Permit CITY OF TIGAR® ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00261
TIGAAD'; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/28/2010
Parcel: 1S135CD02402
Jurisdiction: Tigard
Site address: 11895 SW 95TH AVE
Subdivision: BOETCHERS ADDITION Lot: 8
Project: Carter
Project Description: Reconnect gas furnace
Owner: FEES
CARTER Quantity Description Date Amount
11895 SW 95TH AVE
TIGARD, OR 97223 1 ea Reconnect Only 05/28/2010 $67.84
1 ea 12% State Surcharge - 05/28/2010 $8.14
PHONE: Electrical
Contractor:
PIONEER GAS FURNACE
2636 NE SANDY BLVD
PORTLAND, OR 97232
PHONE: 503 - 249 -5000
FAX: 503 - 249 -8260
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
•
Total $75.98
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 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 17—C-- Permittee Signature: (7N ! /),L/ e- 17- 7 - 76/\/
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 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.
May 28 2010 7:51 AM HP
1.il.if ,.., ', 4,, • _ i )
Electrical Permit Applicatiom i !,. , ,. - . --.'f 1 (H; os 1 1( I. i. ■1 it\ 1.\
114 C s W of Tigard Tigard, OR 97223 MAY 28 2010 Received ...s ,,,, .4.. permitNo...6- A0/0 .-da,24 /
-
, - H al l , Plan Review
Other PenniV16 --
' II Phone: 503.639.4171 Fax: 503•59819
---. A e- • • -+ , e - , D : ' ' (1 4V'
' i I T L.! ; • ;,-;r1J Y'
Inspection Line: 503.6394175 kj ' '-'' . Date Ready/By: Jurtie., 0 See Page 2 fir
Internet: www.tigard-or.gov BUILD'Aci DiViSIO:',1 NOriMed'hiethod: Supplemental isfermati on
/, -9.f..y?:0*';:-,"-.!: '....=:' , :.:- -.-::...,:::, ! ,-. .,,.: : ' -. 'i •, '.,': ::,;: '
0 New construction IX, Addition/alteration/replacement Please check all that apply (sehmit 2 sets of plans w/iterns checked below):
0 Service or feeder 400 amps or more 0 Building ever three stories.
13 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
....":;.:;.'::::'..".:‘:: '•:. ' 4Ttoiltrbtr . IJCfloN .. .. , , . . exceeds 10,000 amps at 150 volts or 0 Floating buildings .
• less to ground, or exceeds 14,000 0 Commercial-use agricultural
,*r 1- and 2-farnily dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings_
El Muhl-family 0 Master builder El Other: . 0 Fire pump. 0 Installation of 75 KVA or
itijt'Igite - ::: - , -:',.,.: ,:,.-, : :: " 13 Eide "'swill" larger separately derived system.
Job no.: I Job site address: 1 143475 S,) eivr-4, , 100HP or more.
0 Six or more residential units. occupancy.
0 Recreational vehicle parks
City/State/ZIP: 77V110: / e.. q77-9-3 10 Health-Care Ineations. facilities.
10 Hazardous 0 Supply voltage for more than
600 volts nominal.
Suite/bldgJapt. no.: Project name: e Ds... or feeder 600 amps ca more.
-- .. :':'-',:. ..,:;. • ''.'':: ;''.:' ':FY,Ek:SO410T.V1*': . .: '''' '.:'-' .
Cross street/directions to job site: - Oescrionea -- 1 Oty. I Fee. 1 rota' 1 •
New residential single- or multi-lankily dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. El or less 145.15 _ 4
Ea. arld'I 500 sq. ft or portion 33.40 1
Tax map/parcel no.:
'' Limited energy, residential '
;••';'...''''';'':;::::,..::";.• ''::.": . ;:' ,':''...;' ';1; ."...";: . " .. 1' , ••*S001105lil , ',01*:' , *;';', "• '':-:".'. ;',::"; ''. • '.' ' '. ':. '": ':-.:' '.'. ' . ; (with above sq. it) 75.00 2
' Limited energy, multi-family
le-1.r 00,142 et "1 aza S r Arrietc, e residential (with above sq. R.) 75.00 2
Services or feeders installation„,ilteration, aed/or relocation
200 amps or less 80.30 ' 2
,:: : ::::: I n:'•:' vHOr*i I • ' . '• ' 1: . '. ' :'- ' ; ' :, :: • :'; 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/71P: Temporary services or feeders installation, alteration, and/or
reiocadon
Phone: ( ) I Fax: ( ) 200 amps or less 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 10 599 amps 133.75 _ _ 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
x's-f: : :, , :,:. :. ,if .:::...;' ; -'-' '43-:6;tiiiticililOgin*:-. r :; : : , above service or feeder fee
6.65
' each branch circuit 2
Business name: , . R Fee for branch circuits -
0 without service or feeder fee,
Contact name: first branch circuit 46.85 2
_ .
Address: 5 il r 131A) Each addi branch circuit 6,65 2
Miscellaneous (service or feeder included) _
City/State/ZIP: Each manufactured or modular
90.90 6 7 .ry
dwelling, service and/or feeder
Phone: ( ) 1_ Fax: : ( ) Reconnect only
I 66.85...7(4 2
E-mail: Pump or irrigation circle " 53.40 2
,'..,' -, .5 ...'':',.;'':."...',.."- '..:,. 1 l :' '''',. '•:::-.:] '.':. ; • ;'''.":;:••• ::: ' . 'CIO • '', , j ,•:'..":':. 7 •: : ::': " •:-. I '''.-, : •:. , ;: '''.:,•.-•:"....: ; . ',' Sign or outline lighting 53.40 2 •
F
Business name: n„,,,,,,,, r re. _„,-- .
corf
Signal circuit(s) or Lim ited-
energy panel, alteration, or _
Address: at„g( CA, n0 iglf oo _ - . extension. Describe: Page 2 2
City/State/ZIP: el 1 10( (9 U 9 - 3 4, 9____
i Each additional inspection over allowable in any of the above
Per inspection .
62.50 • .
Ph. . , i j ) ,,,,, q . oc , , Fax: f i -I ,..., .
• . -.. .. InVesfigation per hour (I hr min) 62.50
- 1
CCB Lic.: 1-7.1 81 vtlectric 12q2 - uprv. Lic.: Industrial plant per hour 73.75 _ !
. • .: : . , : : •tattrilm .irER/Orr.
Suprv. Electrician signature, requir . c ,A 0 ,....7 1,., ,-
Subtotal: • - • ' • - 1.__ ,
v.. i
Plan review (25% of pemtit fee) / / 0
Print name.
' NG elk- Date: 5,-7,i--- . g
_ 6
State surcharge (12% of permit fee): • ,
.
Authorized signattlre: - 1"7 - Je , 11-66.° . TOTAL PERMIT FEE: 075 ,,,p
This permit spplicadon expires if a permit is not obtained within 180 C"
. 1 Date-
Print name: pl E,a 141 6 c, • j3 7?-0//e)
0 1- A