Permit CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00228
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/03/2011
Parcel: 2S109BA08100
Jurisdiction: Tigard
Site address: 13646 SW LEAH TER
Project: Ailshie Subdivision: DAFFODIL HILL Lot: 7
Project Description: (2) branch circuits for heat pump
Contractor: TRI COUNTY TEMP CONTROL INC Owner: AILSHIE, STEVE
13150 S CLACKAMAS RIVER DR 13646 SW LEAH TER
OREGON CITY, OR 97045 TIGARD, OR 97224
PHONE: 503 - 557 -2220
PHONE: 503 - 579 -3547
FAX: 503 - 557 -0919
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 05/03/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/03/2011 $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 OA 952 -00 -00 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,� /
Issued By: - Permittee Signature:
CA/ 'f r - ' v
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.
APR -29 -2011 01:19P FROM: TO:5035981960 P.3
Electrical Permit Applic i i ( , i E I I E D 1 t Ht t i l l l( I t ',T t )\ 11
City of Tigard Received ., �, Pealnit — i ,, a2.2,
'
13125 SW Hall Blvd., Tigard, atPiR232 9 2011 Plan Review � _
I Phone: 503.639.4171 Fax: 503.598.1960 Date/ny Otter Permit: se g20//-- 4e2/
1 i ti A R t) Inspection Line: 503.639.41 Date Ready/By: Jurir 0 See Page 2 for
Internet: www.tigard_or,gpy i T Y OF TIGARD Notified/Method: i 1 Supplemental Information
ttSS DING DIVISION t
TYPE OF WORK PLAN REVIEW
®A ddition/alteration /replacement
❑ New construction Please check all that apply (submit 1 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories,
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 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 ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived syster
Leah ❑ Addition of new motor load of CI "A", "E ", "t -2 ", "1 -3 ",
Job no.: Job site address: f �(�� LCC)J" 1 OW T n. IOOHP or more. occupancy.
OA (1724 ❑ Six or more residential units. ❑ vehicle parks.
City/State /ZIP: ��I(f►yyi�� ❑ Health-care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: I Project name: ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
feelttdes 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 OF WORK (with above sq. fl.)
• Ij'Cf '
_ _ 1 Ore./tit ' Limited energy, multi - family
j � L O �� , a residential (with above sq. 6.) 67.84 2
aY� r1 �).,min i-5 lrt Services or feeders Installation, alteration, and/or relocation
l 200 amps or less 100.70 2
PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2
Name: V lJ1 WO O 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: ae) Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: () &547 Fax: ( ) 200 amps or less 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, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: Same as contractor B. Fee for hranch circuits J
Contact name: Diane Mason without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'l branch circuit 1 7.42 _ _ 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Tri County Temp Control 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 any_of the above
Per inspection 66.25
Phone: (503) 557.2220 Fax: (503) 557.0919 Investigation per hour (t hr min) 66.25
CCB Lie.: 72623 Electrical Lic.: Cie Suprv. Lic. I ndustrial plant per hour 78.18 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 2 ' Subtotal:
Print name: Ran Plan review (25% of permit fee):
�� Date: 2Q I I State surcharge (12% of permit fee):
Authorized signature: .a f' / , TOTAL PERMIT FEE: 1 �/
1 „0
/1 f This permit application expires if a permit is not obtained within 180
Print name: Diane Mason Date: "I/1 days after it has been accepted as complete.
1 • Number of inspections allowed per permit. /
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