Permit CITY OF TIGARD ELECTRICAL PERMIT
111111 c CO MMUNITY DEVELOPMENT Permit #: ELC2013 -00333 • Date Issued: /2013
06/18
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 6 700
Jurisdiction: Tigard
Site address: 11835 SW TIEDEMAN AVE
Project: Nofzinger Subdivision: 2004 -050 PARTITION PLAT Lot: 2
Project Description: (2) branch circuits for installation of mini -split heat pump.
Contractor: A TEMP HEATING & COOLING INC Owner: NOFZIGER, KENNETH RICHARD
16000 SE EVELYN ST 11835 SW TIEDEMANN
CLACKAMAS, OR 97015 -9519 TIGARD, OR 97223
PHONE: 503 - 650 -5014
PHONE: 503 - 624 -8484
FAX: 503 - 557 -2990
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 06/18/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/18/2013 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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- You 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: t�A "9—#9,4 G� 1.y /7—O
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 503.639.4175 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.
06/13/2013 16:06 5035572990 A TEMP HEATING PAGE 02
Electrical Permit Application t" ,..„,, ol. :l= Ir I , ISI; ONi.,
Cl of Tigard JUN /_
:i"i". Pmt No.: 624 —401,/ j
a 131 SW Hal Bivd., Tigard, OR 97223 J �� 1 3 2013 p Review
Phone: 503.639.4171 Fax: 503.598.1960 Dete/B : flier Perna
•
I t •.: ;' is I , Inspection Line; 503.639.4175 CST OFTIGA r I' Date Reedy/By: Ian: El See Poge 2 for
Internet: www.tigard- or.gov R[J11 DING AIVISI • t fiedMledrod: K 7 Supplementallnformadon
TYPE OF WORK PLAN REVIEW
1:1 New construction Addition /altcration/repfacement Pleats chock all that apply (submit seta of plena w /items checked below);
❑ Service or feeder 400 ;wipe or more ❑ Building over three atones.
° ❑ Demolition ❑ Other; where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
less to ground, or exceeds 14,500 ❑ Commercial -use agricultural
1 [ 1- and 2- family dwelling E] Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system, larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1-3",
Ave. Job site address: qq / A 100HP or more. occupy.
iob no.:
Is j 5 " w Ti ie/v4l a •1 ❑ Six nr more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: / G� 1:l Hcalth•anre facilities ❑ Supply voltage fbr more than
C' S �'� `-�
3' e , J 7 2 2. ❑ Hazardoun locations. MO vnits nominal,
Suite/bldg. /apt. no.: Project name: 4 �' l', t l� Service or feeder 600 amps ormore,
FEE SCHEDULE
Cross street/directions to job site: U I Qty. I Pee. I 'meal i •
New residential single- or multi - family dwelling unit,
Includes attached garage.
Subdivision; Lot no.: 1,000 sq. R. or less I 168.54 1 4
Ea add'I 500 sq. R. or portion 33,92 1
Tax map /parcel no.: Limited energy. residential 75.00 2
DESCRIPTION OF WORK (with above s it.)
M L / Limited energy, multifamily 7500 2
�_ h..s .L /1:3 i (; vt • S, /, illp residential (with above sq. R.)
Services or feeders installation altered° and /or relocation
200 amps or less in 100.70 MI. 2
IX PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133,56 2
Name: K _ Zs 401 amps to 600 amps 200.34 2
Vt 6
I 601 amps to 1,000 amps 301,04 2
Address; t 1 7( ?� S G� r r ed..,., a h ,4 Vet'. Over 1,000 snips or vohe 552.26 2
City/State/ZIP: r � � Z Z 3 ? Temporary services or feeders installation, alteration, and /or
i c► relocation
Phone: 6-05) 6 - ire of I Fax: ( ) 200 amps or ices 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 am 168.54 2
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A, Fee for branch circuits with
above service or feeder fcc,
,�Q APPLICANT _ L 0 CONTACT PERSON each branch circuit 7,42 2
Business narrie; " � : l • . t , • y . q • .11 •s k C I B. Fee for branch circuits without
• service or feeder fee, first
Contact name: 16000 SE Evelyn St. branch circuit 56.18 36, r � 2
Address: - Oack2m, 'OK was Each add'I branch circuit • ( 7.42 -7, Y2,„ 2
A3- 6504014 Miscellaneous (service or Feeder not included)
Each manuthctured or modular
City /State /ZIP dwelling, service and/or feeder 67.84 2
Phone; ( ) Fax: : p
(r Da ) 5 y L . _ al ttl) Reconnect only 67,84 2
7
/ Pump or irrigation circle 67.84 2
E -mail: C �e a r 1' Q e __ / ;e4 Ca/owl ''`� �T �j � Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name; panel, alteration, or extension. Page 2 2
ATRMP ��ND cO0� INC Each additional inspection over allowable in any of the abov
Address; 16000 SE Evelyn St. Additional inspection (1 hr min) 66.25/ hr
City /5tatcJZIP: Cractcannas, UK Wad Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: (S ) 5 5 A- -. act ,Q Inspections for which no fcc is 90.00 / hr
- (� � specifically listed �'il hr min)
CCB Lic.: )g d ` Electrical Lie.: C L. I Suprv. Lic.: ZCI Li t OS" ELECTRICAL PERMIT FEES
Su Suprv. Electrician signature, t Subtotal: 3 , 6(a
p g7aature, required:
1 p Plan rew ( 12% of permit fee);
Print name: )6 h Q� f i�0 Da Sta an ev gt (12% of permit fee � r i � /
Authorized siglatur ' ' TOTAL PERMIT FEE: _ 7 r , 2 ✓
r r l � .. . T his permit nev application i expirm if a permit ii net obtained within 580
Print name l - � �
5_±1.4c4 pm,: �� 3_ • lt as complete,
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