Permit ELECTRICAL PERMIT
I�
• CITY OF TIGARD
`` 2 , , COMMUNITY DEVELOPMENT Permit #: ELC2009 -00279
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06!08!2009
Parcel: 25111 DC01300
Jurisdiction: Tigard
Site address: 15900 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 460
Project: Turner
Project Description: Install /alter (1) branch circuit to reconnect gas furnace.
Owner: FEES
TURNER, THOMAS G & ROSE M Quantity Description Date Amount
15900 SW ALDERBROOK CIRCLE
TIGARD, OR 97224 1 crt Branch Circuits 06/08/2009 $46.85
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/08/2009 $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:
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 it 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. You may obtain a copy of the rules or direct questions to oUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: (lnlC rl R Permittee Signature: pp
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 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.
0 k t t` r`i x rti k 1 41 s o 5 :;4,: •dI � "r4 N NN '} n v vtif r rru t ,a
`. etrical Permit Application 4 ", a . , �,r 1 01k0 r41(I4,',S c� Ni . 1 r .,60 . t� s , � � �
1.. r �� ` I Received 9
City of Tigard ," D ceive , Permit NP.�le `
l . 13125 SW Hall Blvd., Tigard, OR 7 2 Plan Rovle,v �
' • Phone: 503.639.4171 Fax: 503, 8. 960 (1 Date /By; Other Permit l
Ins ection Line: 503.639.4175 09 ••. "- `
TIGARD P JU p 4 20 Date R cad y JB y : h,ris Sea PuQe 2 for
Internet: wwsv.tigard -or. gov Notified/Metttod � ) Supplemental lnriromanun
n _ _
. TYPE OF'Wtc*i (j'' IIl71N PLAN REVIEW _
' s rtv °tr i r i t v -
�❑ New construction ® Addit ion /altainn eWial 'CR1Cn Please check all Ihat apply (submit 2 5 Cl; of plan,; »%gCmS chcCkCd hClu,s. I
°." ^° ❑ Service or feeder 40(1 ninp or I1101e 0 ISnddmp user 'hive ,.brit.
❑ Ucuwlitistt ❑ Other where the available (null current ❑ M u•iins aid bod■ oi Os
CATEGORY OF CONSTRUCTION •. Cxeeeds 10,000 iinps ni 150 vulk it M Flo:llmp huddme,
IMO) ground, or exceeds 14,000 ❑ Comu,crcial.,se apriculiu, ui
1- and 2- fun dwelling ❑ Commercial /industrial 0 Accessory building imp. for, it other inslallaiui., 6wldiupx.
❑ Multi - family ❑ Muster builder 0 Other: Q Fire piling. ❑ hlstalianon of 75 5. VA to
JOB SITE INFORMATION AND LOCATION 0 Emergency system separately derived scslrm
I �� ❑ Addition of now motor load of ❑ "A" "F "I : ' I
.lob no.: Job site address: f, ?
0P ,#1 �A/' 12 took- t_ v`/` 10011P of more occupancy.
— — — ❑ Six or more residenlitd minx. ❑ Root:annual relict, pink,
❑ Health teeitilles
❑ Hazardous locations. 0 Stlppl. \()nape for mire titan
City/State/7J P: n p � 7 _ 6181 auhs 00 000 ll
` '
Su ite /bldg. /opt. no.: Project name: ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street /directions to job site: nescriprion I 0,v. I Pre. I tail I ^
Nov residen single- or multi-family dwelling unit,
Includes attached garage.
Subdivision' Lot no.: 1.000 sq. H. or less 145 1 ^_.__._. `l
Ea. add 500 sq. It or portion 33.40 I
Tux map /parcel no,: Limited energy, residential
' DESCRIPTION OF .WORK'. . ' ' ' 6
(wilabove 71A0 2
n Limited energy, multi.f00111y 73.00 n
-- COnnoeft 00,4 residential (with above dq. U.) T —__ —
1 Services or feeders installation. alteration, xatllllr reto_Kriun
200 amps or less Ro._,rl '
�� p. PROPERTY OWNER I ❑ TENANT ' ' 201 amps to 400 amps I06.K5 ••_.+ 2
Name: 401 amps to 600 amps 1 60.60 __ 2
— � ! '"�' -� 601 amps to 1,000 amps 240.60 3
' 'idr /51 0 P 3 EA, / 4-/c1,0,1,, , ,, fL �t ( Over I ,000 amps oar volts _. _'
. ty /State / %11 "j I`�(�4, /M 9 P � � /J� T relocation
services or fe eders inxt911xtinn, Rhin nnrl /m -_
J / (-i i �- I rCtOCattUn
Phone: ( Sr/ ac f.--- (197/ . Fax: ( ) 200 amps or less 66.14 i I
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 ORS 447, 449. 670, and 701. 401 amps to 599 amps 1 33.75 2
Branch circuits — new, alteration, or extension, per panel
Owner sign() iure; Date: A. Fee for branch circuits with
❑ APPLICANT ' j CONTACT PERSON above service or feeder fee,
•
each branch circuit O.6;
I3usiness name: !� I nn
b d t ( - l e a , ,,, f� �f 't r� c oti, rte L C C B. Fee for brunch circuits
J
without service or feeder fee. 46 Contact Hanle: C 1 d e (le i +6 r+% first branch circuit
Address; Each add'i brunch circuit 0.05 -
-- -•- . - . Miscellaneous (service or feeder not included) _
City /Stule /ZIP: Each manufactured or modular 90')(t ?
dwelling, service and /0r feeder
1)15000: (5-v2t ) 3) 3.- 3 51U Fax; : (g ) 6 j i - 3./ y J.-- Reconnect only OO.g5 '
E-mail: Pump or irrigation circle ;3,40 2
CONTRACTOR . • Sign or outline lighting 53.40 2
L3tI tinC55 name: n Signal circuits) or limited-
� i 1464; e a: i.) i ► r �o n e�, yi J� �q I- L energy panel, alteration. or
t7 C J extension. Describe: Page 2
Address: f P • 4 f>x gem‘, 0 '7 - _
City /Stale /!II': YQ g. 0 q 7 Each adoitinnal inspection over allussable in an, of the above
-_
1 � � r Per inspection 62 50 I '� E
Phone: (Z. 7 ) 3 7 . - 0 7 9 ' Fax: (5 0 3 ) C , 5 - /- 33 r Investigation per hour l I hr min) 62 50
•
w.....- — --
L'CR Lie.: � 1• L ,
-q 7 Electrical Lie.: � Suprv. Lic.: Industrial plant per hour 73 -
ELECTRICAL PERM IT FEES
Suprv. Electrician signature, requi` : `
_ Suhtnlul;
in( name: 111/M�� ate: Plan review 125% of permit 1'ru)e).
:
' State surcharge (12% of permit fe
Authorized signature: . 4' IIP . I'Ol'AL. PE;ltfvlhl 1
Data;: y
) I I rO 9 ' {'hi e pe application evplres If a permit Is nil Amine( ulchin 180
„ Print name: e l j n e 61. r� ,, N days after it hits been accepted as vomplcly,
• Number of inspections Mi n psi pct mil
I ihnisiilO \nl'Irn1Ir't :I.C•Pr' n ilApp.d osi: :1 /n0 440.461 i'tI 111USICOM/WU
Z00 j HIVEIDNI,LVdH 9t7CCTS9C09 XVd ZC: CT 600Z/170/90