Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELC2010 -00702
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2010
Parcel: 2S114BB11800
Jurisdiction: Tigard
Site address: 10429 SW TITAN LN
Project: Burton Subdivision: SWANSONS GLEN NO. 2 Lot: 59
Project Description: (1) branch circuit to reconnect gas furnace.
Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: BURTON, CLYDE
PO BOX 80607 10429 SW TITAN LN
PORTLAND, OR 97280 TIGARD, OR 97224
PHONE: 503 -233 -1779
PHONE: 503 - 313 -3980
FAX: 503 - 651 -3345
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/21/2010 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/21/2010 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 9 101 -0090. You may_Qbta'• - • • the rule •r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/ 1
Issued By Al .. / Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Cali 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
0 V4
E
•
lectrical Permit Applicatio110 • Mk 01'x10: 1:.x;1': ONI
City of Tigard o r Q1 Received
UPI Permit N , ,
' 13125 SW Hall Blvd„ Tigar OR 97223 �� �' Dar I i P le 41
,I ' Phone; 503.639.4171 Fax 503.59$.1960 C ' other permit
1' R; A tt t) Inspection Line; 503.639,4175 .... ®0 .,,XS - Date Ready/By; Juno. 14 Spa Page 2 for
Internet: www.tigard- or.gov CNb " �,�`� v Notified/Method; y Supplemental Information
TYPE OF WOR S `� 't "' PLAN REVIEW ;
❑ New construction Mr Addition /alteration/replacement Please check all that apply (submit j sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other; whore the Available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION ' . • . • exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
lase to ground, or exnpeds 14,000 ❑ Commercial -use agricultural
il:. 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
• JOB .$TfE' INFORMATION AND LOCATION Q Emergency system. larger separately derived system.
❑ Addition of new rooter loud of C] "A ". "E", "1.2 ", "1 -3 ".
Job no.: Job site address: /0 O ..e.4.1 4 ` K �> 10011E or more, occupancy.
^ ✓ _ ❑ Six or more residential units. ❑ Recreational vehicle parks
City /Stan /ZIP: •.-�; .C1 J! e 1 !I El Health-care failities, ❑Supply voltage for more than
i �r ���r ttttXXXX lJR. / / Cf,P� ❑ H.rnrdnus 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: oe.ertan40 . 1 Qty, I Fee, 1 Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision; j Lot no.: 1,000 sq. R. or leas I 168.54 14
—
Tax map /parcel no,; Ea. add'I 500 sq. R. or portion 33.92 l
Limited energy, residential 67.84 2
DESCRIPTION OF, WORK.!. ' : :;'.., ; ' • . (with above sq, ft)
Limited energy, multi- faMily 67,84
Pe c t 4 6 Kv,vgeG-- residential (with above sq. ft.)
-- Services or feeders Installation, alteration, and/or relocation
�( 200 amps or less 1 00.70 2 •
ai~r PROPERTY OWNER ' I 1 '13 TENANT ! • 201 amps to 400 amps 133.56 2
Name: -de t 6 0 tP A r ! ( - 401 amps to 600 amp 200, 34 2
/ �iL 6 601 amps to 1,000 amps 301.04 2
',ddress: / _ • .CJ . lea kV( Over 1,000 amps or volts 552.76 2
City /State /ZIP: / die $7� a Temporary services or feeders installation, alteration, and/or
relocation
Phone:,( 2 ) j, 14 42 1 F ax: ( ) 200 amps or less I 59.36 I
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, Icasc, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 599 amps 168.54 2
Branch circuits new, alteration, or extenaion panel
Owncr signature: Date: A. Fee for branch Circuits with •
tip APPLICANT • . I .• ❑ ;CONTACT PERSON, : above service ar feeder f ee,
each branch circuit 7.42
13usintss name: R. Fee for branch circuits without
service or feeder fee. first
Contact name; w_ / , II r `y branch circuit 56.18 �� kg a
a / } • Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder no _ t included)
City /State/ZIP; dwelling, serv ic e �and/or feeder 67.84 2
Phone: 60.3 ) 313- 7 Fax: ; ) Reconnect only 67.84 2
E - mail:
/ _� Pump or irrigation Circle 67.84 2
T CONTRACTOR Sign or outline lighting 67,84 2
,. Signal circuit(a) or Iimlied- energy
Business name: 1 5 a p t . f (� ^ panel, alteration, or extension, Page 2 2
-
Each additional Inspection over allowable In any of the a bout _
Address: PQ 030c e Q 6 7 V Additional inspection (I hr min) 66.25/ hr
City /Slate /ZIP: 'Pc r o e C� j' Investigation (I hr min) 66.25/ hr
` // 6 - - // __ II v� inspections for which no fee is
Industrial plant (1 hr min) 78.18/ hr
Phonc: `��y-7 ) . ' 177 3 ' - 1 - --_ •—
►�l� / Fax ) 6
, � s, ep ci ftcally listed (Si hr min) 90.00 / hr
CCB Lic.:6 � 7 Electrical Lic.: I4/ 2/ ) Suprv, Lie.: //�a:, f
7� 2 t� E1.CTR[C PER MTT FE
Suprv, Electrician signature, required: ��i�[ _ Subtotal: r 1.�
•� Plan review (25% of permit fee);
. rrint name: 111111MILIEME Date: , `0 OW _. State surcharge (12 % ofpermit fee): 1 y
Authorized signature; TOTAL PERMIT FE4; (2 �
T �
g ! , h ls permit application expires if permit Is not obtained within 180
Print name; — 4 Mg r' 41 Date; days. after it has been accepted as complete,
/''t7/ • Number of inspections allowed per permit.
1 \ doe 10/01/09 440- 4615T(11 /05 /COMMBB
ZOO El HIVBONIIVBH - SNBH SbCCT59C0.2 XVI 6 0:ZI OIOZ /OZ /ZT