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Permit
CITY OF TIGARD ELECTRICAL PERMIT '`" '• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00126 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/02/2012 Parcel: 2S110BD04600 Jurisdiction: Tigard Site address: 11882 SW ELEMAR CT Project: DAVIDSON Subdivision: ASPEN RIDGE Lot: 11 Project Description: Gas furnace replacement. Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: DAVIDSON, JOHN J /LAURA L PO BOX 80607 11882 SW ELEMAR CT PORTLAND, OR 97280 TIGARD, OR 97224 PHONE: 503 - 233 -1779 PHONE: FAX: 503 - 651 -3345 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 03/02/2012 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 03/02/2012 $6.74 Type of Use: SF Electrical Class of Work: ALT 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 Codes and all other applicable law. All work will be done in accordance with approved plans. This permit wit 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 OAR 952 - 001 -0090. You may obt �of the r - • direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. n 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. 03/27/2007 23:56 FAX 5036513345 BENS - HEATING &AIR 1 003/003 • Electrical Permit Application R For; orrr(r l `r (1` Ili City of Tigard I `. ` �e - _ _ _ _ a 13125 3W Hall Blvd, Tigard, OR 9722,3 I Phone: 503.718.2439 Fax: 503.598.1960 Dete/B : Other Permit: ,n10. _ ; . , r , l 1 Inspection T, ine: 503.0,39.4175 FE 2 9 2012 Seel Ibr be Internet www.iigord•or.gov 5gppkmentat IMormadon TYPE or woalCITY OF TIGAF1D - r PLAN REVIEW ❑ New construction J] AdditionfaltemtibilliVOW4431 VISION Please check all that apply (submit j sets of plans w /gems checked below): ❑ Demolition Other: 12 Service or feeder 400 amps or more ❑ Huilding over three Anna. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,00n amp; at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ® 1 - and 2- fatnily dwelling ❑ Coinmercia]/itidusuial 0 Accessory building amps for all other installations. buildings. ['Multi-family ❑ Master builder ❑ Other: ❑ Fire pump, ❑ Installation of 75 KVA or JOB BITE INFORMATION AND LOCATION ©1•.mergrncy system. larger separately derived system. ❑ Addition of new motor load of ❑ "A" "E", - 1 - "1 Job no.: I Job site address: 11882 SW Elemar Ct min) or more occupancy. ❑ Six or more residential unite. ❑ Recreational vehicle pain. City /State/ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: Davidson ❑ Service or 2edcr 600 amps or more. FEE SCBEDIJLF. as Cross street/directions to job site: nrrtikka _ - . l otr. I tea 1 'fetal I • ' New residential single- or multi - fatnily dwelling unit. _...,..,_ — ..- -• -- - -- _ _ Includes attached iar*ge - I Subdivision: Lot no.: 1,000 — kg. f. or less 168,54 4 - Ea. add'l 500 sq. 11. or portion 33.92 1 Tax map/parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. A,) 75.00 2 . Limited energy, multi- family 1 — Reconnect Gas Furnace residential (with above aq, ft.) 75.00 2 ' "--•- °- Services or feeders installation, alteration, and/or relocation • 200 amps or lean 100.70 2 • ® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Ntune: John Davidson 401 amps to 600 amps • 200.34 2 601 amps to 1,000 amps 301.04 2 Address: 11882 SW Elemar Ct Over 1,000 amps or volts 1 . I 552.26 2 Temporary services or feeders imtallatlon, alteration, and /or City /State/ZTP: Tigard, OR 97224 relocation Phone: (503)968 -2833 1 ax: ( ) 200 amps or less 59.36 1 Fax: 201 amps to 400 amps 125,08 2 Owner installation: This installation is being made on property that I own which is not 401 ample 599 imps 16834 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701_ Branch circuits - new, alteration, or extension, per panel Owner sigoaturo: Date: , A. Thee for branch circuits with • ® APPLICANT 1 0 CONTACT PERSON above lenrice or feeder fee, 7.42 2 __ each branch circuit Business name: I 3, Fe e for branch circuits without service or reader fee, first X I 56.18 (1' 2 Contact name: Clyde Burton branch circuit _ ,— .-- _-'"'--_'---- — Each add'l branch circuit [ 7.42 I 12 Address: Miscellaneous (service or feeder not included) City /State/ZIP: Each manufactured or modular 67,$4 2 dwelling service and/or feeder Phone: (503) 313 - 3980 Fax: : ( ) Reconnect only 6 2 E Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting f,7.84 2 Signal circuit(a) or limited - energy Business name: Bens's Heating & A/C panel, alteration. or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: P.O. Box 80607 Additional inspection (1 hr mitt) 66.25/lir Investigation (1 hr min) 66.25/ hr City/State/ZIP: Su p rv Li Portland, OR 97280 Industrial plant (1 hr min) 78.18/ hr Phone: (503) 233 -1779 — Fax: (503) 651 -3345 Inspections for which nth foe is 90/ la ' +A ( + � � . T ' . apecificdly listed (Ys hr mi -- _ CCB Lie.: 64597 / / % I .. l ' ELECTRICAL PERMIT PEES $lc ___. — t :tn c a l r S u m i bt t fee ; l: S "...)-• , l Suprv. Electrician si italure, required review (25% of per }stint name: �� i , Dale: w � '� State surcharge (12%0 of permit foe): G , � 111 •i'OTAL PERMIT FEE: , i '7 I Authorized signature: This permit application expires it a permit le net obldoed within 180 Pont name: Cl t 1 ,-, 1 Date: 5— \ - 1.1.. days aft It has been accepted as complete. ».