Permit CITY OF TIGARD ELECTRICAL PERMIT
d: • COMMUNITY DEVELOPMENT Permit #: ELC2009 -00138
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/31/2009
Parcel: 1 S 136AD02800
Jurisdiction: Tigard
Site address: 6913 SW PINE ST
Subdivision: Lot: 0
Project: Cardwell
Project Description: (1) branch circuit to replace gas furnace.
Owner: _ FEES
CARDWELL, FRANK D Quantity Description Date Amount
6913 SW PINE 1 crt Branch Circuits 03/31/2009 $46.85
PORTLAND, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/31/2009 $5.62
Contractor. Electrical
BEN'S HEATING & A/C
PO BOX 80607
PORTLAND, OR 97280
PHONE: 503- 233 -1779
FAX: 503- 651 -3345
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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 througpOAR 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.
I f ti �
Issued By: - v �.� (0 (J j .i\) Permittee Signature: Ilk ) n "t1
OWNER INSTALLATION ONLY �` � �' y �
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.
E1eetrical Permit Applicati hc)It c)rrl<�r. USE, ONLY • J City of Tigard CEIVED Re • ol
cp Penult No.: t � � ,��;
Det ec ived : 6.a E 2 `� �-�
q 13125 SW Hall Blvd.. Tigard. OR 7 Plan Review
' Phone: 503.639.4171 Pax: 503.598.1 MA Date/B : Other Permit. MfeZd)n • ca
Inspection Line: 503.639.4175 R 2 7 2009 Date Road 65 Sec 1 use 2 for � G
/B
Il(■AIIU Y Y hail L S'
use
t‘ww.tigard- or.gov Notified/Mothod: - II (j 1 n
Supplemental Inforrani
O F TIGARD �
• _ .TYPE Ofd 3j± u, , • m VISION PLAN REVIEW
• +❑ New construction 4 Addition /a teration rep accment Please check all that apply (submit 2 sets of plans „Aims checked below ).
❑ Service or feeder 400 amps or more ❑ t4 over three shone.
❑ Demolition ❑ Other: where the available fault eurreni ❑ Muru,ns mid boatyards
CATEGORY OF CONSTRUCTION • exceed% 1 0.000 mpg fit ISO volts nr ❑ Floating builJingr.
• �j loss to ground, on exceeds (4,000 1:1 Con in I -use agi icullw:J
'P1 I - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building amps focal! ulhar inxlatl:aiona. buildings.
❑ Mutts- family ❑ Master builder ❑ Other: ❑ Fire pimp. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. I:uged septumIely denied stem
❑ Addition of new motor load of ❑ °A" "f" '! -�" ^ �. ?`.
Jul no.: Job site address: ! • 3 S W ' I d & Cf� IonHP or more, nccupanc.
n I — '1 r ❑ Sin or more 1'CS did unll >. ID keecea vehicle ',Arks
Cill' /L.IP: n AN 0 oe c17 a t3 ❑ Heahh• care facilities.
CI voltage Inc more than
r ❑ I lacerdous locations. 6011 volts nominal
Su ite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directionS to job Site; Deseriattun I Qty. I Fee, I Thal i •
New residential single• or multi- farnlly dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. 0, or less 145.15 4
Ea. add'( S00 sq. fl. or portion 33.40 h
Tax map /parcel no.: T ' y
Limited energy. residcntiul
• DESCRIPTION OF' WORK • . • • • (with above skill . _ 775.00 .
P p ,. Limited energy, multi - family
e -al/k A I ' ("•4' A/A/s te residential (with above sq. 0) 75.00
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.3(1 2
Igi PROPERTY OWNER
. 0 . .TENANT ' 201 a to 4 00 amps 106.85 '
Nome: K k CAA We LI' 40I amps to 600 amps 160.60 2
!dress: IT / � � S � S 601 amps to 1,000 amps 60
p (=side-, +� 1 ^� Over 1,000 amps or volts I 45 454. 1. ~
454.65 '
1O'iSlate /Z�P: c' :4 ' , � �f; a a..l Temporary services or feeders instnllatlotl. alteration. and /or
!� /t>r / relucatlun
!'hone: C�/ ) . /..114.- / G [ cc2 Fax: ( ) 200 amps or less 66,K5 1
Owner Installation: this installation Is being made on property that I own which is not 201 amps to 400 amps 100.31)
intended for sale, lease, rent, or exchange, according to ORS 447. 449, 670, and 701. 401 amps to 599 amps I]3.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for brunch circuits with
0 APPLICANT ' • I . Ia.-CONTACT PERSON . : above service nr feeder fee,
each branch circuit 6 7
(Business name: i � ^�g, d —
,w 1 rrtar x /r, (p„ �(� o I � G C B. Fee fur branch circuih
nn T l il/tout service or feeder lee. 46.85
Contact name. C( d 2 Dd� r �'o N
first branch circuit
Address: Each add'( branch circuit 6.65
Miscellaneous (service ur feeder not included)
City /State /ZIP: Each manufactured or modular 90,90 2
dwelling, service and/or feeder
I hone: (S'e'3 ) 3),3 396'0 l Fax: : (n 3 ) 4. ; - 7 -33 Sir Reconnect only 66.85 2
1.-:-mail: Pump or irrigation circle 53.40 i
CONTRACTOR Sign or outline lighting 53,40 2 -
Business name: ; Signal circui(s) or limited- "'
t.'" )1 r t N ems. Kg ,r Y ( r�r�nwt✓� c1 L energy panel, alteration. or
Address: f e„, �n4. 07
0 f�i CJ extension. Describe; Page 2
City /State /ZIP: p Each additional inspection over allowable in any of the situ! e
I P i2 +r kKb �'2 7 . Per inspection 62.50
Phone: (93 3 ) a-' 3 47 7 9 Fax: (S7i 3 ) 6.5-/— 33'f r Investigation per hour ( I hr min) 62.50
C.CIi Lic.: 6 y s 9 7 Electrical Lic.: y? L #4 Suprv. Lie.: 'I R a Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature. requir : _ Suhtntal:
mh n Plan reuses' l?5 °io of ernti fee
inn name: ate; ! p
l Sl ad e surehurac (I2°A. oh' permit lee): T
I
Authorized signature: V 6 TOTAL PERMIT FIT:
L}7 —
PI'llll name: /") /! / _ t This permit application expires if n permit in not obtained *ithio tat
1. l t1 c� E Vt d rT° I. DatC' days utter II hits horn accepted its complete,
v ' blumbut of inspections rdhuwed per permit I huildinfpncrmiiil l e•Permi,App.doe e5J2)nw 4.1(1-401Y111 VOA WWFB
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