Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
; '- 0 , . COMMUNITY DEVELOPMENT Permit #: ELC2010 -00700
'TIG 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/20/2010
Parcel: 1S 134CD07900
Jurisdiction: Tigard
Site address: 11810 SW SUMMER CREST DR
i Project: Johnson Subdivision: Lot: 0
Project Description: (2) branch circuits for heat pump and service outlet.
•
Contractor: TRI COUNTY TEMP CONTROL INC Owner: JOHNSON, EVAN
13150 S CLACKAMAS RIVER DR 11810 SW SUMMER CREST DR
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 557 -2220
PHONE: 503 - 886 -9238
FAX: 503 - 557 -0919
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 12/20/2010 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/20/2010 $7.63
Type of Use: SF Electrical
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, 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 O' - ':2- 001 -0090. You 23 . b ' the ru - • • di ect questions to OUNC by calling or 1.800.332. p
Issued By: A .«r - / Permittee Signature: ..at ir• %r.�■is
�� 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.
CaII 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.
DEC -17 -2010 03:49P FROM: TO:5035981960 P.3
Electrical Permit Application lt►It 01.1-1( I 1 !..,1 ( I:\ .
City of Ti and Received
1,1 `J g eii, Date/B : SI T B L Pot No • 6 (6 ". ( 1 U
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1 Phone: 503.639.4171 Fax: 503.598.1960 Inspection Line: 503,639.4175
Date/By: Other Permit:
i ■ �, Ii � �Date Ready/By: runs; 121 See Page 2 for
Internet www.tigard- or.gov 1 `i Notificd/Method; A Supplemental Information
TYPE OF WORK n(v� ' l��i ��� PLAN REVIEW
❑ New construction 1' Ple ase check all that apply (submit 2 sets of plans w /items checked below
® Addition /alterafion/replacement ` below):
.. G�
❑ Demolition ❑Other; 1�‘ ❑ Service or feeder 400 amps or more ❑ Building over three stories. � where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRlJCT101 0v exceeds 111,000 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 ❑ Muster builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
JOB S1TE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ 'A ", "15 , ' 1 -2 ", "1 -3 ",
Job no.: Job site address: I IS i 0 OW V (ne sir 100HP or more. occupancy.
` ❑ Six or more residential units. 0-Recreational vehicle parks,
City /State/ZIP: -11 3 r ^ 6(7,22: ❑ Health -care facilities 0 Supply voltage for more than
J ���""" ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1
New residential single or multi - family dwelling unit.
• -lndttdes attached garage.
Subdivision: Lot no.: 1,000 sq: ft, or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OP WORK (with above sq. R.)
n r ` ePtit n Limited energy, multi - family 67.84 2
rL.i��"1 "� Mai-C.55 `n 1 �J ' i� frl residential (with above sq.
Q '; ® Services or feeders installation, alteration, and/or relocation
• �f �J 1 200 amps or less 100.70 2
' PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: J ‘101/IfteN1 401 amps to 600 amps 200.34 2
�,� 601 amps to 1,000 amps 301.04 2
Address: , J 1 , `�-. Over 1,000 amps or volts 552.26 2
City/Stale /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: Et b J %t . "l q 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 70.1. 401 amps to 599 amps 168.54 2
Branch circuits- ncw, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: Same as contractor B. Fee for branch circuits
Contact name: Diane Mason without service or feeder fee,
first branch circuit 56.18 2
Address: Each add'I branch circuit 1 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
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Business name: Tri County Temp Control Signal panel, or t i o n, or
energy panel, alteration, or
Address: 13150 S. Clackamas River Drive extension. Describe: Page 2 2
City/State/ZIP: Oregon City, OR 97045 Each additional inspection over allowable in aayof the above
Per inspection 66.25
Phone: (503) 557.2220 Fax: (503) 557.0919 investigation per hour (I hr min) 66.25
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COB Lic.: 72623 Electrical Lic.: 01015 Suprv. Lie.: 4(66 Industrial plant per hour 78.18
7t /1 /' S / t ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / �j Subtotal:
1 � Plan review (25% of permit fee):
Print name: + 4 Da O
State surcharge (12% of permit fee):
Authorized signature; te: 4 �7 TOTAL PERMIT FEE: 71,2'
Print name; Diane Mason Date: l�
{4 1 1 I 1 D This permit application expires if a permit Is not obtained within 180
days after It has been accepted as complete.
' Number of inspections allowed per permit.
1 \ auttdingNermhslELC- Pc Is, itApp.dot: 10/01/09 4'10 /OS /COM/WEB