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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00361 111OAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/29/2011 R Parcel: 2S 111 CC21300 Jurisdiction: Tigard Site address: 10250 SW GREENLEAF TER Project: Lawrence Subdivision: SUMMERFIELD NO 5 Lot: 271 Project Description: (1) branch circuit to reconnect gas furnace. Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: LAWRENCE, JANET PO BOX 80607 10250 SW GREENLEAF TERR PORTLAND, OR 97280 TIGARD, OR 97224 PHONE: 503 - 233 -1779 PHONE: 503-620-4998 FAX: 503 - 651 -3345 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 06/29/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 06/29/2011 $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 0 952- -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344, /I Issued By: 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. 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. 06/28/2011 09:43 FAX 5036513345 BENS - HEATING &AIR al003 Electrical Permit Application O I )i IIl t I i': 1 SE : .N I.1 y of T lil-d REC ; ,9 :,- `W txo 13125 s W Hal ga IIlvd - , Tigard OR 97223 Cit A °atelB . a' �� J P ` rm ' E�o20f� / II a • Phone: 503.718,2439 Fax: 503.598.1960 U B 2 Fin Review lnntelBy: Other Permit: i' I t: A It t 1 Inspection Line: 503,639.4175 Date Reddy /Dy, aril: 81 See Page 2 for Internet: www,tigard- or.gov CITY OF TIGAI 1 Notified/Method: 77 Supplemental Information TYPE OF WO '1' 1 1 1 t . 1 PLAN REVIEW - ❑ New construction Addition /alteration/repta cment Please check all that apply (submit a sots or plans w /items checked below): d Demolition ❑ Other: ❑ Service or feeder 400 mops or more 0 Building over three stories, where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Boating buildings. g -- less to ground, or exceeds 14,000 0 Commercial -use agricultural i- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION 1D Emergency system, larger separately derived system. 0 Addition ofncw motor load of 0 "A ", "E ", "1 2 ", "1 - 3", Job no.: Job site address: /09,-p S5 a'ye 1es,+ r–e tr, oo Recreation. ❑ six x o or r more residential units. 0 Recreational vehicle parks. City /State /ZIT': ' O Z - •• � J 0 Health -care f'acililies, ❑ Supply voltage for more then 9 f ❑ 11axud0us locations, eon volts nominal. Suite/bldg. /apt. no,: L Project name: 4 *, (.4 rc-r c e 0 Service or feeder 600 amps or more. — " FEE SCHEDULE Cross strcet/directions to Job site; Dneriudao J Oty- I Fee. 1 Total I • New residential single- or multi- family dwelling unit. "�1 includes attached garage. Subdivision: I Lot no.: 1,000 so, ft. or leas 168.54 4 l Ea. add'l 500 sq, It, or portion 33.92 l Tax map /parcel no.: Limited energy, residential 75.00 2 AF CRII''I'fON OF WORK (with above sq. ft.) - 1,imited energy, multi- tamily 7500 2 r � � ( ` � residential (with above sq. ft.) Services or feeders installation, alteration, and/Or relocation 200 amps or less 100.70 2 a PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 133.56 2 Name: r 401 amps to 600 amps 200.34 2 --� �� La W're^'' C 601 amps to 1,000 amps 301,04 2 Address: r O $ 0 5(A) (.ire e_,0 Le ire - tprifw p Over 1,000 amps or volts 552,26 2 City /State /ZIP: -77-G. L Temporary services or feeders installation, alteration, and /o dt7Z•Q t _ 9 9 o't relocation 200 amps or less 59.36 1 Phone: ,3 L/ p Fax: � ?. 6 ^ / ( ) 201 amps to 400 amps 125.08 2 Owner Installation: This installation is being made on property that I own which is not 401 amps 0 599 amps 16/1,54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits -new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with B. APPLICANT above service or tbedcr tee, I ©CON FACT PERSON each branch circuit 7.42 2 Business name: g Sf lr /are 47`_ � Ai r t Ge_ B. Fee for branch circuits without ^ service or feeder fee, first 56.18 2 Contact name; 01 y d to e u r no branch circuit n Each add'l branch circuit 7.42 2 Address: iP p . /3 gj I0 ? Miscellaneous (service or feeder not included) City/State/ZIP: Pa Ott *MD OR- 99 2810 Each manufactured or modular dwell in_ service and/or feeder 67.84 2 ( 3 ) 23 3— t ”9 I (S 13 6s/ — 2 3 y Reconnect only 67.84 2 Phone: Fax: ) Pump or irrigation circle 67.84 2 E's- mail:. c eat 1 A , CO-00 Sign or outline lighting 67.84 2 CONTRACTOR Signal circuits) or limited -energy . Business name: 1 , - L panel, alteration, or extension, Page 2 _ 2 • Each additional inspection over allowable in any of the above Address: . , _ (- b 0 ,- Addittonal inspection (1 hr min) 66.25/ hr Q �T n Investigation (1 hr min) 66.25/ hr City/State/ZIP: 4 i) g � , q . } , 12 i;92-41"z) i 1� industrial plant (1 hr min) 78.18 / hr PhonC: (4• ) 233 --1 ') 79 Fax: (,fro? ) ' / 330- / b Inspections for which no fee is 90.00/ hr specifically listed (h hr min) CCB Lic.: 4 �� Electrical i.� � w —/IC. Sup rv, L i C .. ,: ELECTRICAL PERMIT FEES P signature, K t Subtotal: s /� Su pry, Electrician si nature, rC uired: iA A Plan review (25% o f permit key Print name: C [ at kr , Dale: 6 r State surcharge (12% of permit fee): 1p r y I l Th is permit application expires if a TOTAL PERMIT FEE: 6 A. ?a Authorized signature: _ p permit is not obtained within 180 � �/�, L /t e i f I _ ,.,./ J days after It has been accepted as complete. Print name: C L L\ LJtj� , Date: /i/ " Number of inspections allowed per permit. is vBuilding \PermitsEIC- Pe,mitApp,doe 07 /u1/lu 440i61 5111 1 /0 5ICOM/wEu