Permit a: CITY OF TIG
,4, PERMIT
PERMIT #: ELC2006 -00031
�� DEVELOPMENT SERVICES DATE ISSUED: 1/17/2006
° - - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S104AC -10800
SITE ADDRESS: ST / �} �� ZONING: R -4.5
SUBDIVISION: HANDY ACRES / oZ qq(o S 40 I.33 LOT : 034 JURISDICTION: TIG
Project Description: Install A/C unit.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
•
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
MICHAEL WEINANDY JACOBS HEATING AND A/C
13300 SW WALNUT 4474 SE MILWAUKIE
TIGARD, OR 97223 PORTLAND, OR 97202
Phone: 503 579 - 8660 Contact #: PRI 503 - 234 -7331
FAX 503 - 808 -9108
FEES
Description Date Amount Reg #: SUP 704LHR
[ELPRMT] ELC Permit 1/12/2006 $46.85 LIC 1441
[TAX] 8% State Surcharge 1/12/2006 $3.75 ELE 26- 807CRE
Total $50.60 REQUIRED ITEMS AND REPORTS
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 you to follow 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 copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1 -800- 332 -2344. _
Issued By: -7 7 y9 , C Permittee Signature: `s e 4s 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 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.
FROM ..:Jac+obsHeating FAX NO. : Jan. 17 200E 11:01AM P2
a 01/13/2006 10:32 FAX 5035981980 CITY OF TIGARD liii 002
Eilifiteral Permit Application 1., r; , ,, r, 1 i , ,,
City of ligprdl V 4 / T. _
13115 SW Hall Blvd., Tigard, OR 972 0 • Nona �/ • O Od /
Phone: 309.639.4171 Fax 503,598.1960 .. Omar Permit;
lamest ion Liao: 50 1639.4175 i JAN 1 , _� i r I
laeesnet: wwcvef .or.� �yj�yzr
in New constructia �Addt ' �,
« • i • _ �I� Pismo ohmic NU Mat apply:
❑ Demolition ❑ L OSsrvicc over 225 amps, carmrtl EHaridous localism
,: [ZSorviec ovor320 main -tubas riBuildes over 10,000 sq. R,
e) t: ' . 4 ' . • r. ••:« • of 1 -and 4.11nnily dwellings 4 or slam new resideelW
. .# 1. and 2- fltmily dwelling ❑ Commerciai/ui iusirial ❑ Accessory bunting OSysten ova 600 volts nomi®1 aids in one structure
Mu1NlAfmtl ❑Master budor ❑Other: �I13 ulidlag war three dories l7Ft 400 amps or mare
Doeamp m had over 99 persons LiDA uod structures or
. e .:4 AITOH'3470' A,,uoN ", ❑RmarrAlghtlng plan RV park
J a b n o . : Job site address: l]Health care fa ty DOta: _
to Ike - .! _ . • . Sabath l aata of plans wits any Mho above.
Clotan inlZIP: At • • 1 C sJ -.;4% 1'bo above are net applicable to temporary cons traceloa service.
Suitabldg /apt no.: Pet ecr names '' ., • .. ?•:,. '• '- ]P !.? _ ld`e:':'x�:: a'' is :
OA l Yw.j Taw r w,
Cross street/d1rcctlons to job site: New residential sleek- or malt: -esmi y dwelling ann.
laohiden attached same.
1,000 eq. 0. or late - 145.15 4
Subdivision: LO1 n p, : Ea. midi 500 sq. ft or pardon 33.40 1
Tax ttedplpstroel no.: Limited enemy, reeldanHal 79.00 - 2
3.00 2
Limited mvgy aon�aidmedat 7
- - '" `•_ ' . : Each wmufaabmred Q modeler
(( ,r. dwelling, service d/or per 110.90 _ 2
�lJl� Services or feeders lasplU 0. atlo alhreatb0. eati
and/or rsloon
300 amps or lase 60.30 2
;p :,; � , , � NOT;:: - , 201 maps to 400 amps 106.5'5 2
401 amps to 600 amps 160.60 2
Name \`. \ J-el (i Y 601 amps to 1.000 amps 240.60 2
Address: Ova 1.000 mops or valta , r 454.65 2 _
City /9tetdZlP: -- -- `�"'�aan' 66.83 e6. 2
Temporary Review or faders lastallatioa, alteration, and/or
r
Monte ( ) Fanc (. ) 200 amps or less �^ 66.85 1
Owner inddlatlon s 'Piste lnstaliadon is being made on property that I own Which la not 201 amps to 400 asps 100.30 2
intended for sale, lease, runt, or exchange, according to ORS 447.449.670, and 701. 401 amps to 600 amps 133.73 2
Owner signature: Daze: Branch circuits - new, alten110 , or extension, per pane .
;e . ' . 71 : i i . ! d . ^ S ' t avOiI'mAR.9, . p i n i t , ' :..y r ,,, A Fee fir branch Circuits we. 4 - •
Business name: Navin or finder ho, mob 6.65 2
b rimait
COMMA name: 13. Fee tar brands circuits
without > 5 erdar s°`, ' 46.85 2
Each add'l brands chant 6.65 2
City /Stete/ZIP: MirseUaneous (ferries or Feeder sot hrdoded)
Phone: ( ) I Fax:: ( ) Pease or Irrigation circle 53.40 2
Signor outline lighting 53.40 2
E -mail: sigma oire er Iinsited
'.' :7 : . i ?., ,•5 :.. :si.?,,; ,.L.: ,'. \, t of •14 .. y in., ti. f r . . .. �w11yWel, allegation. cm
oxteasiose. Dolman; Paget 2
BUameav name: A_ .'a t• \ . ` IS..! *. & r i `
Address: �' 1�, rt�5 v.
. M ` \ \on l i ENO additional las8ettron der eliminate is a�s tie above
,� - : Fa hopcafon - 62,30
City/State/ZIP: r1ck'\ a \R A r `Q lavatkatiem per hoar p hr stn) 62.3 ,
Phone: ( )( 73 l )1 I ' 0 • - L I b B industrial pleat i per bout {s 73.75
_ laNCI I 4o4ym'. Y._4
CC» Lis: 41•.1 Electrical Li � _ _uprv. Lie.: tot. yd �`� Subtotal
Suprv. Electrician signature, required' �'( - - Pion review (x5%ofpamit fee)
Print - r - e ci Oa. ut1 k - 1 .._
' ► j r e. - , s bar . ALP ts � ERmr paro<, tFlee >�)
I l0
Authorized signature: This permitapplieatim eminests molt oit lamer pplwl�d *lido 100
I days i Mier it b beau aeeeased ascempicso
Print name: Date; N ! of a T omit dsta !Waal & ivk ac lad
.dat 12/03 � , (5 44040101110/02/03040V02$ 0 6
•