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Permit IN CITY OF TIGARD ELECTRICAL PERMIT " COMMUNITY DEVELOPMENT Permit #: ELC2011 -00664 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2011 T1G,4RU Parcel: 1 S134DC00102 Jurisdiction: Tigard Site address: 11455 SW 115TH AVE Project: Bourque Subdivision: 2008 -038 PARTITION PLAT Lot: 3 Project Description: (1) branch circuit for furnace Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: BOURQUE, GARY PO BOX 80607 11455 SW 115TH AVE PORTLAND, OR 97280 PORTLAND, OR 97223 PHONE: 503 - 233 -1779 PHONE: 503 - 684 -8551 FAX: 503 - 651 -3345 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 11/30/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 11/30/2011 $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 OA 24: 4 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 87/orr 1.800.332.2344. Issued By: p / i/ l Permittee Signature: C/1/ 9 � G d !% %7�/!1 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 ApvlicatiO ll MI it . 1.: ► 4 L) \1.1 Cl of Tigard �� �� I "te R eceived .. C J I / n / L� �i /3 /i/ > Pennit No.: I tl (h - / r q 131 Hall lvd., Tigard, OR 97223 2 PIan�Rcvicw I lh I Phone: 503.715.2439 Fax: 503,598,19 \I 2 9 2011 Plan RV: Other Permit: t t <, , 1 4 n Inspection Line: 503.639.4175 Date Ready /By: 'uric // ® S m e 1.. 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method; ` / 1 l� Suppl • tat Inter : alien I TYPE O1FI , 0 r PLAN REVIEW ❑ New construction El Addition /alteration /replacement Please check all that apply (submit 1 sets of plans wit' ms checked low): ❑ Service or feeder 400 amps or more ❑ Itu8din ver three a rtes. ❑ Demolition ❑ Other: where the available fault current 0 Marinas nd boatyard , CATEGORY OF CONSTRUCTION exceeds 10,000 amps al 150 volts or 0 Floating . 'dings. less to ground, or exceeds 14,000 ❑ Comm.. int -use agrio , tural ® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buitdin.. ❑ Multi - family ❑ Master builder ❑ Other: 12 Fire pump. Uinstallat,,n I or JOB SITE INFORMATION AND LOCATION - El b d ition y system. of new motor load of Cl" A", • "G' .tely "1-3' +d system. ❑ Addition ❑ "A ", " 2 -2 ", "1 -3' Job no.: Job site address: 11455 SW 115' Ai1f...,"" 1001 tP or more. emu ' + ❑ Six or more residential units. 0 Recr ti eel vehicle . a. Ci /State/ZIP: Tigard ore on 97223 ❑ health -taro facilities. ❑ Supply , Itage for m+ • than Q Hazardous locations, tY S 600 volt nutmeat Suite/bldg. /apt. no.: Project name: © service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: ti .rriplioe Otr. F 1 'ref I - New residential single- or multi- falttlly dwel: rag unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 16' 54 I 4 ----- Fa. add'I 500 sq. ft. or portion 3 1 Tax map/parcel no.: Limited energy, residential DESCRIPTION OF WORK with above sr. ft, 7 "t t 2 Limited energy, multi - family E 00 ■■ 2 reconect gas furnace residential with above a.. ft. Services or feeders installation, alteration, a d /or reloc; lion 200 slaps or less I r e 70 I 2 PROPERTY OWNER 0 TENANT - 201 amps to 400 amps 13 56 2 Name: ry Bourque 401 amps to 600 amps 211 34 2 601 amps to 1,000 amps 30 04 I 2 Address: 11455 SW 115th PL Over 1,000 amps Of volts MINE E311111111•1 2 City/State/ZIP: /State/ZIP: TI and Oregon 97213 — Temporary servk or feeders installation, , I teration, .I d /or ty g g relocation Phone: (503)684 -8551 Fax: ( ) 200 amps or less 5' 36 I 1 201 amps to 400 amps 08 1111 2 Owner installation: This installation is being made on property that I own which is not 401 amps to s99 amps .li 54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. }Trench circuits --new, attention, or extenat n, +er pan I Owner signature: Date: A. Fee for branch circuits with 0 APPLICANT I above service or feeder fee, ® CONTACT PERSON each branch circuit 42 2 Business name: Ben's Heating B. Fee for branch circuits without a service or fader fee, first 5+ 18 2 Contact name: Clyde Burton branch 6ircuil Fitch add'l branch circuit 42 I 2 Address: , Miseellaneousjservicc or feeder not Inelud =1 i City /State /7.iP: Each manufactured or modular 6' 84 111 2 dwelling erviee end/or feeder Reconnect only 6 84 2 Phone: ( - ) Fax: ( ) Pump r irrigation gallon circle 6 84 2 E -mail: / it • • Ito A l , ", Sign or outline lighting 6 0 2 _ CONTRACTOR Signal eircuit(s) or limited-energy Business name: B Heating and Air Conditioning LLC panel, alteration, or extension. P. 2 2 ,� Each additional inspection over allowable ii any of thelabove Address: PO Box 80607 Additional Inspection (I hr min) 66. 5/ hr I Investigation (1 hr min) II 66. 5/ hr � I � City /State/ZIP: Portland Oregon 97280 Industrial plant (1 hr min) 78.. hr � — Phone; (503) 233 -1779 Fax: (503),651-3 45 Q- P 7 ' inspections for which no fee is Inc sl■ ■ a. cificall listed '/ hr min CB LAC.: 64597 E trees' L ic_: 49L it �� up . Lic.: 49LHR _ ELECTRICAL PERMIT ^ ' ES u " $ up rv. )✓lecirician � gt�attir , T oyuired: 1f i/+ a Subtota l Plan review (25% of permit fcc Print name: Clyde Burton Date: j`/a State surcharge (12% of permit fee 7 y 1 TOTAL PERMIT FE: 6 oZ 1 9,2-- Authorized signature; 0 / r*!+i` = ' This permit application expires If a permit Is no' blamed wi In 180 Print name: Clyde Burton Date:: ; days after it has been accepted as c ,, piece. _6 Number of inspections allowed per permit, 1; tuitdingWarmitalEl .GpetmitApp.doc 07(01 /1O 440- 4615T(1 I /03/COM/WSB T00 2 HIY'BONIZVHH - S NHH STC CT29CO5 XHd 92 :8T LOOZ /6T /T0