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Permit CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY DEVE Hall O PMEN Tigard. SERVICES I (503) 639 -4171 DATE ISSUED: ELR2004 O /8/2004 — 13125 V SITE ADDRESS: 12040 SW 119TH AVE PARCEL: 1S134CD 03000 SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5 BLOCK: LOT: 058 JURISDICTION: TIG Project Description: Limited energy for HVAC. Replacement of furnace. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: X DATA /TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: • HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: Owner: Contractor: PLUNKETT, BRUCE A AND PIONEER GAS FURNACE JANICE E 3615 NE BROADWAY 12040 SW 119TH PORTLAND, OR 97232 TIGARD, OR 97223 Phone: 503 - 590 -5858 Phone: 503- 249 -5000 Reg #: ELE 22- 177LHR LIC 36102 FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 10/8/2004 $75.00 Elect'I Final [TAX] 8% State Surchart 10/8/2004 $6.00 Total $81.00 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 wil! 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 throug : • ' • 101 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699. Issu-d by s 1 , II„ I .1. , _L 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'N DATE: LICENSE NO: Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day Electrical Permit Application / I ( I l l I l l l It I I .I ON! 1 City of Tigard EVE Da ('ffMlar Permit No.: E ..... et 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review u� ��„ Phone: 503.639.4171 Fax: 503.598.1960 _ ,. Date/B Other Permit: Inspection Line: 503.639.4175 t J C 1 8 200 o 'J. Date Ready/By: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: / Supplemental Inform ation L TYPE OF WOR PLAN REVIEW ❑ New construction Addition /alteration ri p acement Please check all that apply: ['Service over 225 amps, comm'l ❑Hazardous location ❑ Demolition _ ❑ Other: ❑Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential l- and 2- family dwelling El Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑Building over three stories ❑Feeders, 400 amps or more ❑ Multi - family ❑ Master builder ❑ Other: °Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park I ❑Health -care facility ❑Other: Job no.: I Job site address: /20/0 c 9 4 .p /Q J / / 1 �'e Submit 2 sets of plans with any of the above. City/State /ZIP: / Q Q 972 z3 The above are not applicable to temporary construction service. FEE* SCHEDULE Suite/bldg. /apt. no.: Project name: p / 1 Re :// Description Qty. I Fee Total I " Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. fl. or less 145.15 4 Subdivision: - Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular �) dwelling, service and/or feeder 90.90 2 /� -le–e lac ✓ a Vn�� — er �.t re Services or feeders installation, alteration, and /or relocation t t )Ork 1oil i 5 0 7.c.t .ste e rind ❑ PROPER WNER (J ❑ TENANT a ps or less 80.30 2 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 6 rtiC e- P j c i ee 601 amps to 1,000 amps 240.60 2 Address: S`t V U Over Reconnect amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: Temporary services or feeders installation, alteration, and/or (� 3) 5 90 5 5% relocation 00 m Phone: 8 � (S Fax: ( ) 200 amps or less 1 66.85 l 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 600 amps 133.75 ' 2 Owner signature: Date: Branch circuits – new, alteration, or extension, per panel ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: Sa �1 � a v1 �� _ branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, IRE each branch circuit 46.85 2 Address: Each add'l branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) I Fax: : ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extend n Page 2 2 Business name: P b h ee t t as' F�.rna c e 1 Address: 310/ 5 ,4J 6 r - o Each additional inspection over allowable in any of the above Per inspection 62.50 City/State /ZIP: Por -HQ. , ©i ' 72 32 . Investigation per hour (I hr mitt) 62.50 Phone: (�co 249 Soo& Fax: (5 03 249 826710 Industrial plant per hour 73.75 \ft t r ELECTRICAL PERMIT FEES* CCB Lic.: 3 / E lectrical Lie.: IZ2 1 ic f l�� Subtotal 75_ 00 Suprv. Electrician signature, required: G ( \ 4 - I ( T Plan review (25% of permit fee) Print name: he„.„ ` x / O O State surcharge (8% of permit fee) r Date: G �� TOTAL PERMIT FEE g . - r� Authorized signature: , i // This permit application expires if a permit is not obtained within 180 / / days after it has been accepted as complete Print name: Date: 6 Q 6 - 4 ' Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed Electrical Permit Application - City of Tigard Page 2 - Supplemental Information 4 LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION . Business Line: (503) 6 9 -4171 MST BUP Received Date Requested AM PM BUP Location 1 D- © Leo /19 Suite MEC O — b6 G2 '- Contact Person a - _ Ph ( )5 /) - S PLM Contractor Ph ( .;' ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC g Access: // s �� LSt�v ELR O 6 Ft Drain � I t I Crawl Drain d Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm �� \` Susp'd Ceiling Roof Other: ` Final PASS PART FAIL PLUMBING C Post & Beam Under Slab Rough -In ` l Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final FAIL C M C 'f ist & Rough -In Gas Line Smoke Dampers Fi FAIL LECTRIC Rough -In UG /Slab Low Voltage Fire Alarm F ail ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL S E 111 Please call for reinspection RE: Unable to inspect – no access Fire Supply Line ADA Date 1/ Z - I actor �� Ext Approach/Sidewalk p Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL