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Permit 11 y q CITY OF TIGARD ELECTRICAL PERMIT 11 • COMMUNITY DEVELOPMENT Permit #: ELC2009 -00510 1Gt3 RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2009 T Parcel: 1 S133DD05300 Jurisdiction: Tigard Site address: 11546 SW LAKEVIEW TER Subdivision: Lot: 0 Project: Jackson Project Description: Reconnect furnace and a /c. Owner: FEES JACKSON, DOUGLAS Quantity Description Date Amount 11546 SW LAKEVIEW TERRACE TIGARD, OR 97223 2 crt Branch Circuits 09/30/2009 $53.50 wo /Purchase Service or PHONE: 503 - 524 -4249 Feeder 1 ea 12% State Surcharge - 09/30/2009 $6.42 Electrical Contractor: TRI- COUNTY TEMP CONTROL 13150 S CLACKAMAS RIVER DR OREGON CITY, OR 97045 PHONE: 503 - 557 -2220 FAX: 503 - 557 -99+9— 2 Z 2 0 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $59.92 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 952-001-0100. You may obtain o copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: -125) l :t I .1i _Q 3,13 IJJ j Permittee Signature: Q A 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 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. SEP -29 -2009 12:16P FROM: TO:5035981960 P.1 Electrical >� ' RECElectrical Permit A Iicatl0 1.014 01414 1. t'SI 0 \1.1 . City y of Tigard Date/B : ,ii Permit No.: . CZOOQ .0Q ( • 13125 SW Hall Blvd., Tigard, OR 97225 EP 2 9 2009 ■ : Phone: 503.639.4171 Fax: 503.598.1960 EN111.1111.1111 other Permit: i It, n 1: t7 Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: INNI See Page 2 for Internet: www.tigard Not illed/Method: Supplemental Information BUILDING DIVISION TYPE OF woRK PLAN REVIEW ❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /Items checked below). ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or © Floating buildings. less to ground, or exceeds 14,000 0 Commercial - use agricultural ® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. E] Multi-family ❑ Master builder El Other: ❑ Fire pump. ❑installation of 75 KVA or JOB ., ❑ Addition of system. larger E".' separately "1 system. OB SiTE INFORMATION AND LOCATION El Addi6an of new motor load of ❑ "A", "E". "I - ", "I - ". Job no.: Job site address: ii64.4 e,w LOJ' Ii il) -e 100HP or more. occupancy. ❑ Six or more residential units. ❑Recreational vehicle pvka. City /State /ZIP: Tigard, OR 1� ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg.lapt. no.: Project "tame: O Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Nee. i 'Intel i ^ New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. A. or less 145.15 4 Ea. add'l 500 sq. ft. or portion r 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK s (with above sq, ti.) • eeontra turnaCt. el Q1 r sand: °n or. Limited energy, multi - family 75.00 2 residential (with above sq. ft.) Services or feeders installation and /or relocation 200 amps or less 80.30 2 K PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: ug n 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City /State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( 6(a) s24-424q Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: Same as Contractor B. Fee for branch circuits Contact name: Diane Mason without service or feeder fee, 46.85 2 first branch circuit Address: Each add'1 branch circuit 1 6,65 2 Miscellaneous (service or feeder not Included) City /State /ZIP: Each manufactured or modular 90.90 2 dwelling, service and /or feeder Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Temp Control Signal panel, or limited - Business name: Tri County P energy panel, alteration, or Address: 13150 S. Clackamas River Drive extension. Describe: Page 2 2 City /State /ZIP: Oregon City, 97045 5 7 a. Z 2C ) Each additional inspection over allowable in any of the above . 55 Per inspection 62.50 Phone: (503) 557.2220 Fax: (503) 557.0919 investigation per hour (I hr min) 62.50 CCB Lie.: 72623 Electrical Lic.: 527LHR Suprv. Lie.: 2567LEB Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Print name: Dave Salholm Date: VIM Plan review (25% of permit fee): Stale surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: 612_ � This permit application expires if a permit Is not obtained within 180 Print name: Diane Mason Date: ( �� days after it has been accepted as complete. • Number of inspections allowed per permit. I: Building \Permns\ELC- PermiApp.duc 05/23/06 440.4615T( I I /05 /COM/WEB Di al\ e _ ry G in SEP -29 -2009 12:16P FROM: TO :5035981960 P.2 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* Xr Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. L are required for all other installations i UsuudingWermlrs \CGGPcnniIApp , doc O3/23/O6