Permit CITY TIGARD ELECTRICAL PERMIT
CITY V
PERMIT #: ELC2008 -00652
COMMUNITY DEVELOPMENT DATE ISSUED: 11/26/2008
TIGARD'' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S103BB 03700
SITE ADDRESS: 12153 SW 125TH AVE ZONING: R -4.5
SUBDIVISION: BROOKWAY LOT : 037 JURISDICTION: TIC
PROJECT: LAUZON
Project Description: Reconnect furnace and a /c.
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: 1 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:
THOMAS LAUZON TRI COUNTY TEMP CONTROL INC
12153 SW 125T1-I AVE 13150 S CLACKAMAS RIVER DR
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: 503 - 590 -4641 Contact #: PRI 503 - 557 -2220
FAX 503 - 557 -0919
FEES
Description Date Amount Reg #: ELE 527LHR
[ELPRMT] ELC Permit 11/26/2001 $53.50 LIP 72623
[TAX] I2% State 11/26/2001 $6.42 SUP 2567LEB
Total $59.92 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 = '0.33 .2344.
Issued By: J am , , l _ , Permittee Signature: c Az„fieTelir.
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.
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Electrical Permit ApplicatioE ECE1 I " ICI ti t� ic ,i ��; ; � b ' .
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+- Ci }� , of Tigard l,' 0 p , Permit No ' s, ,� M
`J I V 1 �" J Date/13 ®�0 C� O
� 11 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
ipi
li? Phone: 50 3 .639.4171 Fax: 503 .598. D ate/9 Other Permit:
Y. p FF Y OF -�MARG y:
iri ' inspection Line: 503.639.4175 1 y y p� ,p�j oti
Date to C El See Page 2 for
I'1UAR1) BUILDING G 7-✓I ISI4!
!.i ii Internet: www.[igatd- or.goV L �� fied/Methnd: i Supplemental information
TYPE OF WORK 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 I so volts or ❑ Floating buildings
less to ground, or exceeds 14,000 0 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
❑ Emergency system. larger separately derived system
3013 SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 "1 -3",
Job no.: Job site address: 12„, /24 (((///JJJ(((��� ( �r� t00HP or more, occupancy.
V CI or more residential units. I=1 Recreational vehicle parka.
City/State /ZIP: Tigard, OR Ej ait 0 Health -care facilities,
❑ Hazardous locations, ❑ Supply voltage for more than
600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/dircetions to job site: Description 1 Qty. I tree. 1 Twat 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or Icss 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 l
Tax map /parcel no.: ,
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
�QD�n residential (with above sq. ft.)
o Rewired � y A ^ , ^ d ;l o ^ .p, r . Services or feeders installation, alteration, and /or relocation
( r " Y 1 Vf 200 amps or less 80.30 2
JAN PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Thin ` 4 ali0 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: :a t) Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) t fj ' - I Fax: ( ) 200 amps or Tess 66.85 1
Owner installation: This installation is being made on property that i own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or ex tension, ter panel
Owner signature: Date: A. Fee for branch circuits with
AAPPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Same as Contractor B. pee for branch circuits �
without service or feeder fee. 1 46,85 , v' 2
Contact name: Diane Mason first branch circuit
Address: Each add'I branch circuit 1 6.65 4, 4c 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: Tri County Temp Control energy panel, alteration, or
Address: 13150 S. Clackamas River Drive extension. Describe: Page 2 2
City/State /ZIP: Oregon City, 97045 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 557.2220 1 Fax: (503) 557.0919 Investigation per hour (I hr min) 62,50
CCB Lic.: 72623 Electrical Lic.: 527LHR Suprv. Lic.: 2567LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ai 1011`1 Subtotal: 5�j� r7V
Print name: Dave Salholm Date: l Plan review (25% of permit fee): "
�� State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: i
�� This permit application expires it a permit is not obtained within 180
Print name: Diane Mason Date: �`�� �� days after it has been accepted as complete.
• Number of inspections allowed per permit. 53 • `
1 \ Buildina\Pcrmits'ELC- PermitnpP. doc 05/23 /06 440- 4615T(1 I /05 /COM/WEB
cITr OF TIGARD
BUILDING DIVISION PERMIT #: L,G20 (*.00t
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 „.4.1',41L
Inspection Requests (24 Hrs.): (503) 639 -4175_
INSPECTION WORKSHEET FOR DATE: At J ity TIME: PAGE:
SITE ADDRESS: \ 2.153 6 W I ZS' PV
• CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 1� o' Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
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PA. PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
Rim . ik CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G7' Date: I� V Phone #: (503) 718- 2
1
CITY OF TIGARD
- BUILDING DIVISION PERMIT #: CLC200B 006 2
AR 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/06/2008
Phone: (503) 639 -4171 e J++
Inspection Requests (24 Hrs.): (503) 639 -4175 .. �_... "'!+
INSPECTION WORKSHEET FOR DATE: 12/2/2008 TIME: 7:00Am PAGE: 27
SITE ADDRESS: 12163 SW 125TH AVE . CLASS OF WORK:
SUBDIVISION: 'E3ROOKWAY LOT #: 037 TYPE OF USE:
PROJECT NAME: LAUZON
DESCRIPTION: Reclaimed. furnace and eic :.
OWNER: L.AUZON, THOMAS PHONE #: 503-590-4641
CONTRACTOR: TRI COUNTY TEMP CONTROL INC PHONE #: 503 - 557 -2220
Inspection Request Scheduled For: Date: 12/2/20013 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 078669 .01 503 -557- 2220 N
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAI
/ L1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: Date: ( 4 Phone #: (503) 718 -