Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00345
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06!23/2011
Parcel: 1S134AC04800
Jurisdiction: Tigard
Site address: 10873 SW 109TH AVE
Project: LEEPER Subdivision: HART'S LANDING Lot: 19
Project Description: (2) branch circuits.
Contractor: A TEMP HEATING & COOLING INC Owner: LEEPER, MICHAEL & STEPHANIE
16000 SE EVELYN ST 10873 SW 109TH AVE
CLACKAMAS, OR 97015 -9519 TIGARD, OR 97223
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 06/23/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/23/2011 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 52- 001 -0090. You ma obtain a co y of fh ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: ,>% •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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
06/22/2011 08: 05 5035572990 A TEMP HEATING PAGE 01
Electrical Permit Application ' 114.* 01.11CL I ISE ON LA.'
City of Tigard Received ft_ 0 ,
111 le 1 DateiBv: t.9
i 0 Nan Review
Inspection 1 .inc: 503.639.4175 4 V c RCAO.I .TuriN: el See Page 2 fOr
GOO. ificcliNictliod:
TYPE OF WORK (.* 1 0 PLAN REVIEW •
0 De m o1i tion 0 Other: 0 - whom Me romillble 1:1011 correol 0 MririllM .111(1 b(mlyarlis.
r.Nceects 10,000 amps at ISO volts or 0 Floating buildings.
CATEGORY OF CONSTRI T:IIION
IR 1- and 2-lamily dwelling 0 C:ommercial/indirsirial 0 Accessory balk:ling amps rOt Ali tidier in5thliciijons, Imildim.
El M1111.1-fillilily 0 Master builder 0 Other: 1:1 rite. 'Nitro. 0 Installation of 75 K. v A or
JOB SITE INFORMATION AND LOCATION
Job no.- Job site address:10 c iTh c, L lOcti 100) fl or more,
CI SiN Or , nore residential 'mils 0 Recreational vehicle parks.
00() vol Is nominal.
Si.liteibltig./apt, no.71 j Project name: t„.-ecke 0 Service or reciter imn amps or more.
Cross stroclidirec lions Wirth ; :dre:
New residcntinl single- or multi-family dwelling unit.
Includes attached garage.
Tax mapipareel no,-,
Limited energy, residential .—
DESCRIPTION OF WORK (with aboys TILL) _ „
- •-• Limited energy. multi-Famtly
75.00 2
. 2. \tit oa■ el\ r., t w■ Is- N. 0 Se_4-v cia_. residential (with above sq. a.)
Services or feeders ingnilAtiOn, alteration, anclio relocation
200 amps or less l R0.70 2
o lgl PROPERTY OWNER 1=1 TENANT 201 amps to 490 amps 133.56 2
401 amps to 600 amps 200.14 2
601 amps to IMO amps 301.04 2
City/Statef7AP ; ' '' , , 0 r c l, 1 9-7-3 Tc:rnporrtr or Feeders installation, alteration, andfot
relocation ,
201 atrps to 400 amps MI ' 125,08 2
Owner installation: This installation is bcina made on property that I own whidi is not —
401 amps to 599 aiht)S 168.54 2
intended for sale. lease, rent, or exchange. tiecording to ORS 447. 449. 670, and 70 I, ,. ..,. —
Branch circuits - new, a Iterntinn. Or extensta pane!
Owner signature: _ .... Date: A. Pee rn- branch circlets 11-ii/r
eAPPI Al.:ANT 0 CONTACT PERSON a hove service or feeder roc.
7,42 2
_. - „.... service nr feeder fee. :first _,
Contact name; branch eirmin
Address: Clackamas, OR MI5 _„ .
Miscellaneous (service or feeder not• included)
SW-MO-3014 -
r manufactured or modular
67,84 2
dwelling. service and/or feeder
Phone: ( ) lox: : ( ) Reconnect only
-- .., signal cifetilits) or limited-energy
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panel. alteration. or intension Pnec 2 ,
Address; 16000SE Evelyn St. Acid ii ional inspection { I Or mini Oti '5/ lir --
66.25/ hr
C(11.3 Lic.:1 IC; 7 z6 Hedrical Lie. C 5 si, i v. Lit: 1 : ELECTRICAL i'ERMIT FEES •
Plan rcv icw (25% or permil. fee);
Authorized signature: ," Torn I., Pl.:RMIT F111E: --a, 7 ,, s
Print ;mine: t„.1,,,_ 0 ,.... ', ts,.. 6., v ...,, k o. I Dtte: (8(74,401 firct's after it hr. been ileCeptrd F* coin pletr,