Permit ' r CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00193
a Date Issued: 04/22/2010
TEGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 112 BA03800
Jurisdiction: Tigard
Site address: 14115 SW 80TH CT
Subdivision: WAVERLY MEADOWS Lot: 17
Project: Fastenow
Project Description: (2) branch circuits for heat pump
Owner: FEES
FASTENOW, AARON M Quantity Description Date Amount
14115 SW 80TH CT
TIGARD, OR 97224 2 crt Branch Circuits 04/22/2010 $63.60
wo /Purchase Service or
PHONE: 503 - 881 -1775 Feeder
1 ea 12% State Surcharge - 04/22/2010 $7.63
Electrical
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
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, orf 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 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5 *i 246.669• • • 1.800.332 2344.
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on p perty I ow ch 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 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.
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Electrical Permit AppIIC 1 �,i . �,' i ..fi ,a ' , 1 oR 01 I Ic l 11S1 0N1 1 ,,' x
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City of Tigard i °' Received , y
Permit No
r.: t 6 00 193
`J g Date /B : /�ti ..44 L '
010 Plan Review
B ° 13125 SW Hall Blvd., Tigard, OR 9/7235, " M 2 Other Permit:
-� Phone: 503.639.4171 Fax: 503.549.1160
Date /B .
7`i G A Ii 1) Inspection Line: 503.639.4175 Date Ready /By: fur ® See Page 2 for
. :. Internet: www.tigard - or.gov CITY A OF TIGARD Notified/Method Supplemental Information
TYPE WIURtI DMS1l1 "- PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ 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 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ 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 ", "I - 2 ","I - ",
•
80th 100HP or more. occupancy,
Job no.: Job site address: 14115 SW 80 Court
❑ Six or more residential units. ['Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Heat Pump Electrical ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Fanno Creek and 80 Court Description 1 Qty. 1 Fee. 1 Total 1 *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Waverly Meadows Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: -
Limited ever
gy, residential 67.84 2
. DESCRIPTION OF WORK , (with above sq. ft.)
Limited energy, multi - family 67.84 2
Adding one 240V 30A circuit for heat pump installation residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
Adding one 120V 15A circuit for heat pump utility /service GFI outlet 200 amps or less 100.70 2
® PROPERTY OWNER " " ' ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Aaron Fastenow 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 14115 SW 80 Court Over 1,000 amps or volts 552.26 2
City/State/ZIP: Tigard, OR 97224 Temporary services or feeders installation, alteration, and /or
y g relocation
Phone: (503)881 -1775 Fax: ( ) 200 amps or less 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, le e, rent, exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: G4,Z - VC.oi D A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT. PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 1 7.42 7.42 2
Address: Miscellaneous (service or feeder not included)
manufactured Each
City /State /ZIP: dwell ng, service and/or feeder
67.84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Q �� panel, alteration, or extension. Page 2 2
2 Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (% hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES •
Subtotal: 63.60
Suprv. Electrician signature, required: o
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): 7.63
TOTAL PERMIT FEE: 71.23
Authorized signature: Aril.... This permit application expires if a permit is not obtained within I80
y , / � A � � S r �� , dope afer h as bep e accepte as complete.
Print name: /�f , Date: Number of inspections a llowed per permit.
1:\Building \Permits \ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /C0.M/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIALWORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
Ft Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
I - 7 Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 1 0/01 /09