Permit 11 CITY OF TIGARD ELECTRICAL PERMIT
= COMMUNITY DEVELOPMENT Permit #: ELC2012 -00267
Date Issued: 05/09/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S102CB03301
Jurisdiction: Tigard
Site address: 9952 SW FREWING ST
Project: Darrow Subdivision: FREWING'S ORCHARD TRACTS Lot: 20
Project Description: (2) branch circuits for gas furnace and NC
Contractor: A TEMP HEATING & COOLING INC Owner: DARROW, DON S
16000 SE EVELYN ST 9952 SW FREWING ST
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 05/09/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/09/2012 $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 OA 2- 61-8 90. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 o or,
r1.800.332.2344. /
Issued By: Permittee Signature: 0� '1 ,4 e "9 7 0" ^
•
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 603.639.4175 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.
RECEIVED 5
. Electrical Permit Application rO►: ()ri l('1.: use: t1N1.1
C i t y of Tigard MAY — 7 2012 Raeaivcd MI
1 li
13125 SW Hall Blvd., Tigard, OR 97223 plan Review
Phone: 503.639.4171 Pax; 503.598 Qi11°r Pu opt'
\ ;; , Inspection Line: 503.639.4175 Q1' O F TIGARD nom: h � , ,til�C._r —iD �aq
Internet: Www.tigard-or.gov BUILDING DIVISION Notifud/Metbod: to Sex Page 2 for
me
� e.7 Supplemaotal
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TYPE OF WORK PLAN REVIEW
❑ New constru Addition /altdrationfrepIteement Please check all that apply (submit 3 sets of plans w /items chocked below):
' ❑Demolition Other: CI thre
Service or feeder 400 amps or more ❑ Building over e stories,
_ where the available fault eutrent ❑ Malin ss sae boatyards.
CATEGORY OF CONSTRUCTION esureds 10.000 amps at 150 volts or ❑ Floiuiou buildings.
less to ground or exceeds 14,000 ❑ Commercial -tide agricultural
1- and 2- family dwelling ❑ Commercial/industrial E Accessory building amps for all other installations. buildings.
Cl Multi - family 0 Master builder ❑ Other: D Fins pump. ❑ tnttall aeon of 75 KVA or
JOB 9rfE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived dyatnm,
/ ❑ Addition of new motor load of ❑ "A ", "6•, "1 -2 ", "1-3 ",
Job no.: Job site address: � t 100EP or more. ouuiwaay.
W 4 d Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ( 5 4 ,, 1 t) (2..., 9.Z2 *, ❑Health -tarn fiwWane. ❑ Supply voltage for more than
❑ flats rdow loc:uions, 600 volts nominal.
Suite/bldg. /apt no.: j Project name: As C) ( A ) ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: oa¢ripeioe otv. rex. Total •
New residential single- or multi- family dwelling unit.
_ Includes attached garage.
Subdivision: - I Lot no.: 1,000 sq. ►L or leas 168.54 4
Ea. add'1500 sq, ft. or portion 33.92 l
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.) itci Limited energy, multi - family 75.00 2
C f ( U ► • PA) jij( residential (with above sq. ft.) .
,,, /� J l A Serviets or feeders installatio, alteration, and/or relocation
f -- -7\f` tiAC-Alt
�'y -C/ 1 ' L 1 �, ` `�J 200 amps or less 100,70 2
4 PROPER rr OWNER ❑ TENANT 201 turps to 400 amps r 133.S6 2
Name: � o.C('o 401 amps to 600 amps 200.34 2
` 601 amps to 1,000 amps 301.04 2
Address: C A&Z . 54 FrEv /+ �.6�/ Over 1,000 amps or volts 552.26 2
City/State/Z lP: g S
VV � D ' Q., 2 y 3, Temporary services or feeders installation, alteration, and/or
f � U1'•!/- v relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 maps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amp - 168.54 2
Branch circuits - new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
4 APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each brunch circuit
Business name: 'e A- 747AdD A 11TI1 T 111f1s �+ B. Fee for branch circuits without
--�-• � 1� •MOLThi r lDIC service or faedsr fee, first 1 56.18 S ( Pl 2
Contact name: 16000 SE Evelyn St, branch circuit Q
UIZ yWl3 • - Each add' l branch circuit I 7.42 .7.42, 2
Address: miscellaneous (Nervier or feeder not included)
Each manufactured or modular 67.84 2
dwelling, service and/or feeder
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Phone: ( ) p ax:: %1:13 ) 55 q � ict d D Reconnect only 67.114
2
1 Pump or irrigation circle 67.84 2
E - mail: (O b Q (5 &, 8 ev I T7N r CO ink Sign or outline lighting 67.84 ' 2
CONTRACTOR it Signal circuit(s) or limited energy •
Business name: • panel, alteration, or extension. Page 2 2
A TEMQtiPAT1NG AND COMM. MC Each additional inspection over allowable in any of the above
Address: 16000 SE Evelyn St. Additional inspection (I hr min) 66.35/ hr
City /State /ZIP: � b
=camas, UK 91(115 - lnveadgatian (1 hr m in) 66.25/ hr
�3 5n Industrial plant.(1 hr min) 78,18/ hr
-
Phone: ( ) ' I Fax: ( ) 5 5 t — .2-(>� �•0 Inspections for which no fee is
specifics listed ('/r la min) 90.00 / hr
ACS Lic. :,,7 I d p t, '3 etrical Lie.: CC lttr St prv. Lie,: 2q Lt ps" ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: _ r Subtotal: ? �,�
(- _ Plan review (25% of permit tee):
Print name: Db n 0\ I j f 1 : ila/ 2 State surcharge (12% of permit fee):
Authorized signatur rs� � �' TOTA PERMP[' FEE: / . S
This permit applieadon expires if a permit is not obtained within 160
Print name: bfl ,, S 4 �l r days after it has boon accepted as eomplel.
, 9 r' 0 ll�' Date '� . Number of inspections allowed per permit.
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Somewhere between too hot and too cold there's....
F A --TEMP
HEATING & COOLING, INC.
,ui, _ -u ' 1. •u
A 16000 S.E. Evelyn Street (503) 650 -5014
Clackamas, Oregon 97015 FAX (503) 557 -2980
X TO: C � � i� TcAS FROM: 4
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ATTN: ferrAoNt (c) DATE; /
T PHONE: TIME;
■ FAX: # OF PAGES:
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❑ URGENT
A OR REVIEW
❑ PLEASE REPLY
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