Permit CITY OF TIGARD ELECTRICAL PERMIT
' - 111 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00658
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2011
Parcel: 2S110BD05600
Jurisdiction: Tigard
Site address: 11904 SW VIEWCREST CT
Project: Osterman Subdivision: ASPEN RIDGE Lot: 23
Project Description: Install heat pump. Placement of unit must meet minimum 5' side and rear yard setbacks.
Contractor: A TEMP HEATING & COOLING INC Owner: OSTERMAN, EDWARD J
16000 SE EVELYN ST 11904 SW VIEWCREST CT
CLACKAMAS, OR 97015 -9519 PORTLAND, OR 97224
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/07/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/07/2011 $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 OAR 952 - 001 -0090. You may obtain a copy of the rul es errfrtecF• estions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i a Permittee Signature: _ .rt
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.
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Electrical Permits I n n RECEIVED
icat n t��oit of i iulc l,.i l `ONl.ti /^� / r
1114 Cl W TI Tigard NOV 2 5 2011 p i tt, l� of � ��/ .0. — 6 5 r
>� g Permit No.:
,--- • 13125 SW !tall Blvd., Tigard. OR 97223 Plan Revie +' • • Phone: 503.718.2430 Fax: 503.598.1 �'qTY Ijar other Penni':
OF TIGARD
TI r -i l5 Inspection Line; 503,039.4175 BUILDING DIVISIO Date Ready/By;
I�1 'See Page 2 for
Internet '<vww.tigard- or.gov Notitird/Mrthod: Supplemental lnfornrariun
TYPE ON WORK PLAN REVIEW
' ❑ New construction 121.,, Addilion /alterauiorb'replacernenl Please check all that apply (submit 2 sets ol'plans wit terns checked below):
❑ Service or feeder 400 amps or more ❑ Building over thiee sturics
❑ Demolition ❑ Other: where the mailable fault eternal ❑ Ivlaiiuss and boatyards.
CATEGORY OF CONSTRUCTION e•cectls 10,000 ;Amps at 150 volt,. or 0 FIvet11,6 build i NS,
km to ground, or exceeds 14,000 ❑ Commercla•ttse agricultural
f • I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building on for all Libel installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire poop. ❑ installation of 75 K VA or
JOB SITE INFORMATION AND LOCATION ❑ 1 d system. larger sepsrat ly derived uVticlll.
❑ A ddiion of new motor load of
Job no.: /] Job site address:
( , 7 _ " 1140 r1,14 1 y1� �i� C 1 IOOHP or more. occupancy.
0 12,1.1,,,, llal ve hicle arks.
♦ ❑ Six o r more residential uni i
City /State /LIP: -rt } Health -care facilities, ❑ Supply voltage for more than
` .4,2.2 ❑ Hazardous locations. 500 volts nominal.
S uite/bldg. /apt, no.: Project dame: 054 e,r1i1A10 ❑ Service or'l'ecdor b?U ;rips to mum. Y
FEE SCHEDULE
Cross street/directions to job site: uescrtptlan TQN. Fern Tota
- "•' W' New residential single- or multi- tainily dwelling unit.
includes attached garage.
Subdivisiurt; Lot no.: 1,000 sq, ft. or lose 168.54 _ . 4
Tax n1A !areal no.: Ea. as3d''I 500 sq: rt. or portion 33.92 l
p p Limted energy, residential
DESCRIPTION OF WORK ,,with above sq. ft.) 75.OU 2
t Limited energy, multi- family 75:00 2
IA • kk. j U 4 ' ( 4, \ _4i oi\ 1 t S7 A6(r\ C t r ^ U 1 . residential (with above sq, ft.)
Services or feeders lustallation, alteration, andfor relocation
200 amps or less 100,70 2
a PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 1 33.56 2
1�an7C:
0 E t v� a� '- 401 amps t 6 00 strips 200.34 2
__�•,,.. 601 amps to 1,000 amps 30).04 2
Address: i 0 .
\R LW C f} ` ( Over 1,000 amps or volts 552.26 2
• "-' Temporary services or feeders installation, alteration, end /or
City /State /ZIP: - 'cl q 6 ,,,. r I Q G 41:1 4 relocation
Pax: ( ) 200 amps or less 59.36 1
Phone: ( ) - - ----° - °,------- -...`.
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is riot 401 amps to 599 amps 168,5 f 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
rg APPLICANT El CONTACT PERSON agave service or feeder toe 7A2 2
_ each blanch circuit _
Business name.: _ • - 13. Fee for branch circuits without,
service or feeder tee, first 1 56.18 ') ' Q 2
Contact Hanle: _- branch etrcuif a
Each add') branch circuit 7.42 2
Address: .; ! ORM Miscellaneous (service or feeder not included!
—503004014- "" Each manufactured or modular
City /State /GIP: dwelling. service and/or feeder 67.84
Phone: ( ) Fax; . (cp i 664 — Z — Reconnect only 67.81
1 Pump or tmgatron circle 67.84 2
E-mail: , . .... Si8r1 oroutliN.lighting 67.84 2
CON•fRACTOR S i o nal cireuit(s1 or limited-energy BUSineSs name: - cl, alteration. or extension. Page 2
A ?9Cr in+ T T-... •.__ Each additional inspection over allowable in any ul' the above
--- R = �,r� � �Tt:z �svr� Ate, INC .
Address { 1 l/ Additional inspection (1 hr min) 66.27/ hr
<) t St., lnve sti8aliop (1 hr min) _ 66.?5; hr
City /Stalc/Z Clal:!~at'nas, (.,P 97015 __.
Industrial plant (I It mgt) ?B. its; hr
3 - b5 x/44 _ --
Phone: ( ) t -it,x; ( ) lnspecuons whl
Ili( Ch no tee is vo.00/ hr
. ., specii"ically Iis I hr mm)
CCl3 Lic.: Q LlcCtrical Lie : Sup rv, I.iC.: G. } ,1 O
- eLl CTRICAL PERMI FEES
c� sublutac —,5 D1�_..
Suprv. Electrician signature. required; Plan review (25% Cif permit fee):
_ _
Print nz7me: il.
0 V1 e . �� yr i � • Owe: } (5/ Stale sur0htrrge (12 °/u OF permit lee): i-1--k • -° i ToTA I... PERMIT FEE.: 2. 42.,
Authorized signature: AL 4, •.: t.. _ This permit application expires If a permit is not obtained within 180
V me, 1 [ / days after it has been acespiraccepted a m
coplelc.
Print name; D f l 4P �� Date: 1 ��/ ) -
. . l � " Number of inspections allowed par permit.
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