Permit CITY OF TIGARD ELECTRICAL PERMIT
°►'� - COMMUNITY DEVELOPMENT Permit #: ELC2013 -00292
13125 S W Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2013
TIGARD Parcel: 1 S133DC11300
Jurisdiction: Tigard
Site address: 13401 SW LAURMONT CT
Project: Edmondson Subdivision: ARI GREEN Lot: 4
Project Description: (1) branch circuit for furnace reconnect.
Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: EDMONDSON, JEFF
PO BOX 80607 13401 SW LAURMONT CT
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 05/23/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/23/2013 $6.74
Type of Use: Electrical
Class of Work:
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 OAR 9 2- 090. Y u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,
Issued By: Permittee Signature: 04/ .970,00/-/ e '�TON
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 603.639.4176 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.
05/23/2013 13:02 FAX 5036513345 BENS - BEATING&AIR 11 003
Electri 1 Permit Da te/B y;
ApplicatiollRECEII JF FOi; OFFI(l: F..,h: 0.N1.,
111 1141 of Tigard Received S /�3 /3 . Permit No.:�tr� —De '92.
13125 SW hall Blvd., Tigard, OR 97223
M P l att Review
Phone: 503.639.4171 fax: 503,598.196d'' Y 3 Other Petmi 6 < �.�/3
I 1 i ; :� a I) 1 nspection Line: 503.639.4175 `t Date Ready/Ry: loci,. See Page 2 for
• ∎ntemet: www.tigard- or,gov �Q1� OFFTG Notified/Method; �� � Information
Supplemental Informati
- TYPE OF WOD1W DivIJIUNI PLAN REVIEW
• ❑ New cons , ction I Addition/altcration/replacement Please check all that apply (submit sets of plansw /itonts chocked below):
O Service or feeder 400 amps or more ❑ Building over three stories.
❑ Dcmoliti a. I ❑ Other: where the available fault current El Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps of 150 vnitc nr ❑ Floating buildings,
less to ground, or exceeds 14.000 0 Commercial -use agricultural
1- and 2- . oily dwelling ❑ Commcrcial/induslriul 0 Accessory building amps for all other installations. buildings.
❑ Multi-tau. ly ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION 'AND LOCATION ❑ Emergenuy system. larger separately derived ayaten
❑ Addition of now motor load of ❑ "A ". `0 ". - I -2 ". "1.3 ",
Job no.: Job site address: / 1 L_ ..L � CA. VIVA+ 1001-EP or more. occupancy.
❑
CJ 1 0 Six or more residential unite. Recreational vehicle parks,
City/State /l.,I I t (, (d q "a 0 Healthcare facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 611 n nn
0 vulls um 33
Suite/bldg, /a,: . no.: V t Project name: ❑ Service nr feeder 600 maps nr more.
FEE SCHEDULE
Cross streel/d I ections to job site: Deftrionon 1 Ow I Per, I Tatar .... .
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168 ^ 54 j r
Ea. ndd'I 500 sq. R. or portion 33,92 1
Tax map /part I no.: Limited energy, residential
DESCRIPTION OF WORK • (with above sq. R.) 67.84
Limited energy. multi- fumlly 67,84
-• : , R.A.... CCU- roidcndal (with about sq. ft)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70
0 1' OPERTY, OWNER I ❑ TENANT 201 amps to 400 amps 133.56
401 amps to 600 amps 200,34
Name: 601 amps to 1,000 amps 301.04 .
' ddress: Over 1,000 amps or volts 552.26
City /State /'L! Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( I Fait: ( )
200 amps or less 59.36 1
201 amps l0 400 amps 125.0E .
, Owner instal : tion: This installation is being made on property that I own which is not - 401 amps to 599 amps 168.54
intended for s le, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signal.. e: A Date: A. Fee for branch circuits with
i.• APPLICAtN'C i ❑ CONTACT PERSON above service or feeder fee. 7.42 each branch circuit
Business 11x111: a, Fcc for branch circuits without
J �1t ,, service or feeder the. first 56.18
Contact name N branch circuit
�` 4� e- iS i f %TO i Each odd'1 branch circuit 7.42
Address: _Miscellaneous (service or feeder not included) —
Clt /Stoic /ZI' Each manufactured or modular 67.84 .
y dwelling, service and/or feeder
Phone: 60,3 3i3'79go Fax: : (SC:a— (12SI- 33 Lis- Reconnect only 67.84 ,
Pump or irrigation tittle 67.84 .
E - mail: - 1 C4ed r c ve. .i-i-e.. r • CO Vh Sign or outline lighting _ 67.84
CONTRACTOR Signal circuits) or limited - cncrgy
Business nam : San.) S r r /� r '�' , panel, alteration, or extension. Page 2
17 C+oM I �T Each additional inspection over allowable to any of the above
Address: I t Q �3 2g g p iA Additional inspection (1 hr min) 6625/ hr
City /State /ZI' M1 Oe� 7 7 1 . g° Investigation (1 hr min) 66,25/ hr
At industrial plant (I hr min) 78.18/ hr
Phone: /7 (,)3) e$' /. 33 4,c-- inspections for which no ice is 90.00/ hi
1✓✓/ s pecifically listed (I/i hr min) -
CCl3 Lic.:‘ , .7 7 Electrical Lie,: / / /I� Suprv. Lic.: 4141 2 ELECTRICAL PERMIT FEES
. Q ,// Subtotal: Suprv, Elect' ran signature, required: Plan review (25% of permit fee):
. ; rintname: a1t�e, l3 t4r• / 0 Date: ^ State surcharge (12% of permit fee);
/I� TOTAL PERMIT FEE: c� , 9 2 t/
Authorized si , attire: (""'(!�� This permit application expires If a permit Is not obtained within 180
j / �.�/ ^/ ' - }— days after it has been accepted as complete.
Print name: YL e (4r'—'0‘%1 Date: f d pt Number of inspections allowed per permit,