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Permit ELECTRICAL PERMIT a (:ITY OF TIGARD '1 a COMMUNITY DEVELOPMENT Permit #: ELC2009 -00495 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2009 Parcel: 2S102DB00604 Jurisdiction: Tigard Site address: 8825 SW OMARA ST Subdivision: Lot: 0 Project: Tombleson Project Description: Reconnect heat pump, furnace, and add exterior GFCI. • Owner: FEES TOMBLESON, BRUCE Quantity Description Date Amount 8825 SW O'MARA ST TIGARD, OR 97223 3 crt Branch Circuits 09/23/2009 $60.15 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 09/23/2009 $7.22 Electrical Contractor: PRO CIRCUIT ELECTRIC LLC PO BOX 3948 WILSONVILLE, OR 97070 PHONE: 971 - 563 -8211 FAX: 503- 266 -1349 • 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 through 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: ! Taal Q �Q Permittee Signature: A Q r Ap� OWNER INSTALLATION ONLY CCC" 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. r h ri / ECE ; / ! X/. J /iJ.f 2 09 J FanFe:rtn �.__... _ �/ 01' ,/ c D r NOM. ✓U✓. 11 /I j . 591.�I/.. �� 1 I Ja(C Bt" l tts txlion l�ttd 503.039.4175 Wee ed/Meth lore :: sec Voce 1 tin I T rc.��° lnt�t: www.tigard nr.gov CITY OF TIGARD t o R /By Supplemental mfrwmatixm TYPE OF «,o UItDIPIG DIVISI PLAN REVIEW Please cheek all that apply (submit 2 secs of plans Wheats checked below): ❑ Demolition construction 0 O nlalterat;on/rcplacement 0 Service or ft r 400 amps or moo 0 Building over three stories. ❑ Qemolition ❑Other where the available fault current 0 marine and boatyards. meals 10,000 amps at 150 volts or D Floating bends tg: CATEGORY OF CONSTRUCTION meals less to ground, or exceeds 14,000 ❑ Commercial -au agricultural j- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. of75 KVA or ❑ Fin pump- larger atio o f 7 y derived system ❑ Multi - family ❑ Other Qemergency JOB SITE INFORMATION AND LOCATION D Addition of new molar load of 0"A". "E". "I - 2", "I ". ,,� �� }� 1 0O11P or more. occupancy. .B(A) Qf' P fv D Recreational vebick parks. Job no.: Job site address: gees ❑ Six or more residential units. ( � Supply voltage for more than ❑ Health-care facilities. Su p volts nominal. City/State/ZIP: T, 6,0 00., ['Hazardous locations. CI or iot�Cr loo amps or move Suitelbldg /apt no.: Project name: FEE SCHEDULE px, Fee Total damn ” a dwelling rust • Cross street/directions to job site: New residential stogie- or multi- family ng Includes attached garage. 1,000 sq. ft. or less 145] 5 4 Ea. a sq. ft. — Lot no.: dd'l 500 sq or portion 11111 33. _ T abdivisi Limited energy, residential 75.00 III Tax map/p arcCl no.: 1111 (with above • . 0.1 D)FSCItIP110N OF WORK Limited enemy, multi- family . 75.00 - © `n ? �s• A ) residential with abow sq. ft. ��(� ■ f „1 V L - Services or feeders installation, alteration, and/or relocation 2 NI 8030 NMI Q I CO r�"� 20l amps to less amps 106.85 '© Zi• PROPERTY OWNER ❑ TENANT 111111 160.60 _Q 401 amps to 600 amps 2 Name: M 240 60 b fl 601 amps to 1,000 amps _ • Over 1,000 amps or volts 454.65 _© Address: Temporary services or feeders installation. alteration, and/or relocation �0 Phone: 200 amps or less Phone: ( ) Fax: ( ) 201 amps to 400 amps 10030 _Q made on property that I own which is not 401 amps to 599 amps MI 133.75 _© Owner installation: This installation is being made to ORS 447, 449, 670, and 701. Branch circuits- new, alteration, or extension.. r ' nel intended for sale, lease, rent, or exchange, S Date: ----- A. Fee for branch circuits with Owner signature” ❑ APPLICANT ❑CONTACT PERSON above service or feeder fee, 6.65 each branch circuit B. Fee for branch circuits 111111P33 Business name: Fee for ranch i t uits fee. first branch circuit 6.65 _© Contact name: : Address: Miscellaneous service or feeder not included Each manufactured or modular 90.90 El City/Slate/ZIP: dwellin: service and/or feeder 66.85 0111111:11 Reconnect only 53.40 r 2 Phone: ( ) Pump or irrigation circle Sign or outline lighting 53.40 �© CONTRACTOR Sign circuit(s) or limited- � 7--- ... ' _. energy panel, alteration. or Page 2 Business name: r i _ V.L extension. Describe: Address: • . I. Each additional i , v lion over allowable in an of the above City/State/ZIP: �3 a (Q ``� 4 17. Per inspection — 62.50 — )nvcstigation per hour (I lir min) = MI= Pty (TX ) • • Fax ( • t. Industrial plant per hour ' • Z Electrical Lie.: ;-1g01 g__ r Suprv. Lie.: 610 '7 5 ELECTRICAL PERMIT FEES ti C CB Lic.: Y__. Subtotal:[ i r; Suprv. Electrician signature, required: [ Plan review (25% of permit fee): Date: State surcharge (12% of permit fee): Print name: L 1.+ TOTAL PERMIT FEE: + Authorized signature: This permit application empires if a permit is not ohm' Date: days after it has kali 21:f131101 as co mph co l ` l 7 Print name: • Number of mspeetioes allowed per permit. �Jl ado -4ei5 (iu05/COM/wt:a I :lauadirgl4amiuv ?LC- 1`amdaFVdo° pave Z• d 617C 1,99Z£09 o!JTo )!n°J!O cad dZ9:80 60 6Z des