Permit 1114 �,�
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011-00729
T1GAR_ 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/29/2011
Parcel: 2S104DD04300
Jurisdiction: Tigard
Site address: 13520 SW AERIE DR
Project: TOBIN Subdivision: EAGLE POINTE Lot: 34
Project Description: (2) branch circuits for NC and furnace.
Contractor: A TEMP HEATING & COOLING INC Owner: TOBIN, HOWARD & LOIS A
16000 SE EVELYN ST 13520 SW AERIE DR
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 12/29/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/29/2011 $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 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 ect questions to OUNC by calling 503.232.1987 or 1.800.332 2344. •
Issued By: //1 •ermittee Signature: -- _ l i /��u
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 0 •
IrO1. 01 <.f: 1;s1: (ONLY
City of TIgard q Received
13125 SW Hall Blvd., Tigard, O 7V�' 4\\ Dare/3 1, '
• Phone: 503.639.4171 Fri.: 50 Plan �
Date/13 : Other Permit:
I t cn It.1 Inspection line: 503.639.4175 - ` , lC'j� 10 Data Ready/By: / s a Peg — _
Internet; www.tigard- or.gov H pl ePena 2 for _
���lS Dlotifiert/MetJwd; 8u
�. � Supplemental Information
TYPE ON WO ' . '� . PLAN REVIEW
❑ New construction R Addition/alien/fie, • 3 cment Pleaze check all that apply (aubmit a acts of plans w /items checked below),
Q Demolition ❑Other; ' ❑ 8rrvice or feeder 400 amps or more 0 Building over three stories.
where the available built current ❑ 'marinas and boatyards,
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
Co
d
ro
1• and ? family dwelling ❑ Commercial/industrial less to ground, or exceeds 14,000
❑ Accessory building [] rmharoial - nee agricuhural
12 Multi
Multi-family ❑ Master builder amps for another ilatallations. buildings.
❑ Other: I� Fire pump. ❑ Installation of 7510 Vp or
JOB SITE INFORMATION AND LOCATION E•' ❑ Emergency system. larger separately derived systcru.
n ❑ Addition of new motor loud of ❑ "A ", " "1 - "1 -3"
Job no.: Z .43 1 Job site address: l 3 U SW J 1 , t !rive 100HP or more. occupancy.
City /State /ZIP: i / ' rr ❑ Six or mare residential units. 0 Recreational vehicle perks,
r 1 0 1•teslth -csre facilities. ❑ supply voltage ton more than '
El Hazardous locations. 600 volts nominal.
Suite /bldg, /apt no,: El Service or feeder 600 amps or more. name:
• • . FEE SCHEDULE
Uered , . INIGninwitinzm
New residential single- or multi- family dwelling unit.
includes attached garage.
Subdivision: Lot no.: 1 oq. ft or leas
Tax • , . Ea, add'! 500 sq. ft. or portion —
Limited energy residential
DE
111 SCRIPTION e e with above a.. ft. 75.00 �
Limited energy, multi - family
' ' residential with above a. . it 75.00 0
Services or feeders installation alteration and/or relocation
200 amps or leas _ 100.70 El
rr PROPERTY OWNER !B TENANT 201 amps to 400 amps 11 133.56 Kil
Name: h i 401 amps no 600 amps 200.34
• • 601 amps to 1,000 amps 301.04 El
Address: O ; • VV./ Over 1,000 amps or volts 552.26
2
EMEMIEM O ( 6 1 2Z Temporary services or feeders installation, alteration, and/or
relocation
200 amps or less 59. 36
Owner instllation: ThiS installation is being made on property that 1 own which is not
201 amps to 400 amps 125.08
intended • ' • ) 701.
401 amps to 599 amps 168,54 gi
Owner signature:, _ _Date: Branch circuits — new alteration or extenaiva, per and
A. Fee for branch circuits with
4 APPLICANT Cj CONTACT t above service or feeder fan,
each branch circuit 7.42
Business name: " M �. , .1' �, • • y f� c • • u � t} t♦ ■ !, 1 i B. Fee for branch circuits without
Evelyn branch ur tucdpr fee, h first St' 1
Contact Hattie, 16000 SE $ve Sk. 'ranch circuit
Address: Clackamas, UR 9l4.145 Each add'I branch circuit MIZEIRIEN1113
03- 6505014 Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 U
dwelling, Service and/or feeder
Phone: ( ) Fax; : 03 ) c - Z , ' Reconnect only 67,84 0
E-mail: a , �, V a� 2 /i e �� Pump or irrigation circle 67.84
1" ' C �� Sign or outline lighting 67,84
CONTRACTOR Signal circuit(s) or limited- energy
Business name Each additional tlonai i t d eetion. P. _c 2
- tl ..t`_ yla t `_ *a/ L t i,' en over allowable in an of the above
Address: 16000 SE Evelyn St. Additional inspection (1 hr min) 66,25/ hr
City /State /ZIP: 5nj 15 Investigation (1 hr min) 66 25/ hr
Industrial plant (I hr lnin) 1 78.18/ hr OM.
Phone: ( ) pax; (, ) 55.or — 2ti ct Q Inspections for which no f cc i
1 s.ccifical] listed 14 hr min 90.00 / hr II
CCE Lic. :- ! I 11=112101111111 Suprv. Lie.: 2 41 •
Suprv. Electrician signature, required: Subtotal: 11! .7
1.2 �■ t• ,� • Plan review (25% of permit fee):
Print name; On y •
• f, . lt 4 I r 14111111MMISMI / State surcharge (12% of permit fee ):
Authorized signtitur ;�' 3y�� TOTAL PERMIT FEE; 11 rj,-
This permit application expires if a permit is not obtained within 80
Print name: r �,1 � �• �
5 o i i Date: J `( I I • days after it has boon accepted as complete.
Number of inspections allowed per permit,
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