Loading...
Permit , CITY OF TIGARD ELECTRICAL PERMIT 1 '! ;" COMMUNITY DEVELOPMENT Permit #: ELC2010 -00060 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/04/2010 TIGARD Parcel: 2S104AB10600 Jurisdiction: Tigard Site address: 12365 SW 132ND CT Subdivision: MORNING HILL NO. 6 Lot: 135 Project: Harral Project Description: Reconnect gas furnace. Owner: FEES HARRAL, GENE D & Quantity Description Date Amount PATTIE M REVOC TRUST, 12365 SW 132ND CT 1 crt Branch Circuits 02/04/2010 $56.18 wo /Purchase Service or PHONE: 503 -590 -2684 Feeder 1 ea 12% State Surcharge - 02/04/2010 $6.74 Electrical Contractor: BEN'S HEATING & AIR CONDITIONING LLC PO BOX 80607 PORTLAND, OR 97280 PHONE: 503 - 233 -1779 FAX: 503- 651 -3345 Type of Use: SF 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. ATTENTI• : • egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -00 hrough OA' =52 -r' '10r You may obtain a copy of the rules or direct questions to OUNC by calling 546.6699 or 1,800.332.2344 • I A A Issued :y: Permittee Signature: _ /J.• ,„e A uk 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' 41111111116W ! Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. r. le- Electrical Permit Application RECEIVED • FOR,01 /Ii.I(f 'I'1 oNt.l City of Tigard FEB 0 4 2010 Received Date/B : if O Permit No,; fie i , , -4 13125 SW Hall Blvd., Tigard, OR 97223 • " I Phone: 503.639,4171 Fax: 503.598.I� OF TIGI�RD Other Permit; • TIGAItli Inspection Line: 503.639.4175 Data R 5d See Pe Internet: www.tigard or,gov BUILDING DIVISIO Not Read ethod 4e 2 (or Supplemental Information ���,jj/ OF. WORK ' PLAN REVIEW El New construction ddition/alteration/replaCemenl Please check all that apply (submit 3 sets of plans w /items checked below): El Service or feeder 400 amps or more ❑ Building over three sturies, DemolitionOther where the available fault current El Marinas and boatyards, CATEGORY. OF CONSTRUCTION. .. ',. `,:; : " e' • ,----- exceeds 10,000 amps at 150 volts or ❑ Floating buildings. and 2 dwelling Commercial /industrial less to ground, or exceeds 14,000 173 Commercial - use agricultural 1 Y g ❑ ❑ Accessory building amps for all other installations, buildings. Multi - famil © Master builder ❑ Other: ❑ Firo pump. ❑ installation of 70 KVA or JOB SITE INFORMATION AND LOCATION? ❑ Emergency system. larger separately derived system • ❑ Addition of new motor load of 0 " A•' "E^ "1 - 2" "1.3 ", Job no,: Job site address: , J Cr Six or occupancy. r ❑ Six or mare residential units. ❑ Recreational vehicle parks. City/State/ZIP: f i- et c7 -a,2 3 ❑ Health -care facilities, ❑Supply voltage for more than t ❑Hazardous locations, 600 volts nominal. Suite/bldg. /apt. P roject name: U FEE SCHEDULE Cross street/directions to job site: I5ucrlptton _Lam.] - 1 '. e. I 'r at.l _(„ _ New residential single- or multi-family dwelling unit, Includes attached garage, Subdivision: 1 Lot no.: 1,000 sq. ft. or lass 165.54 r 4 Ea. add'! 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential • f / .� f�Gr' DESCRIPTION OF WOAI{ '. . :;*: :.,':1•::.' ;: a: (with above aq. ft.) 67.84 2 �,� � � �%' Limited energy, multifamily 2 ^.. F e � ��✓�r C residential (wits, above aq, 0.) 67.84 Services or feeders installation, alteration and/or relocation 200 amps or less _ 100.70 2 *PROPERTY OWNER 1 'TENANT 201 amps to 400 amps 133.56 2 Name: be / 7'44! t 401 amps to 600 amps 200,34 2 Address: / 'a 3 6 s /Sa + - Over 1, 0s to m. u aims 552 04 2 (�/ Over 1.000 nm. s or volts 111.1 552.2G 2 City /State/ZIP: s el / ? k 3 Temporary services or feeders installation, alteration, and /or ,., Cth relocation Phone: (,S,V3) alv it ,, A 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 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: _ A. Fee for branch circuits with $!APPLICANT • • I ' ' 0 CONTACT PERSON • above service or feeder fee, 7.42 2 Business name: each branch circuit —^ ^ to �14 I A .J B Fee fur branch circuits 1 Contact name: without o branch service feeder fcc, 56 ,/ a first branch circuiui t 2 Address: Each add'! branch circuit 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: (,C.Q _3) 3l 3 / 3 F7 Fax: : ( ) Reconnect only 67.84 2 E - mail: Pump or irrigation circle 67.84 2 CO OR Sign or outline lighting 67,84 2 Business name: 1 t�� / � J " /t✓ �'/ Signal panel, er or t i on , or m energy panel, alteration, at Address: p , g 0 q 0, �l ✓ extension. Describe: Page 2 2 City/State/ZIP: e I • .„-- • C ( g am - Q " ^ � C� �•7 Each additional inspection over allowable In an�nf the above . - - I o QS- 4 .. Per inspection 66.25 Phone: ,�) . -- / 7 Fax: (Cr _Z) 661— 3 Investigation per hour (1 hr min) 66 25 CCB Lic.: w S Electrical Lic.: 0 i ". Suprv. Lic.: L Industrial plant per hour 78,18 Ear t ELECTRICAL PE FEES Sultry. Electrician signature, required: ``/ Subtotal ,6(p. /g Print name: c i f Date: �� Plan review (25 °l0 of permit fcc): _, " .r., Slate surcharge (12% of permit fee): 6. 747„f _ _ Authorized signature: ) o f illria. TOTAL PERMIT FEE: 2 Print name: C `, D �� This permit a pplication expires if a permit is not obtained within 190 lA f d ays after It has been accepted as complete, ' Number of inspections allowed per permit, l'. Buildlea \Psrmits1ELC•PermitApp.doc 10/01/09 440.401ST(11 /o5 /COM/wEB T00IJ 2IIV — SNBH 07CCTS9CO2 XVd 90:6T L00Z /T0 /T0