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Permit , r CITY OF TIGARD ELECTRICAL PERMIT 1 111.1 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00191 Date Issued: 04/30/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103CD06000 Jurisdiction: Tigard Site address: 11670 SW FAIRVIEW LN Subdivision: Lot: 0 Project: Roth Project Description: Install (3) branch circuits to reconnect furnace and heat pump, and install work plug. Owner: FEES KOEHLER, JAY Quantity Description Date Amount 11670 SW FAIRWAY LN TIGARD, OR 97223 3 crt Branch Circuits 04/30/2009 $60.15 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 04/30/2009 $7.22 Contractor: Electrical CANBY ELECTRIC INC 790 S IVY ST CANBY, OR 97013 PHONE: 503 - 266 -7878 FAX: 503- 266 -5543 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $67.37 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- 00171100. You may o<t \ ain a copy of the rules or direct questions to OUNC by callin 246.6699 or 1.80 332.23 Issued By: \� M�J' \ Permittee Signature: pp lc OWNER INSTALLATION ONLY ' 1 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 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. y t. fit rin Mil ll'i le c al Permit A pn ic�ation TOR OFFICE USE ONLI' %..1. APR 2 8 2009 Q City Uf Tigard Oataa/B d . d �i t. t. I'crntit lJv. . ,' 1� • 13125 SW Hall Blvd.. Tigard. OR 97223 Plan Review . I . Phone: 503.639A 17I Fax. 503 598,194ITV OF TIGARD Date/By: Othet Permtl TWA LU) Inspection Line: 503.639.417> BUILDING DIVISIO " Date Ready/13y: r - f t See - vie a rue lntcm't: www.ti�_urd- nr.guv Notified/Mcthod: .,..._. -_ f. supplemental Information . TIDE of wox PLAN v 'VIEW ❑ New ctinstrucIion Additionlaltcration/rep ! acemenf �� Please check• :III that apply I.t.nit :sets of plans w/nems checked Wow): ' ❑ Service or feeder 400 amps UI Min ❑ Buildmp over throe stories. ' ❑ I)sRloiIt on Other: where the available fault current tti Marina: and boatyards. ..' CATEGORY OF CONSTRUCTION : Il ` , r' 'F exceeds I0,000 avow., at 150 volts or El Floating buildings, ' ' –( .. �i 1 -A _ _ ,� - ' '' less to round, Or exceeds !4,000 ❑ CvmmcrclaLu a�iu,hliiral . arn ily dwelling ❑ Commercial /industrial ❑ Accessory building a mp s lop all ink, m,tallartuns. building, • ❑Multi- family EJ Master builder ❑Other: ❑ Fire pwnp 0 Installacionor ' ^^. ❑ Fystem lar per , enarately derived gyare,n: . JOB SITE INFORMATION AND :I'OC �TTON • :.:;.;' ❑ Addition of new mut,u Inml ul ❑ A " „ 1 " 7 " "I Y Job site address: ( ` I 1001IP or mon: occupancy Job no == �0 � .. I f 7x' W I ��� f�l 4� [� Six Ur,n(1re ceSidhthel uniti L I It cc, cat�ocial vehicle parks: ' ('Ito /State /1;,1 f': y J / z f� Health-care facilities Cl Supph ■i,hagc for mote than .. . 666 ", tt 1 .. t► . Har tdoun locus s :y. , 00 vo31i nominal. Project ❑ Service or feeder 600 ,Imp). or more Suttetild flu.: .. 1 Y %acct name: go ; I,;;.. FEE • SCHEDULE p:,.:.;;,. �; , Cross strezddireclions to job site: Description 7 (t . rec. L Tole " – —' – —'. ' New residential si ngle- or multi - family dwelling unit. • . I ncludes attached gar age. . • Subdivision: Lot no.: 1 sq. ft. or less 145. 4 - --- -^-^ -- Ea. add'I 500 sy. R. or portion 33.40 ' ' I ' Tax map /parcel no.: _" Limited energy, rc,idc rtial ._..- b1 75.90 ) • DESCRIPTION OF 4VO1t I{ w ith above so. tt ) Limited energy, multi - hand!) 75.00 2 • ' i'f Z , residential (with s .q. 0.1 hove - ' - "' Services 0r feeders installation, A lteration, and /Or relocation ' ' "� , . 1,./Dv-k, L :' *f�NT 204 humps of lcsse � K0. - ---- ❑ PROPERTY ><3 . 201 amps to 400 amp: 106.85 2 Name: 401 amps to 600 amps 100 0)) 2 1�C7 _�l -- ._.,., - 601 amps to 1.000 amps {. _ 2 2 • A'ddreSS: Over 1,000 amps or volts r 45-I 65 2' 'City/State/Z[1'. 'L"r" Temporary services or' feeders installation, alteration, and /or — ..__ relocation Phone: ( 7 �I !. q . C p I Fax: ( ) 200 amps or les, _ _ L ......., ._ 66 85 • I l 201 amps to 400 amps 100.30 2 • ' . Owner installation: This instillation is being made on property that 1 own which is not _.. --- intended for sale. lease- rent, or exchange, according to OILS 447, 449, 6'70, and 701. 401 amps 10 599 amps 153.7S 2 Branch circuits– new, alteration, or extension, per panel I)ati - . ()wrier signature' A. F cc for branch circuits with :, : . ❑ APPLICANT' © CONTACT . PERSON abo ve SC rvice or feeder foe 6.65 – .,.. — each brmrch circuit —..,-- _ Business - name: B. Fcc for branch circuits - • - - -- ..._ - ........- .r. , .,. widroul service or (ceder' roc. 85 46. li‘ � ? Contact name: first branch circuit ' Addre §S: Each udd'I branch circuit II- 6.6.5 1 2 _ - . ..... . . ... - . Each (service or feeder not i nc l udcrt) ' . • (at)' /State /Zt P'. Each manufactured or modular 7 90 90 2 _. - - - __ , scrvicc er Vnr teL'CICr . • Phone: ( I 1 l -"ax :: p ow t twc°n l y bb.ft5 2 ( 1 KG�lrrlIle. t __ , T _ ._.. ...,. E mail: — iri gation circle 53 40 z C ONCItAC1'O'. ,,, - Sign or vuttine lighting 1- / . "• L. " "" Signal circuit(s) or limited- 1 ' Business name ,� 1 P .f ,'\- A C . i. C- ," energy panel, allcrtion, or - -- , Page 2 1 extension. Deicrthe. Address: I Clay /$talc /2.1f' ` E ach add i nspection over' allowable in a ny of the a bove . �.�Va ° �` ... inspection Per nspecton Phone: �d 3 'Z Co L, !,?.50 I'ax: c- hIV85ti_ l lour „un{ 02.50 ' ' t G L (� a �1 b t 6i (I I ant l F c:h o ` i tt tl(' A 9 €'t:fZMil i 1 2c, Industrial plant _ L. ('C 13 Lic.: \ l:lcctrlc ll 1 .. S t,Pn. Li � l Z�i..� _ FEES • Suer\'. Elect,lulan :ii.lnattlr t,ttllilrud:.l .. , a. 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