Permit • ,, CITY OF TIGARD ELECTRICAL PERMIT
` °! COMMUNITY DEVELOPMENT Permit #: ELC2011 -00482
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/26/2011
Parcel: 1 S125DC04200
Jurisdiction: Tigard
Site address: 7072 SW BARBARA LN
Project: Leonard Subdivision: RAZBERRY PATCH, THE Lot: 35
Project Description: Reconnect furnace and a /c. A/C unit must maintain a 5' side and rear yard setback.
Contractor: TRI COUNTY TEMP CONTROL INC Owner: LEONARD, PATRICIA V
13150 S CLACKAMAS RIVER DR 7072 SW BARBARA LN
OREGON CITY, OR 97045 TIGARD, OR 97223
P
PHONE: 503 - 452 -0652
HONE: 503 - 557 -2220
FAX: 503 - 557 -0919
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 08/26/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/26/2011 $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 -. ..ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance wit' - pproved 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. •TTENTION: Oregon I: ' re. , i you to follow the rules adopted by the Oregon Utility Notific- Center. Those rules are set forth in OAR
952 -r'1 1 -0010 thr.ugh OAR 9 • $1-0 I 9 4 ou may obtain a copy of the rules or direct questions to OUNC by c- ' fl1!5 1987 or 1.800.332. 44.
Is- ed By: 0144-6 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 QNLY
SIGNATURE OF SUPR. ELEC' ,i 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.
AUG -26 -2011 01:44P FROM: TO : 5035981960 P.1
1 e
Electrical Permit Applicati E . I p, volt 0141( 1 ti 0\1,1
Received Q
City of Tigard A U G 2 6 ? 011 Date/By: c+ 01., � Permit No.: EL // g '$$
II4 'm 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
a Phone: 503.639.4171 Fax: 503.59 : Date/By. Other Permit:
Inspection Line: 503.639.4175 t1 I V OF TI A RD Date Ready/By: luris: 0 See Page 2 for
1 it.ARI) »a
Internet: www.tigard- or.gov RAI DWG a Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition El Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
® -1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
less to for other a exceeds alga ons, ❑ Commercial -use agricultural
g amps for ell other installalians. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived systcn
❑ Addition of new motor load of ❑ "A ", "E ", "1 - 2 ", "1 - ",
Job no.: Job site address: 7O72� 4i f:)„,,,,,,„„,0„,, Six or m r more. occupancy.
❑ Six or more residential units. ❑ vehicle parks.
']i
City/State/ZIP: ❑ Health -care facilities.
0 Supply voltage for more than
� ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: orscription J Q ty . I Fe e. I Total I •
New residential single- or multi - family dwelling unit.
-Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
kozwinal -&.0 Ya,C, il al r 01) al - h 4Yx • residential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
PROPERTY j4ER I TENANT 201 amps to 400 amps 133.56 2
Name: f tt 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 3 rit, Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
n � y relocation
Phone: .(VO).1 2, 0(
(iJ� Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: Same as contractor B. Fee for branch circuits
Contact name: Diane Mason without service or feeder fee, 1 56.18 2
first branch circuit
Address: Each win branch circuit 1 7.42 2
Miscellaneous (service or feeder not Included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal panel, er or limited -
Business name: Tri County Temp Control
energy p alteration, or
Address: 13150 S. Clackamas River Drive extension, Describe: Page 2 2
City /State /ZIP: Oregon City, OR 97045 / 1 t / Each additional inspection over allowable in any of the above
l Per inspection 66.25
Phone: (503) 557.2220 66C/C Fa x: (503) 557.0919 1
( Investigation per hour (I hr min) 66.25
CCB Lie.: 72623 1✓ Electrical Lic.: . 5.2.71.14R -- l Suprv. Lie.: 41&65/ Industrial plant per hour 78.18
f - ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: fi, 'r......., -1. • «<yyy,ayy Subtotal:
Print name: . l ikYld eh5 Date: s eifil I i Plan review (25% of permit fee):
State surcharge (12% of permit fee): I
Authorized signature: .0' , ) TOTAL PERMIT FEE: 7I , Z7
QQ This permit application expires if a permit is not obtained withln'180
Print name: ;Mane Mason Date: Q days after it has been accepted as complete. jp/ J
• Number of inspections allowed per permit. (rdt�
t : \ Building \Pennito\lLC- PermitApp,doc 10 /01 /09 440-4615T(t1105 /COM/WEB U -