Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00470
T [ G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/07/2012
Parcel: 1S133DB12300 •
Jurisdiction: Tigard
Site address: 11381 SW PALM PL
Project: Ford Subdivision:iCHOLLS FERRY ROAD TOWNHOME: Lot: 49
Project Description: (1) branch circuit for push/pull gas furnace
Contractor: A TEMP HEATING & COOLING INC Owner: FORD, BYRON E
16000 SE EVELYN ST FORD, PATRICK N
CLACKAMAS, OR 97015 -9519 11381 SW PALM PL
PORTLAND, OR 97223
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 08/07/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/07/2012 $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 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 OA 52 -001- 090. You may obtain obtaiin as copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: J(1 Permittee Signature: Pk\ U ei
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 503.839.4175 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.
Electrical Permit Application REC E1. 1 jE 1. urrl(1; t sr. i tNI.,
Cif" of Tigard 7 2 01 Other Permit �/ C ( , R0°2JY0d 1 Permit No.; �.�C , • 6
13125 SW Hall Blvd., Tigard, OP. 97223 l ge will
a Phone: 503.639.4171 Fax: 503.598.1960
1 i ,;:� i:. t 7 I ��� t
Inspection Line: 503.639.4175 e rrs! ur nun 'i l = : SI Seer 2 for
Interne www.tigard- or.gov BUILD DIVIS� L' (0 Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ Now construction NrAddition /alteration/replaccment Max check all that apply (submit I sob of phwe w /Rouw vhcek d bcluw):
❑ Service or feeder 400 amps or more ❑ Building over three scoriae.
Demolition ' ❑ C] Other: where the available fault current ❑ Marinas and boatyards,
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings,
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
IN 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑bias pump. ❑ Installation or7s KVA or
JOB SITE INFORMATION AND LOCATION CIAdd i Lion o system. "A", "A", "2". "1 -2 larger 2"."1 -21, 1- aystam.
CI Addition oA ", "1 3 ",
Job no.: it 46 lob lite address: r j l$ I $ W Pt/A r, p 1 IOOfir or more occupancy.
❑
❑ Si x or more rcaid2ntiol umits. Recreational vehicle parks.
City / State/ZIP: - 1 - j L! ( 1 o a . 4 1 - 2.2 ❑ Meudth-care Gu: tics. ❑ Supply voltage for more than
°! I:1 Havmdaas Locations. 600 volts normal.
Suite/bldg. /apt no.: Project name: F C ❑ Service or fesder 600 amps or mum.
FEE SCHEDULE
Cross street/directions to job site: Dneri,ti o tv . Fat. , Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no,: 1,000 sq. R or less 168.54 4
fax map/parcel no.: Es. add'1 S00 sq. ft, or portion 33.92 1
Limited energy, residential 75,00 2
DESCRIPTION Oft WORK . (with above sq. it)
t r Limited energy, multi -amity 75.00 2
b cd. rY, k c r r t d 4- P i d I»f ti I ( Gip. J R S residential (with above sg. it)
EJ C Q, (n e7 ��� Services or feeders installation. alteration, and/or relocation
► 200 amps or hiss 100.70 2
.3 PROPERTY OWN R I ❑ TENANT 201 amps to 400 amps 133.56 . 2
Name: 0 C 401 tamps to 600 amps 200.34 2
CO 601 amps to 1,000 amps 301.04 2
Address: (I 3 j J 5a r I m 11 Over 1,000 amps or volts 552.26 2
ar� ' Z�
F a Temporary services or feeders installation, alteration, and/or
City /State/ZIP: l relocation
(
Phone: ( ) x: ( )
200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 "cops to 400 -turps 125.08 z
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 801 amps to $99 amps - 168.54 — 2
• Branch circuits – new, alteration, or extension, per panel
Owner si
gnature: Date: _ A. Fee for branch circuits with
4 APPLICANT J ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name; 'e B. Pee for blench circuits without
ArTEMPHEA Tf COO iteTi �.�. • service or feeder fee, first
branch circuit 56.18 54 f 2
Contact name: 16000 SE Evelyn St: Each add'b branch circuit I I 7.42 I 2
Address: magma UK Y/WS
e , I I Miscellaneous (service or feeder not included)
Each manuf or modular 67.84 1 2
City/State/ZIP; . dwelling, service and/or feeder
Phone: ( ) Fax: : 03 ) 5 -Z., ., I Reconnect only - 67.84 2
Pump or irrigation circle 67.84 2
E - mail: CV 1,e, / . . • 1' r _, Sign or outline lighting 67.84 2
CONTRA r e R Signal circuit(s) or limited-energy . '
Business name: panel, alteration. or extension. Page 2 2
ATEMp UWA'ri1'Ii(, cooj(3 fl ( Each additional inspection over allowable in any of the above
Address: 1�00 SE Evelyn St. Additional inspection (1 hr min) 66.25/ hr
Clackamas,
City / State/ZIP' UKv Investigation (1 hr mitt) 66.25/ hr
503- 650 -5n14 Industrial plana(1 hr min) 78.18/ hr
Phone: ( ) I Fax: (r 93 ) 55A- - 2ei ctQ . Inspections for which no fee is
specifically listed ('h br min) 90 hr
CCB Lio.:4 l V' 3-17 I Electrical Lie.: G C. I Suprv. Lic.: 2q t4 OS' ELECTRICAL PERMIT FEES
Subtotal: 516' • I t{
Suprv. Electrician signature, required: Plan review (25% of permit fee):
r r r
Print name: ) G h i ! e . r • . / state surcharge (12% of permit feu): Lit
• II t
Authorized signatur ;�tt� - . This TOTAL PERMIT FEE:_ u �, Z • permit application expires t<a permit is act obtained within 180
Print name: l�n 1:7? r�+ SGk t7 fy e...101 1 Date: / //{ days after it hna beam accepted as complete.
I L • Number of i,wpoetiona allowed per permit.
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F A -TEMP
HEATING & COOLING, INC. www atempheating nom
A 16000 S.E. Evelyn Street (503) 650 -5014
Clackamas, Oregon 97015 FAX (503) 557 -2990
X TO: ( �; o 4 — 7/5 FROM: . I - gym 1 0
ATTN: e(' M■rl DATE: ' 1
PHONE: , TIME:
T FAX # OF PAGES:
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