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Permit ELECTRICAL PERMIT - CITY ®F TIGARD RESTRICTED ENERGY ��/I DEVELOPMENT H BMENT Tigard, SERVICES (503) 639 -4171 DATE ISSUED: 12/11/03 SITE ADDRESS: 09095 SW BURNHAM ST PARCEL: 2S102AD -01300 SUBDIVISION: ZONING: CBD BLOCK: LOT: JURISDICTION: TIG Project Description: HVAC thermostat. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA /TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: • HVAC: X PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: WYATT, DEWEY ROTH HEATING & COOLING c/o WYATT, EUGENE 6990 S ANDERSON RD 9095 SW BURNHAM CANBY, OR 97013 TIGARD, OR 97223 Phone: Phone: 503 266 - 1249 Reg #: LIC 14008 ELE 3- 314CRE FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 12/11/03 $75.00 Elect I Final [TAX] 8% State Surchart 12/11/03 $6.00 Total $81.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throug Issued by /50(. Permittee Signature - /2/ !/ 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'N DATE: LICENSE NO: Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day Received: 12/10/03 2:02PM; 5035981960 -> ROTH HEATING; Page 3 12/10/2003 13:35 FAX 5035981960 CITY OF TIGARD ' • 1003 . t. A/ • :1 Elec Permit Application Received FOR OFFICE USE ONLY Electrical {��{ DatelBy: /!7 f l r 9 1 i PT2 Permit No- �,�� . 0 04 7�- FIEC 1 V ED • Planning A rov I Sign' City .of Tigard DateBy: Permit No,: • 13125 SW Hall Blvd. Plan Review Other :.:,.1".X:•..:% DEC y ° h • Tigard Oregon 97223 C 1 1 ZOO • Date/By: w Permit n d Use , 4 M..• . hone: "5 03 - 639 -4171 Fax 503 -598 -1960 post -Revie . - .P /r, nn;:,!,u ? ' I \ • • Date./By: Case No.: Int www rd iis' p ' frji"=i% F TIGARD :, J Contact Ju n See Page 2 for 0:2 -hour Inspection Name/Method:. Ils Supplemental Information, �'�' InSP Q r ' a : -. -, ;. °!: leaseicheck�alfthaGap :r, : -•r > ± :i - x. ;, . _ : �,:::,'::< :. �':T�E� OF'WORK °.;.: ° :,? .,•,: �: �. � �:.:.:.:.: = :.':":,,'. ", . , )PI:�eN REV[£W:(I P ❑ New construction ❑ Demolition • TI Service over 225 amps- ❑ Health -care facility commercial 0.11azardous location RI Addition /alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10.000 square feet, .,., :;,,_,,. sidential units in .::� f our or more re ict :.,;; .:•.: �.:. _ -...:,. • .:.. _:..;.t _CATEGORY : (3di: -CONST7[tUCTCON: < -'� ;::: .'::,••':: ° <:: • �' 1 & 2 family dwelli D 1 & 2- Family dwelling El-Commercial/Industrial ❑ System over 600 volts nominal • one structure . . ❑ Building over thrcc stories ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family 0 Occupant load over 99 persons. • .0 Manufactured structures or RV park ❑ Master Builder El Other: ❑ Egress/lighting plan . • 0 Other: ^r ,.,.,,, Submit — sets of plans with any of the above. :' JQBiS) cjE:) FOR11IiA '�I01�:'8tlld:;lOCt�T11O1v';i * ''.' ` ".`" The above arc not applicable to temporary construction service. Job site address: 1 O'i S SLA- "air ten:. w^- ., :`FEE *: SCHEDU) -. ",.':''- . _ : „ `•ai: .. , Suite #: •— I Bl /Apt. #: - Number of inspections per permit allowed Project Name: _ � {_l iv._ Olc' kc_T -o✓� Description Qty Fee (ea.) Total 1 New residential - single or multi - family per Cross Street/Directio to jo site: dwelling unit. Iaclades attached garage - Service Included: 1000 sq. ft or less 145.15 4 • Each additional 500 sq. ft orportion thereof 33.40 1 Limited energy. residential 75.00 2 Subdivision: °' [Lot #: ti = . Limited energy, non residential • 75.00 2 ,..,�, Tax map /parcel #: - Each manufactured home or modular dwelling t ; '., r : i y .. ...... ... :;.... dESC[tiPTI01!L:OFVORK' ;:'., , .. '+ "` `: : , service and/or feeder 90.90 2 Services or feeders - installation, ''?...4,... ' � ' kI' •vKSiS•-1-g,+ t�Nr. 4'v'' l-Vt. CA-J`- alteration or relocation: • : 200 amps or less 80.30 2 ' 201 am to y.. � . Ps 400 amps 106.85 2 „rf� ' 401 amps to 600 amps 160.60 2 ' ;: ROP£RTY'QWNER _'' l -.:. I'? ....., :o.a 601 amps to 1000 amps 240,60 2 Over 1000 amps or volts 454.65 2 Name: -� 13 /. ,r�A- !t � Reconnect only 66,85 z Address: 'Ix i S'" SC1� 4�v(' 1^a ✓W- Temporary services or feeders - installation, 1 alteration, or relocation: City /State /Zi� � : a o. r 0 f-a�o V`- 200 amps or less ' 66.85 1 r 20 1 amps to 400 amps . 100.30 2 Phone: a b i (� F aX. 401 to 600 amps 133 -75 2 • APl'r:ICANT :'' .• ::" •'•'1• l; ;;, ?CO T :i`C:�.: ;i . Branch circuits - new, alteration, o r Name: _ e S & , . Y Y `-e v . i k \ `rL TU2,1.1 M extension per panel: Address: • 'P. T!. ✓X 1Z la r (] A Fee for orfeedeiree, each purchase of 6.65 2 service or feeder fee, each branch circuit City /State /Zip: ,Ab 1 O. -e st;•.,N_ `loo i 3 B. Fee for branch circuits without purchase of ' 8 service or feeder foe, first branch circuit 46.85 2 Phone: , 2 to -- IZct k I Fax: ZLa to - 3� 8 Each additional branch circuit . 6 -65, _ 2 E -mail: Misc.( ervice or feeder not included): , ....: :•.•:'. , ;• � D or irrigation circle 53.40 2 - ..- , . . , Each porn • • '° � -� „ ' Each sign or outline lighting 53.40 2 Job No: a / S 3 S Signal circuit(s) or a limited energy panel, i alteration, or extension Page 2 2 . Business Name: -1-6_ 4-, p a- Co g � f^ Desorption: Address: i b. ,3- ex /210 30 °_', City /State /Zip: Co ✓I by ©/ 9 1 3 Each additional inspection over the allowable in any of the above: 1. f ;{ Per inspection per hourlmin. I hour) 62.50 ,* 'yew Phone 7.1 ✓a - I ' ?-4' Fax Z � to -- 3 2 / - investigation fee: . ' . CCB•L #: / I/CX0 b L ie- #: 3 _3)qs � . Other: HV�C. —p-v,/no • ig ` ` .... , . .. . Electrical:'Pctimiteip es''''. : , :: ,.:.u;...;_ <. • '- 1.; � �. , . Sup erv i s i ng electrician 7s - s Su btotal $ 1..-- .- ��, .signature required: -%�� /�CG'KQ�- • Plan Review (25% of Permit Fee) S • , `.. Print Name: . i(G 1n &Pv� I Lic. #: ° I©i Lap State Surcharge (8% of Permit Fee) $ 6 °" . ; TOTAL PERMIT FEE $ ,gr/• BUJ i ..' Auth orize ♦� permit application expires P i Notice: This ermlt s headon c tree. if a permit is not obtained within Signature: Date: /z �� 180 days after it has been accepted as complete - ' Oa Y ' JL/ YV ■ ; I ` *Fee methodology set by Tri- County Building Industry Service Board. 1 (Please pr'i'nt name) N i_ \Dsts \ Permit Ferms\E1cPermitAnp.doc 01/03 .