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Permit
f' . CITY OF TIGARD ELECTRICAL PERMIT , . COMMUNITY DEVELOPMENT Permit #: ELC2009 -00341 Date Issued: 07/13/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Parcel: 2S103DD04100 • Jurisdiction: Tigard Site address: 10740 SW GARDEN PARK PL Subdivision: Lot: 0 Project: Clark Project Description: Add /alter (3) branch circuits for furnace replacement,and add heat pump and outdoor outlet Owner: FEES CLARK, LANIE Quantity Description Date Amount 10740 SW GARDEN PARK PL TIGARD, OR 97223 3 crt Branch Circuits 07/13/2009 $60 15 wo /Purchase Service or PHONE Feeder 1 ea 12% State Surcharge - 07/13/2009 $7 22 Electrical Contractor: ERIC OLSON ELECTRIC COMPANY 11607 NW 33RD AVE VANCOUVER, WA 98685 PHONE' 360- 609 -4901 FAX 360- 693 -2980 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $67 37 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 thro gh OAR 952- 001 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800 332 2344 Issued By: /I CU V Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 4 `i Electrical Permit Application FOR OFFICE USE ONLY 1E9 City of Tigard ' Date/By 0,1)$ Permit No . 1( ?a09 . � 13125 SW Hall Blvd , Tigard,OR:` "' IVD Plan Review Phone: 503.639 4171 Fax: 503 ' : b0 Date/By. Other Permit. Inspection Line 503.639.4175 Date Ready/By Juris El See Page 2 for Internet www.tigard- or.gov JUL 13 2009 Notified/Method -1,-) 9 Supplemental Information TYPE OF PLAN REVIEW 1� '�F TIGAFiB Please check all that apply (submit 2 sets of plans w /items checked below) ❑ New constructionAddltion/t�lh *t ❑ Service or feeder 400 amps or more '�'vti -unV LJi V' �VJIY p ❑ Building over three stories ❑ Demolition ❑ Other: where the available fault current ❑ Mannas 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 Oil- 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 system ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", Job no.: Job site address: I0 7 1-/CD $' t) G c (n Ariz r/ � 4 �OOHP or more occupancy L� J g�ix or more residential units ❑ Recreational vehicle parks CI /State /ZIP: ❑ Health -care facilities ❑ Supply voltage for more than ty ' `D D n e d (� y 7 z 3 ❑Hazardous locations 600 volts nominal Suite /bldg. /apt. no. • Project name: -_., a alog r'4 ❑ Service or feeder 600 amps or more. FEE SCHEDULE - Cross street/directions to job site: Description I Qty. I Fee. I Total I * New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq ft. or less 145.15 4 Ea add'I 500 sq. ft or portion 33 40 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq ft) 75.00 2 Limited energy, multi - family qee d (-/ L � O(. bL�V °Ol e residential (with above sq ft) 75 00 2 Services or feeders installation, alteration, and/or relocation re- t 60 t r'l / l` -6.J Uf(CfL 200 amps or less 80 30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address. Over 1,000 amps or volts 454 65 2 City/State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66 85 1 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 133.75 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, each branch circuit 6.65 2 Business name: B Fee for branch circuits Contact name: without service or feeder fee, ( 46 85 2 first branch circuit ( Address: Each add'I branch circuit -v 6 65 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular dwelling, service and/or feeder 90 90 2 Phone: ( ) Fax' : ( ) Reconnect only 66 85 2 E -mail: Pump or irrigation circle 53 40 2 CONTRACTOR Sign or outline lighting 53 40 2 Business name: j" O (5 'BO U c' C/ (' Signal circuit(s) or limited - — - A nU energy panel, alteration, or Address: `1 b c ' %,,} 3 3 V- f V- ' ,_ extension. Describe. Page 2 2 City/State /ZIP: \�(�/ (f �✓ � - �P6 6' 5 Each additional inspection over allowable in any of the above (� j _ 09' K � Per inspection 62.50 Phone: (,O ) r y 0 ( Fax: 7� ) Cj C O � L Investigation per hour (1 hr mm) 62 50 CCB Lic.- I71. Y0g Electrical Lic.: 371�'5k Suprv. Lic.. tee 5 industrial plant per hour 73.75 ,,�� ((,,, r I U, ELECTRICAL PERMIT FEES • Suprv�leclr3�ian si nature, require 11 �� 1 10 L Subtotal: Print name: 2 (U ©t S qs Date: / 13 / p G Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: TOTAL PERMIT FEE 37 This permit application expires if a permit is not obtained ( , 7 7 within dio Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit 1 \Building\Permiis\ELC- PermitApp doe 05/23/06 440- 4615T(11/05/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls ❑ Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n O utdoor Landscape Lighting* ❑ Protective Signaling I O ther Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I \BuddmgWermits\ELC- PermaApp doc 03/23/06