete. �- * Number of inspections allowed per permit. is18udldinSlPermiaelR2�C34rraUtpB . idO. 05111l0G 44044151y11/071CoMNU&e f6.--