Permit ELECTRICAL PERMIT -
CITY TIGARD RESTRICTED ENERGY
_1 DEVELOPMENT SERVICES PERMIT #: ELR2002 -00112
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/20/02
SITE ADDRESS: 07632 SW DURHAM RD 120 PARCEL: 2S1136A -00400
SUBDIVISION: SW CENTER SDR1999 -00020 ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of low voltage for HVAC wiring.
A. RESIDENTIAL • B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
OPUS NORTHWEST AMERICAN HEATING
111 SW COLUMBIA STE 870 1339 SW GIDEON ST
PORTLAND, OR 97201 PORTLAND, OR 97202
Phone: Phone: 239 -4600
Reg #: LIC 33135
ELE 26- 683CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 6/20/02 $75.00 2720020000 Elect'I Final
5PCT CTR 6/20/02 $6.00 2720020000
Total $81.00
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 o .moo follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- -0010 through OAR 900 1080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 987. /
lssu by j. •_ J A / // _ , /y - Permittee Signature l0S1111A /. 1
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
l
A Electrical Permit Application OFFICE USE ONLY
Date received: J , / mi Permit no.: EL /,ii, _a //
'�.l'�l City of Tigard Project/appl. no.: `ire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: Ri t no.:
Phone: (503) 639 -4171 - Receipt
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial Cl Multi - family IIICTenant improvement
❑ New construction ❑ Addition/alteration/replacement O Other: O Partial
JOB SITE INFORMATION
Job address: 7(.3a So 1 ag.14 ' lb . Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 'Block. i Subdivision:
Project name: 5Gtr 4 ,4, ga.... I Description and location of work on premises: l ry
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: American Heating, Inc. Description Qty. (ea) Total no.insp
Address: ew residential -single or multi-family per
1339 SE *Gideon S r. ST dwellingtmit .mcludesattachedgarage.
City: Portland I State: OR I ZIP: 97202 -2418 Servioehtcude l: .
Phone: .239-4600 I Fax:239 - 7038 I E -mail: 1000 sq. ft or less 4
Elec. bus. 11C. no: Each additional 500 sq. ft. or portion thereof
CCB no.:
1111 I �6— �R3c�r,F
Limited energy, residential • 2
City /metro fie. no.: 60114 , Limited energy, non - residential 2
C) 1 J � / /1 iet 7 7 " 6/57e Z Each manufactured home or modular dwelling
Signature of supervisinec tc (required) Dale Service and/or feeder 2
Sup. elect name (print): Thug S. Y License no: 2640}x'1.+ Services or feeders— Installation,
alteration or relocation: •
PROPERTY OWNER 200 amps or less 2
Name (print): . 201 amps to 400 amps 2
Mailing address: 401 amps to 600 am 2
601 amps to 1000 amps 2
City: I State: 'ZIP: Over 1000 amps or volts • 2
Phone: I Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 'State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, first branch circuit 2
Each additional branch circuit
PLAN REVIEW' (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps-commercial O Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extensro *
/ 2
❑ Building over three stories 0 Feeders, 400 amps or more *Description: J e
O Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lighting plan ❑ Other: Per inspection
Submit _ sets of plans with any of the above. investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ - 75 5 1 0
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
O visa ❑ MasterCard Plan review (at _ %) $
expires i f a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ to -DU
Expires accepted as complete. TOTAL $ �1 •'��
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)