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Permit CITY OF TIGARD ELECTRICAL PERMIT 1111 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00143 Date Issued: 04/02/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: 2S103CD02000 Jurisdiction: Tigard Site address: 13770 SW FAIRVIEW CT Subdivision: Lot: 0 Project: Powell Project Description: Reconnect (1) branch circuit to replace gas furnace. Owner: FEES POWELL, FLORENCE A TRUSTEE Quantity Description Date Amount 13770 SW FAIRVIEW CT 1 crt Branch Circuits 04/02/2009 $46.85 TIGARD, OR 97223 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 04/02/2009 $5.62 Contractor: Electrical 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. At 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 R 952- 001 -0100. You may obtain a copy of of the f j�f� rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: I\9- tt 2 Permittee Signature: - Ii1 e on n 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 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. I e rica! Permit Application) F014 on is e USK 0N`T,; . • City of Tigard CE Dat sr. Q n / / a �J � DatelBv'. y. � �� l � Permit Ni.). 0 17��`•( �C'` 1.4. - - - 13125 SW Hall Rlvd., Tigard, OR 97 Plan Review s Phone: 503,639.4171 Fax: 503.598.1960 Datelt3y: Ottar Permit (� ee n. nt' 001 T[ .AltIl Inspection Line: 503.639 Date Reasy/tiy: lllt � El Sec Page 2 2 f / ur n Internet; www.iigurd -or.gov APR Y 200 Notified /Method: TIC f Supplemental lofnrnnrliun PLAN REVIEW ---1 `X Oi~.TI TYPE OF 4 ARD: ❑ Now construction 3 Addition /alias nt). I:'i+ IB4NISION Please check all that apply (submit 2 seta of plans whims checked helm, i { ❑ Service on feeder 400 amps or mitre 0 Building over lluee senile:,. ❑ Demolition © Other: where Ihe:w, iinbie fall current ❑ Marinas rind honiyinds. r- CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating hui(dings. less to ground, or c ieced& 1.1,000 ❑ L,tnlnrcicl:ll'n. a alit lenllnllll 04 I • and 2- family dwelling ❑ Commercial /industrial © Accessory building amps for of other insitillai ions butJmga Ili Mu lu litmiIv ❑ Mastcr builder ❑ Other: 0 Fire pump. ❑ In>I:tlmiun of 75 1 O.\ at -- - -_ ❑ Emergency sysiem,. tnruar sepnrateh do ncd Nystcnl JOB SiTE INFORMATION AND LOCATION ❑ Addition anew motor load of 2 - ° . .0th Ito,: Job site address: / 3 70 s ti) An ( U►' IQOt(N or more. CCUpmcy. ❑ Si x or more resi i n, kolas, ❑ Recremt vehicle poi i.: • C / ^ ? U Health-care Hazardous lo ca ❑ Supple voltage I ii or more thou _ -. �/ rC ❑ Hazardous ous cations. (r00 vnhs nomiu.hl Suite /bldg. /apt. no,: Project name: - 0 Service or feeder 000 molls or more. FEE SCHEDULE Cross street/directions to job site: Description Q ty. Fte. 5'a ;ll New residential single- or multi - flintily dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145, 1 5 _I _ Ea, addi 500 sq. II. or ponies 33.4(1 I 1 ax neap /parcel no.: Limited energy, residcmiu) - _.___'_ -- .._ .. DESCRIPTION OF WORK ' ' ' ' ' (w_ ith above stL1,) 7 —� , .I/t 601-//4--C,' Liaised energy. i .ly '`L'1 n/ i residenliaf (with, th abbove ve sq. A.) 7;S.00 ' Services or feeders installation, alteration, and /ol relocation 200 amps or less I 80.30 2 —, PROPERTY OWNER , I a'TENANT, 201 amps to 400 amps I110.8 2 • Noose; fi O , r i k P a 4 J e . L L 401 amps to 600 amps , - 160.00 - 601 amps to 1.000 amps 240.00 2 ' rfdressi / 3 - )_20 4 WJ 1r lJ f &,$) CA Over 1,000 amps or volts r _ 454 65 ..,ty /Stntc /ZIP: 'T/ 4 16 . OR 9� 7 emporary services (Jr feeders installation, nitet'atlhut, and /or G relucatiun Phone: ( I Fax: ( ) 200 amps or less (,0.83 I Owner Installation: This installation is being made on property that I own which is not 201 amps In 400 amps 100.30 ?_ intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 — Branch circuits - new, alteration, or extensinn, per panel Owner signature:,, Dole: A. Fec for branch circuits , •----- r rdl ,---• : :' --- — 0 APPLICANT ia- CONTAC PERSON above service or feeder fee. 6.65 _' Business name: l each branch circuit ,,, S of v- 4 'r Ao t L t C 13. Fix 0,r branch circuits • /3 without service or feeder fee. Contact name: C I M I�41 r�U J first branch circuit 46,$5 �_— Address; Each add'l branch circui 6 6 3 ; Miscellaneous (service or feeder not Included) City /State /LIE': Each manufactured or modulor 90,90 dwelling, service and /or feeder Phone: ( ) 3),3.- 3`l i'0 Fax:: (5z j ) ( .1 -33'/ r Reconnect only 60.85 1. -mitt: Pump or irrigation circle 33.40 v CONTRACTOR Sign or outline lighting 5 3.40 7 Signal c or limited- 13usine / A• 6).d( •fq energy c N'e�">` 7) v r l ,✓ r N I. ener panel. alteration. or Address: extension, Describe: Pave 3 2 City /State /ZIP: , Each additiunxl inspeeliun over allowable in tiny of the — abo ��( �nr� / viz 9 .... ` Per inspection i 02.50 Phone, ()ti 3 ) ,7_13 !„ 9 Fax: (31 ,1 ) G r/ 33 t f ) Investigation per hour (I hr mint - 62,50 CCU Lie.: 6 g3 - 1 3 7 Electrical I.ie.: v9 1_,/f Suprv. Lie.: Industrial plant per hour 71 ELECTRICAL PERMIT FEES Suprv, Electrician signature, re ctui• -e, _ �_.___�___ Subtotal: ~ T flan review (25% of permit fee): State int name: ' alp: - - --- I' surcharge (12% of permit fcc): llulhoriiedsigilalure: • ' 1 , CUTAL I'I.RNIII II'I. - Print name: 0/ I ii J / / } ^ Q Thls permit application expires If a permit is nut untanned within Iltn /� to 3 c! hoc r � o r" _ Date: . ! v 1 days niter It has been accepted as cooplete. tJ ' Number of inspections allowed per 606t1. I Isuuniup■ermhril.I.i- Permitrvpp.doc u5 /2.1/0t 44u 41, 1 "Iii l /u! /CUM /wtitt C00 HIY'80NI,LV3H - SNdH CFCCTC9C0C XYd CZ :CO 6002/T0/fi0