Permit •
I v CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00693
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2010
Parcel: 2S103BB12900
Jurisdiction: Tigard
Site address: 12245 SW ANN CT
Project: ARDINGER Subdivision: LAKE TERRACE NO. 2 Lot: 22
Project Description: (3) branch circuits to reconnectd air handler and heat pump.
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: ARDINGER, KEITH E & SHERRY A
PO BOX 3948 PO BOX 23459
WILSONVILLE, OR 97070 TIGARD, OR 97281
PHONE: 971 - 563 -8211
PHONE: 503 - 590 -1621
FAX: 503 - 266 -1349
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 12/16/2010 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/16/2010 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 Net forth in OAR
952 -001 -0010 through OAR 952- 001 -0090. You may obtain a co• o th u es or • r-ct questions to OUNC by calling 3. . 987 or 1.800 -, .2344.
Issued By: _ i — _ Permittee Signature: Y1
i
' 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.
Electrical PermitApplicatioL . , I � FOR OFFICE USE, ONLY
.i
City of Tigard DEC 1 6 2010 Re c y � /Y / J(, /n `_ PennitNo.:
° 13125 SW Hall Blvd., Tigard, OR 97223 C G t D ifs' my, 613
I..' Plan Review
Phone: 503.639.417 ] Fax: 503.598.
Tl GAt_ inspection Line: 503.639.417 OF T1GA1�D Rite/ y furio omit:
.. Date Read/By; 1eris: Sce Page 2 for
Internet: www.rigard-or.gov BUILDING DI VISION NotifiedRVkthod: "7 T ' Supplemental Information
TYPE OF WORK DIVISION :7 lJ PLAN REVIEW
❑ New construction ., Addition /alteration/replacement Please clumkall that apply (submit Z sets of plans w /dems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑ Mamas and boatyards.
CATEGORY OF CONSTRUCTION exceeds !0,000 amps at 150 volts or 0 Floating buildings.
1- and2 - famil dwelling less to ground, or exceeds 14,000 ❑ Commercial-use agicukural
•E Y g ❑ Commercial /industrial ❑ Accessory building amps buildings_
❑ Multi - family 0 Master builder
0 Other: 0 Fire pomp. ❑ lrtstailation of 75 KVA or
JOB :i11'E INFORMATION AND LOCATION ❑Emergency system. larger separately derived syster
❑ Addition anew motor load of ❑ °p ", ^p "i - ", 1 - ",
Job no.: Joo site address: 121, 45 5i „� �j' r -- I00HP or more. occupancy.
�"' `� 1 ❑Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ' 'n n-) CI Health-care facilities- ❑ Supply voltage for more than
�l �� ❑ Hazardous locations. 600 volts nominal.
Suite/bldglapt. no.: Project name: ❑ Service or feeder 600 amps or more.
—
Cross street/directions to job site: FEE ] SCHEDULE
Dncri piion l Qty. Fee I Total 1
' Ncw residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: _ Lot no.: 1,000 sq. R or less /68.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ff_ or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. R.)
�7
Limited energy, multi- family
r �11Jt & t 1- ( - L 11404 t ( p residential
rU (with above sq. 0.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
PROPERTY OWNER J ❑ TENANT 201 amps to 400 amps 133.56 2
Name: �t"[ A ; k
�►! 401 amps to 600 amps 200.34 2
Address:
r1•E 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State/ZIP: • Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( 5li 5ct 0 iter 2/t I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 _ 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
Business name:
each branch circuit 7.42 2
H. Fee for branch circuits
Contact name: without service or feeder fee, 1 1, 56.18 S1p« 2
first branch circuit
Address: Each add'l branch circuit 2— 7.42 114 • Si 2
City /StatclZlP: Miscellaneous (service or feeder not included)
Each manufactured or modular 1 67.84 2
dwelling, service and/or feeder
Phone:
( ) I Fax: • ( ) Reconnect only 67.84 2 '
E -mail , Pump or irrigation circle 67.84 2
CONTRACTOR Signor outline lighting 67.84 2 '
Business name: p p\o C_ e c 01- E �; f h 1 r� Signal circuit(s) or limited-
energy panel, alteration, or
Address: T. t) S ., Lifl extension, Describe: Page 2 2
City /State /ZIP: Wm(o w Inc.. a ick D7 a , Each additional inspection over allowable in an _attic above
e
Phone: I Z'(( Fax :( e t f Per inspection 66.25
(T7[ 5,3 g 51$5) ucco (3c/9 investigationperhour(I 66.25
CCB Lic.: 1 1 Electrical Lic.: —(00( ,, Suprv, Lic.: S 5 industrial plant per hour - 78.18
Suprv. Electrl n� attire, required: l 7 /' / t J 1 (��t ) ELECTRICAL PERMIT FEES
Subtotal: /1 1 , 02
Print name: !A.:NJe_ t / j/C\(t• Date: ID- ZZ-oq Plan review (25 %of permit 0c ):
Authorized signature:
1 State surcharge (12% of permit fee): e r
TOTAL PERMIT FEE: - 79 .
Print name: Date: This permit application expires if a permit is not obtained within I80
- days after it has been accepted as complete.
laauildirglPcrmiutELC- PcrmilApp. 10/01 '09 -
• Number of inspections allowed per permit.
440-1615 TO l I /05/COM/ W EB
Z a 6b£1.99Z£09 oul°a13 tinaln aid dZ17:LO 0l• g 6 oea