Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00155
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/22/2012
Parcel: 1 S133CD10100
Jurisdiction: Tigard
Site address: 11856 SW WILTON AVE
Project: Huynh Subdivision: COTSWALD MEADOWS NO.3 Lot: 133
Project Description: Reconnect gas furnace.
Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: HUYNH, QUYNH -HOA T
PO BOX 80607 11856 SW WILTON AVE
PORTLAND, OR 97280 TIGARD, OR 97223
PHONE: 503 - 233 -1779 PHONE:
FAX: 503 - 651 -3345
FEES
• Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 03/22/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/22/2012 $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 actor• , • 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. ATTE ' •N: Oreg• • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -001 throu e h OAR 95 0' -0 0. ou may obtain a copy of the rules or direct questions to OUNC by callin • • .1987 or 1.800.3 2.2344,
Issued B / 1 . I W �r Permittee Signatur " . _. r �
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'
• 1arrra• -` 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.
09/17/2007 01:50 FAX 5036513345 - HEATING&AIR a 003 /003
r
Electrical Permit Application ` \\ ‘ 1 OFFICE b: USI ()NIA City of Tigard e (10 ( g i IMiz(9 Penult No.: k p a pO /5
,- • 13125 SW Hall Blvd.. Tigard, OR 'a_ • �
�" : Review r — -
g Phone: 503.639.4171 Fax: 503.59:.19: t C ry � , s.: c/By: Other Permit.
tIUAI?I)
Inspection Line: .503.639.4175 �Q < .,\ ` sate Ready/By; )wis 35 See Pale I fur
Internet: www.tigard- or.gov (:)% ,C O r Notified/Method: Supplemental Information
TYPE OF WORK v> - PLAN REVIEW
❑ New construction Addition /alteration /repl Please check all that apply (submit ;sets at plans writems checked below)
❑ Service or feeder 400 amps or more ❑ Budding over duce stories.
D Demolition Other: whew the available (null cumin ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION omens 10,000 amps at ISO y in ❑ hl,cnurt; bwlthnt:,
ICU In ground. or exceeds 14,000 0 Cummcrciol -use. naneuhurnl
NI 1. and 2-family dwelling ❑ Commercial /industrial ❑ Accessory building amps Ibr all utlwi installations. buildings.
Multi- family 0 Master builder ❑ Other: ❑ Fire pump, ❑ Installation 01 KVrt or
JOB SITE INFORMATION AND LOCATION
['Emergency A d Addition o f new m otor load of
target sepatai'ly - t r cd system.
Q 1 ( - ' D Ad o new m ❑ "� ". "t", •• I -_
)rib tits.: rat; site address: ��$ , �.�.) t ' e f ix or more or mum occupancy
1 VL 1 ❑ Six or m residential units. ❑ Recreaunnnl Wilkie parks
( /Stale % %1 P: fit ` 0 z 4 -7 ? 23 D l lealdwcarc facilities. ❑ Supply voltage fur more than
❑ 1434;161mm localmns. 600 yens nomuwl
F Suite /bldg, /apt. nu,: Project name: 1,V.. , v t t �ii ❑ Service or feeder 60u amps or more.
FEE SCHEDULE
('rnSS street/directions to job site: Description 1 Otv. I ree. I Total 1 •
-- — - New residential single- or multi• family dwelling unit.
Includes attached garage.
Subdivision: • Lot no.: ',ono sq. R. or less 168.54 — _ , -- , n ;
- • F.a. ndd'I 500 sq. R. or portion 33.92 _ I
TUN map /parcel no.: Limited ener residential
�'• 67lt4 3
DESCRIPTION OF WORK with above sit. ft.
Limited energy, multi- family
67.84 '
residential (with above sit tl )
11.�C. bpNY� - 4 CS t`US , N 44� L
Services or feeders Installation, altcr�tittn, and/or relocation
200 amps or less 100 70 — T?
II PROPERTY OWNER I 7 0 TENANT 201 amps to 400 amps 1 33.5h
l\ _ 401 amps to 600 amps 200.34 2
1i 41 .5c . ,„ . \,,\_V \ . ...... 601 am to 1 am „� 301.!14 '
•ldreis: -_ IN �c-CP l,.) , �k , , Over 1,000 amps or volts 552 26 '_-
"' -- Temporary services or feeders installation, alteration, and/or
City %titan / %IP: '7\ t oq ot112_3 reluca(lult
r
' ) C . toper Fax:( ) 20u amps or less 59.36 l
• 3 �;- 201 amps to 400 amps 125.0f) 1
Owner Installation: This installation is being made on properly that I own which is not aul amps to sQV amps 168 54
^
intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701. -
Branch circuits new. Alteratlo . ore tension, () panel -
Owner signature: •... Dale: ACT PERSON A. Fee for branch circuits with
1
v ❑ CON'! shove service or feeder fee
..r_ �" APPLICANT -- _
each branch circuit 7 42
► IIl1Sl(IC5S ❑11111 13. het) f ur branch circuits wrrhour
._. _ -- ....... _ service or feeder fcc, first i sb.18 5� • �
Contact name: IA rO branch circuit •
,.
II Each add'I branch circuit 7.43 -
Address: Miscellaneous (service or feeder not included)
Each manufactured ur mudulai
CityiStrae / dwelling, 67.84
servitt' 1'ccdcr __ ___ - i
7 n •'7 Rr:eannpetonly - ..__.. - ... - / ± 7 84
Phone: tai!,) ,� ea - ,�9�� Fax: ( ) 1 i....
utnp or irrigation circle b7.84 '
l:•tttdil: 2
—, , , Signor outline lighting 67 84
CONTRACTOR Signal circuit(s) or limited - energy
panel, allatation, or extension. tI j . t w f� G Page 2 2
-_ _
I lu:utcs5 name: 3C� S /ye„7]t )1 r ,
• ..., .` I ash addltlonal insMCtion over allowable in any of Iltr ahoy
Address: po C3Q e O e , 1 X Additional inspection (I hr min) 66 25/ hr J .•„ I i
• P s i rt-(ritu ` o ^ 7 7 as � Industrial plant (l hr mm) t,h.; 5/ Ili'
d K - Industri hr min) - r �- T -- 78 18/hr - -�
Phone: 603) ' ' 7 17?9 Fax: ) 6s1 32 4,5 Inspections for which no lei is
90.00/ hr
specifically listed (IA hr min)
(XI3 Lie, :� 4/ 7 Electrical Liu.: 45 ai' Suprv. Lie.: in 2 it f ELECTRICAL PERMIT FEES
Subtotal: / '
Suprv. Electrician signature, required: N — ' - - ~ w. � - ' •
• i� Pl an review(25%ofpermiticc):
,•tint name: (1 C ' , Date: Slate surcharge (12% of permit fee): - - __...• If.
- I TC )FAI. PI• : :RMIT f1:1i: spa •9
r \uthpri /ct1 signature: This permit application expires If a permit Is nut obtained ailhin I
Print name; _A after It has been accepter! as complete. (
1 r ' Dale: 3� (/ - • N um b er of inspections allowed per permit
I umWmN Pn,n,i, IAI.r•PcrnuiApp doc Io nu,w 440-wi sr( I uustrOM/wrn