Permit /� p
4 CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00510
COMMUNITY DEVELOPMENT DATE ISSUED: 9/4/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 BA- 028.00
SITE ADDRESS: 09815 SW JANZEN CT ZONING: R -4.5
SUBDIVISION: MCDONALD ACRES LOT : 003 JURISDICTION: TIG
PROJECT: LARSON
Project Description: (1) branch circuit to reconnect gas furnace.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
DOUGLAS LARSON BEN'S HEATING & A/C
AILEEN A PO BOX 80607
9815 SW JANZEN CT PORTLAND, OR 97280
TIGARD, OR 97223
Phone: 503 - 620 -1753 Contact #: PRI 503 - 233 -1779
FAX 503 - 651 -3345
FEES
Description Date Amount Reg #: ELE 49LHR
[ELPRMT] ELC Permit 9/4/2008 $46.85 LIC 64597
[TAX] 12% State Surchar 9/4/2008 $5.62
Total $52.47 REQUIRED ITEMS AND REPORTS
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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
r
Issued By: ice i � • 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'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.
S E p —04-2008 08:g7 AM BENS s oy) 503 651 3345 P . 02
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Electri e nl t 1 n (II lit I usi.i oNL
City of Tigard Y ,
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S 0 EgalifIZIEBEMIMM- _ i
I I ... . 13125 SW Hall Blvd., Tigard, OR 97223
I. . Phone: 503.639,4171 Fax: 503.598,1M1 - eammilm
Oft °Ill P°rmit
Inspection Line: 503.639.4175 Sec Pap 3 for
Internet: wwwtigard-or.gov . 0.0691 Mill Supplemental Information
. .
PL AN _ .‘,. !I vin
1 19 ,11 . i ';'' 1 fat , 052 Irak , , • ,,,,, ); ;.iT . A .. • • • •
-,„ __,,•...,'''',' : 's,)., ,,, I, a . , ,41 v. , ,,,,, „ ,,,,/ ‘ 1,, ,,i, .,,,, i..,. : ::L ,. ,, r'i F
Please check all that apply (submit inks of plana vditeins checked below)
E3 New construction .". Addition/alteration/replacement
0 Service or feeder 400 amps or more 0 Building over three stories
0 Demolition EJ Other: where the available fault current 0 Marinas and boatyards.
. 111101/11 ' 0 ' t En wt ZlIENIVISIF V V
gt. . ,;', , r ' ' ,Y ' P . ' , tt t,16 i .41; i 4, . , ,, exceeds 10,000 amps at 150 volts or Ej Floating buildings
less to ground, or exceeds 14 sloo D Commercial-use aorieull win]
g! 1 - and 2-family dwelling NI Commercial/industrial • Accessory building amps for all other installations. buildings.
12) Multi-family • Master builder 0 Other: El Fire pump. 0 installation of 75KVA or
(4 0 Emergency system. larger separately derived gYsle ill
'JOB . 6 1? ' ' ' :0 'VII , WWI ' 1 ' . ' ' '11E61 D Addiiion.f.„..i.dof
,2 . 6. . ... _ ..___... 6. 100HP Or Mete occupancy
Job no.; Job site address: j .5_0 z . 0 si, or more residential units. C:1 Recreational vehicle parks
Cily/StateiZtP: rt 1A-L-4 o e 9 Aa 4/ 0 Hazardous locations. 0 Health-care facilities.
0 Supply voltage for more than
600 volt nominal.
Suite/bldg./apt, no.: Project name; i_ct r-scrl/ • oservi. or f..der 600 amps or more.
,:gagossiamt t o , riKE•!:. J:..,,,.: '; :,:... .'.. : • ' :' .
Cross street/directions to job site: ■ ,eri boa Kammommmimmmmum
New residential single- or multi-family dwelling unit,
Includes attached gara!e.
Subdivision: . _ Lot no.: 1,000 sq. it or less II . 145.15
II
Ea, wk 500 si. ft, or portion 33.40
l'ax map/parcel no.: Limited energy, residential
75.00 1
• '' ••'..,. '%,'.. ,, a '17:latiiAt ,W4, c assoi , with above sq, ii,) 2
Limited energy, multi-family 75,00
.(.,Z. C494Ple-- 6 45 rt.rtA/o4ee.„. residential (with above se ft.) 2
Services or feeders instaiia thin, alteration, and/or relocation
200 amps or less 80.30 2
1111111F- '.tiliOrE110. :1 ' tt -;;7, ,'•i' V V,1111:E=sit); ;cit,4,4;41■:,,i:',:i.';! 201 amps to 400 amps 106.85 ' 2
Namcl i A e*rr,...c4"/ 401 amps to 600 amps 160.60 2
Ok
60! amps (0 1,000 amps 240.60 2
Address: 9 Os" 4/Al : • , Over 1.000 amps or volts .
454.65 2
„.. _-'ity/State/Z1P: -r ,. Alio •
Temporary services or feeders installation, alteration, and/ r
relocation .
... ' ,
Phone: 603) (9 2 • — I 7$ Fax: ( ) 200 amps or less 66.85 1
Owner Installation: This installatio is being made on property that I own which is not 201 amps to 400 amps 100 30 2
intended fbr sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. " 401 amps to 599 snips 133,75 2
Owner signature: Date: Branch circuits - new, alteration, or ex tension, per ppanel .
_
. _ A. Fee for branch circuits with r
,:. p::i,A:-,,,00.77,,,,,0„0 above sentiee or feeder fee, 6.65 2
each branch circuit
Business name: Ii 4 . .
1 ta...a 4- : ' '4 • 1 Ie. I ' “ C B, Fee for branch circuits
Contact name: C . r
; . w i I Ito to service or feeder fee, 1
-I g„. +0 r- first branch circuit 46 85 2
Address: Each addl branch circuit 6,65 I '
-
Miscellaneous (service or (ceder not Included)
City/State/LIP: '
' Each manutitctured or modular 90.90 2
• dwelling, service and/or feeder
Phone*. (5 1 3 L3 - Y ge6) Fax: ; (5 ) ) 4 5 -33 'J Reconnect only 66.85 2
,
E-mail: Pump or irrigation circle 53.40 2
IMINIESIE1MMaii'lL • 4 NirVti; ;AlK Si n or outline Ligh
__g_____ 2
Signal circuit(s) or limited-
Business name: 1 , 01. energy panel, alteration, or
r °
Address: extension. Describe: Page 2 2
to, a _ 6 , . ,.. ,
Cit ,1! . • Each additional imipection over allowable in any of the abou
ill , ir ' 1 9 7 „..,0 Per inspection 62.50
Phone: . OD 3 ) as 7 ... , Fax, ( 3 - 0 3 ) 0 33 ...3— — ,...._
Inv csoption per hour (I hr min) _ 62.50 ,
CCB Lic.: 6 I/ 5 I 7 Electrical Lk.: 10 4#g Suprv. Lie.: industrial plant per hour 73.75
' itiMMA,• ,4 ,'il i .'` PERMIT FEES .
ii , r _..,.__
Suprv, Electrician signature, requ.,;;N: 4111, • gm ..
aim . /Iv £ Subtotal:
i ate: ,
Plan review (25% of permit (be):
''rint name: ■e__ -0
---- State surcharge (12% of permit fee): 54 (;s
...•
Authorized signature: Yr el .11' -' 0: TOTAL PERMIT PEE' 6" 3 . q 7
. ___ , .. . ---
1 i p This permit application expires if a permit is not obta tied within 1110
Print name: Cl J 6:,4, + 4 _ Date: — .... OL days after it has been accepted as complete.
■ i tY c4 r •
' Number of inspections allowed per permit.
1.,Boidin onvoa 440.46 isittitoscommea
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BUILDING DIVISION PERMIT #: ELC2008-00610
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 91412008. Phono:(588)G39��171
Inspection Requests �4Hm]:(503 830~4175' "�
INSPECTION WORKSHEET FOR DATE: EV11/2008 TIME: 7:00AM PAGE: 17
SITE ADDRESS: 09815 SW JANZEN CT CLASS OF WORK
SUBDIVISION: MCDONALD ACRES LOT #: 003 TYPE OF USE:
PROJECT NAME: LARB0N
DESCRIPTION: (1) branch circuit to reconnect gas furnace.
OWNER: LARSON, DOUGLAS PHONE #: 503-020-1753
CONTRACTOR: BEN'S HEATING & NC PHONE #: 503-333-177$
Inspection Request Scheduled For: Date: E/11/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 075343-01 503-233-1779 Y &�~'
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Corrections/Comments/Instructions:
•
•
•
I I PARTIAL APPROVAL EI CANCEL | I NO ACCESS
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FAIL �� CALL FOR INSPECTION �� ADD0C�NALFEES ASSESSED
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Inspector: " 1 0. Date: -/-- - Phone #: (503) 718-
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