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Permit 41 CITY OF TIGARD E PERMIT COMMUNITY DEVELOPMENT Per E m EL - 004 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/08/2011 Parcel: 1S136CA05401 Jurisdiction: Tigard Site address: 11285 SW 78TH AVE Project: GALLUCCI Subdivision: Lot: Project Description: (1) branch circuit to reconnect gas furnace. Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: GALLUCCI, NAOMI ALVIA TR PO BOX 80607 11285 SW 78TH AVE PORTLAND, OR 97280 TIGARD, OR 97223 PHONE: 503 - 233 -1779 PHONE: FAX: 503 - 651 -3345 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 09/08/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 09/08/2011 $6.74 Type of Use: Electrical Class of Work: Type of Const: Occupancy Grp: Total $62.92 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Code a d all o er - •plicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuanc , r if w• k is - sp ded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification nt . ose rules /. re - • • • - 952 - 001 -0010 throu. e,,.- -- 2-001-0090. You • • • - • cosy of es or direct questions to OUNC by calling 503.232 98 r 1 tz r0. aW -� �! 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. Electrical Permit Application FOR OFFICE USE ONLY • City of Tigard Date/Bed ,' ` - er.7 IIIII ° 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review r ♦ PePermit No. I Other Permit: /� Phone: 503 639 4171 Fax: 503 598.196 \� Date /B _ MI �C-2U1 f ' 001 Inspection Line: 503.639 4175 �� r .. Date Ready /By: luris ® See Page 2 for T;IGARD l / Internet www ugard or. gov �,� ` Q Notified /Method / +:e—e Supplemental Information TYPE OF �'c' e PLAN REVIEW El New construction ddition /alteration /repl% * 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 El Demolition Other: W 4 where the available fault current ❑ Marinas and boatyards CATEGORY OF CONSTRUC I`' exceeds 10,000 amps at 150 volts of ❑ Floating buildings less to ground, or exceeds (4,000 ❑ Commercial -use agricultural I- and 2- family dwelling III v 1=1 ❑ Accessory building amps for all other installations. buildings Multi - family ❑Master builder ❑Other: ❑ Fire pump ❑ Installation 01 75 KVA or ❑ Emergency system larger separately derived system. JOB SITE INFORMATION AND LOCATION ,/� ['Addition of new motor load of ❑ "A ", "F. ", "1 - ? ". "I -3" Job no.: Job site address: Il gs' j '7 T Six or or more occupancy. ❑ ❑Si or more e residential units Recreational vehicle parks. City/Slate/ZIP ' ■ r�A ❑ Health -care facilities ❑ Supply voltage for more than ^ ? '` l �� � ❑ 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: Description 1 Qty. 1 Fee. 1 Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. It or less 168 54 4 Ea. add'I 500 sq ft. or portion 33 92 I 'Fax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq ft) 67.84 Limited energy, multi - family 67 8a &COIN) by r um/ residential (with above sq ft ) f' Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 rit PROPERTY OWNER � TENANT 201 amps to 400 amps 133 56 2 ^ /� r J 401 amps to 600 amps 200 34 ' _ Name / – /'!�//{� t (/ /7 {rf 601 amps to 1,000 amps 301.04 2 i ' "Idress: / ( � G ' 7 Over 1,000 amps or volts 552 26 2 � � � Temporary services or feeders installation, alteration, and /or City /State /LIP: relocation Phone. ( ) Fax: ( ) 200 amps or less 59 36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits – new, alteration, or ex_ tension, 1Lej panel Owner signature. Date: A Fee for branch circuits with 1 APPLICANT ❑ CONTACT PERSON' above service or feeder fee 7 42 , each branch circuit Business name' B. Fee for branch circuits without / / v service or feeder fee, first l l / 56.18 c6, 1 y , 1 / Contact name: ,ci� Ar1'o branch circuit 2 `�� Each add'I branch circuit 7.42 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67 84 - dwelling, service and/or feeder Reconnect only 67 84 FT Phone (�0;) 3 is) -3780 Fax: : ( ) Pump or irrigation circle 67 84 2 I: -maiI: Sign or outline lighting 67 84 2 CONTRACTOR / Signal circuit(s) or limited- energy Business name: . 3�?,n) S i t w e J[ panel, alteration, or extension Page 2 ( Each additional inspection over allowable in any of the above 2 Address: P U G0 e o 6 r7 f Additional inspection (I hr min) 66 25/ hr ^e) r t 0 is ^ ^ agO Investigation (I hr min) 66 25/ hr City/State/ZIP: I LJ (� `j I t/ Industrial plant (I hr min) 78,18/ hr Phone: )3 ) a -- / 779 Fax: (cos ) GAS /- 33 '/S Inspections for which no fee is 90 00/ hr /l specifically listed (% hr min) CCB Lic..6 //5y 7 Electrical Lie.: /.1. / L/' f Suprv. Lie.: 76/ A �a ELECTRICAL PERMIT FEES. Subtotal: g-61' t( 1 Supry Electrician signature, required. �Cl1A. - Plan review (25% of permit fee): ant name: C i s C • r ` ♦ A.) Date: q ' l State surcharge (12% of permit fee) C. ^7 a . �n TOT AL PER MIT FE _ i,t., Authorized signature: Cal permit application expires if a permit is not obtained within 180 /�6 (-71 days after it has been accepted as complete. ( ; Print name' ! t , J , �'• Date: % /I " Number of inspections allowed per permit I liuddmg'Permits doe 10/01/09 4 -4615 /05 /COM/WEB 4 1 1 / („3 / Electrical Permit Application FOR OFFICE USE ONLY City of Tigard R eceived Permit No Date /B UPI • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone' 503 639.4171 Fax 503 548.1960 Date /B Other Permit TIGARD Inspection Line: 503.639.4175 Dale Ready /By, inns El See Page 2 for Internet www.ngard -or gov Notified /Method Supplemental Information TYPE OF WORK PLAN REVIEW ❑ Ness' Please check all that apply (submit 2 sets of plans w /hems checked below) de w construction ❑ Addition /alteration /replacement ❑ Service or Feeder 400 amps or more ❑ Budding o5 e1 three stor ❑ DC11101111011 ❑ Other. where the available Fault current ❑ Marinas and boatyards CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings ❑ Multi-Family ❑ Master builder ❑ Other: • ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived s■ stem ❑ Addition of new motor load of ❑'A ". "E', "I -_ I - ? ", Job no. Job site address: 100HP or more. occupancy. ❑ Sr\ or more residential units ❑ Recreational vehicle parks City/State/ZIP ' ❑ flealth -care facilities. ❑ 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: Description I Qry. I Fe, I Taal I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision Lot no . 1.000 sq it or less 168 54 4 Ea add'I 500 sq. It or portion 33 42 I Tax map /parcel no.' Limited energy, residential 67 84 DESCRIPTION OF WORK (with above sq 0 ) Limited energy, multifamily 67.84 - residential (with above sq. ft.) Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 401 amps to 600 amps 200.34 I '_ Name: 601 amps to 1,000 amps 301 04 2 ' ddress: Over 1,000 amps or volts 552 26 2 City/State/Z11' Temporary services or feeders installation, alteration, and /or relocation _ Phone: ( ) Fa ( ) 200 amps or less 59,36 1 1 201 amps to 400 amps 125 08 2 Owner installation: I his installation is being made on property that I own which is not 401 amps to 599 amps 168 54 I 2 Intended for sale. lease. rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, _er panel Owner signature. Date. A. Fee for branch circuits with II APPLICANT I CONTACT PERSON above service or feeder fee, each branch circuit 7 42 Business name. B Fee for branch circuits without �7 � service or feeder fee, lust 56 18 Contact natne• 0,//,8e- t rrON) branch circuit 2 77 h� Each add'I branch circuit 7.42 2 Address. Miscellaneous (service or feeder not included) Each manufactured or modular City /Stale /LIP: 67.84 n dwelling, service and/or feeder Phone: x60; ) 3i 5 .. 7 gQn Fax:: ( ) Reconnect only 67,84 2 `,� / U Pump or irrigation circle 67.84 2 E -mail Sign or outline lighting 67 84 2 CONTRACTOR Signal circuit(s) or limited- energy ' Business name. e . 5 / } ' �. �/G panel, alteration, or extension Page 2 2 /) Each additional inspection over allowable in any of the above Address: p0 ^ G Vc e c & 17 v Additional inspection (I hr min) 66 25/ hr City/State/ZIP. 4JC) r'�"L� A 0 (�_ ei t� Q0 Investigation (I hr min) 78 1 8/ hr H Industrial pant (I hr min) 78 18/ hr Phone: (3 I 23 .. l7 Fax: 3) s/- 5 /- 33 i./3' Inspections for which no fee is 90.00 / hr ' '/ ���111 specificall listed (% hr min) CCB Lie 6 5c7 7 Electrical Lie.. 1. / 9 L f(2, sup,. Lic.: 76/ A µ� ELECTRICAL PERMIT FEE$ r� Subtotal. Stipp:. Electrician signature. required: A /f l v SILL Plan review (25% of permit fee). c fiat name: el 3,r Date: Stale surcharge (12% of permit fee)' TOTAL PERMIT FEE of Authonred signature: This permit application expires if a permit is not obtained within ISO 'J � • days after it has been accepted as complete. Print name: a_.[ t j J L, % /- "O Date' e Number of inspections allowed per permit. I ` iluilding Perm'ilApp doc 10/0 pug 440 4615T(I 1 /05 /COM/WEB )