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Permit
,� CITY OF TIGARD ELECTRICAL PERMIT " 1 2 ' ' COMMUNITY DEVELOPM Permit #: ELC2011 00526 Date Issued: 09/23/2011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Parcel: 2S104CA04500 Jurisdiction: Tigard Site address: 13521 SW MICHELLE CT Project: Rushlow Subdivision: HILLSHIRE Lot: 45 Project Description: (2) branch circuits for furnace replacement and a/c install Contractor: A TEMP HEATING & COOLING INC Owner: RUSHLOW, MAREE HOLLAND 16000 SE EVELYN ST 13521 MICHELLE CT CLACKAMAS, OR 97015 -9519 TIGARD, OR 97223 PHONE 503 - 650 -5014 PHONE: FAX 503 - 557 -2990 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 09/23/2011 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 09/23/2011 $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 sued subje o 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 ap• •ved 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 AT ENTION• Oregon law -q•.res you to follow the rules adopted by the Oregon Utility Notificati•• Center Those rules are set forth in OAR 952 -001 -r 010 thro •h OAR 952 -'r 809. ou may obtain a copy of the rules or direct questions to OUNC'• - • •A1 987 or 1 800 33 344 OA e Issued — J- • 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. Electrical Permit Application H ' �1i , p 1�� 1�()I!: < >f•i lc.t..l;�it ONLY City of Tigard i . R ece.vd r 13125 S W Hall Blvd , 'I'tsard, OR 97223 }p an R �J e // ry II p„nit No E/ CaQl t -66 n /! Phone 503,71824:39 Fax 503,598 1960 SEP 2 2011 I'IonRcv3ew �'So Inspection Lilo, 503 6304175 Date /lay OtherPcrtnir, •!' l C,iA R'f) CITY p �°�� Date Reudy/Bv kris Internet: www.tigard- or,gov CI t [ OF TIG '� See Page tar r�S'l� N oufiud ntethad Mr Jr" .�.:,, , -�,,,� ,,. SuDPICIDCatkt Lnlarn,afiUn TYPE OF W4(iKILI_ alt ✓ltv3�� - -� -_.— PLAN REVIEW ❑ New construction RAdditio /alteration /replacement Pk/44 check all that ap ply (subr 2 :els ofp}atis w / {tans cheeked below) — ❑ Service or teedcr400 amps 01 1lru10 ❑ 8ailding o\ el thise storie © l)CntOf rUUtt ❑ Other: whey the uaulabic 14n1( ciurent (;I Mtu and boatyards CATEGORY OF CONSTRUCTION eocueas 10,000 snips at 150 volts at Cl Floamtg brnldui5s l- and 2- family dwelling U Commercial /Industrial Accesso1' 1 oi to ground, or e\CCUJs Ia,000 Q COtnut coil - = y buildntg r, ❑ MitlLi- family Ma autos for all other insiallaimils buirJ,nes, ❑ stet builder Other: in Fire pwnpr' El installation of 75 K VA u, JOB SITE INFORMATION AND LOCATION 0 Frncl Fenny assist„ lamer separately derived ;ysrcm ❑ Addnwn of nevi 1110101 toad 61 E • A ', • -E ', .1-2", .1-3 tub no: Job site address: 13,. 2 r Z. ( t1A e II 2 I loPo mai �. 11 ISCaCe /Zl1'' ! �� 9 l •yE• ❑ }�r ul-I Ot It1ow r Icsidcmial ,,,,,k, 0 Rect.u,,,,, vol,,,,,, ad; �, y t ' , 0,,c) 0 i 13 0 I -rte facilirit s ❑ Su ,ollu fur mole than SOIL / tat �. a t n 0.: ` � ^ ❑} locauuus 600 ruffs nominal b p Pro rut name: V S I 0 ❑ Serwce or torso 6U1) a mps ut lung, (;rosy street /directions to job site: `— .� FEE SCHEDULE -�„_ T , - -� Dr^ crlphurr • ,_ I I�CG rulat — ^ n� - New rrsideutial single- or multi - family dwelling u nit � I neludcs attached garage. Subdivision: +Lot lt0 : �� 1.000 s q. ft or}cs8 _ 168 Stl 4 - -. F,a 8dd'i SO0otl t1, arporuun 33 42 1 Tax map /parcel no.; Lutliled encr> )), rrstdra,ttal • -- DESCRIPTION OF WORT; 7j,0U CWttll abUYC SG n } 2 T" y Limpet! energy, tttulti- )omit • 75 00 2 / 1 J UG s-�� 12 residential (with above sy H. Services or feed illation, alteration, and/or relocation CNA c 11 ers nsta g PROPERTY OWNE 200 amps or less 100. 70 _ El 201 amps w 400 amps _ 133 56 Name; C uCh t, ui 4 UtaYnpstob00amps 200 3.1 J v 001 amps to 1,000 slaps 301 04 2 Address: J GkQ 11,k, Over 1,000 strips Or volts _ 26 2 ( fly /State /LJP; J l t" p • Z Temporary services or feeders installation, allerxgou, and /o v ri relocation Phone: ( ) PAX: ( ) 200 amps or less 59 36 I Owner installation: This installation is being made on property that I own which is not 401 amps to 400 amps 125 08 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps w 599 amps 6i1 >4 2 Owner Signature: A. Branch circuits - new alteration, err extension pe age! Date: A. Fee for brunch cireuds rvetle tgl ^ - APPLICANT ...,=-- ❑ CONTACT PERSON above service or feeder tee, 7 42 ` 2 each branch crew; [3USine55 name: 13. Fed for branch circuits wlthar,t — server or feeder far, first j 2 C:onlaCl n „ ame: urouii 56 18 e1 C^ � i , r f i 1 branch a �t (. 7015 * Ol L Each add'I branch uirccircuit 7 t2 • Address: � hltscellarieous (service ur teeder nut included) City/Stale/ZIP: Each manufactured or modular 67 84 2 dwelling, sot and /or feeder Fax: ( Reconnect only 6 / g4 P h o n e Pump or i _0n circle 2 CONTRACTOR Sign or outline lighting 67 84 2 Signal arcun(s) or limited-energy 13u$il'IC55 name: panel alteration, of eNtan5 P 2 2 - A TB ' �INl-p 'CDQ Each a dd ll i o nal inspection over ailowablc in xin the II buvc Address ) of i (il.P■ " 16:;'. ,.1 t' Additional inspection (1 II( min) 0C125/ h1 " . ` investigation (I h1 mi t - City/State /TIP. C:rlc�(s111 7$, (.4 )'7O 5 6625, hr Industrial plant l I hr min) 76.18/ hr Phone: I ) -563--1!6•FP9J.4( 1 Inspections tor which no tee is `T speciticallR fisted IV ht ,uln) 9011(}/ IYr C:C [� Lie.: 4 Q Llreuieal Lie.• - Suprv, Lie -: 2, ELECTRICAL PERMIT FEES _Suprv, Electrician siglZautrc, reduired, Subtotal - .� Plan review (;j ° /uul'prrntl(fee)' Print rimier 0 V I k j ' C (1 Y1"11 Date. 6 \ 2.j State surehalge (I of poratit fee) Authorized signature: - Ili TOTAL Pf_RN1IT FEL- _ y _ This permit applicuhan expirev ii' pe it out ubtainr thin TSU Prin l 118,111C: VI l h 1 „( Dare: /1 3 I dys a after it lieu becnaccepled as complete. 4 SA'f i !� / " Nuurbcrullnspechon, thawed 1)41 p;,rnnr I' \Ri.�in- \i,�, „•i .11-I ('- Pnrmii tl„i, .f... ,i ,iii iii r CO 39dd ONIlt13H dW31 d 966ZLSSCOS ZZ :ZT IT9Z /EZ /69