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Permit CITY OF TIGARD ELECTRICAL PERMIT Per COMMUNITY DEVELOPMENT Permit #: ELC2012 -00302 T [ G A T-7 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2012 Parcel: 2S102CA00923 Jurisdiction: Tigard Site address: 13200 SW VILLAGE GLENN DR Project: Cosa Subdivision: VILLAGE GLENN Lot: 23 Project Description: (2) branch circuits for furnace and A/C Contractor: A TEMP HEATING & COOLING INC Owner: COSA, MARIANA 16000 SE EVELYN ST 8150 SW 80TH AVE 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 05/22/2012 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/22/2012 $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 h _ I / {J f/;f 2- 001 -00 0. You may obtain as coppyy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.. y Issued By: wt - Permittee Signature: (/rte /`i PPU C! D AL. 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. • �/ jectricala P� Dpli_cat ECE1VED t t► It o..,.,e l.: I,SI•. t)i,,i.1 City of Tigard 13125 SW Hal] MAY 2 1 2012 Received S» z x �, � 30 � 13fvd., Tigard, OR 97223 Datd � Permit �� r Phone: 503.639.4171 1 503.598.1 Plan Review 1 1 t; ,;,;1, Inspection Line; 503.639.4175 ern OF TIGARD � �y / sy: r + r Internet: www.tlgard•or.gov BUILDING DIVISION Nodded Mothed' 6, ®5eoPagte =fur 9up Info sae sties TYPE OF VY PLAN REVIEW ❑ New construction �Additi roration/ lacemt:nt Plro=e check all that apply (submit 2 acts of plans w /items clucked below): CI Demolition ❑Other: Q Service or feeder 400 amps or more ❑ Building over throw stories. where the available fault current ❑ Marinas anti boatyards. CATEGORY OF CONSTRUCTION meads 10,000 amps a 150 volts or ❑ Floating buildings, � I - and 1 - family dwelling ❑ Cotnmereial/irtdustrial ❑ Accessory buildin ❑ MUlti• family leas m gpd or auceeds 14,000 CI oa,met aviculture aviculture amps f or dl oun o ther installatie buildi ois!•u ❑ Master builder ❑ Other: ❑ Fire pump. ❑ IAA/illation of 75 K VA or ID Emergency system. larger soperately derived system. SITE INFORMATION AND LOCATION ❑ Addition dome motor load of ❑ "A ", "E", "1 -2 ", "L -3 ", Job no.: � 'tq•� 35 Job Site address: /n� 1 �1' / 100HPorluone, .� 1! SW Y I 4.q aL l� I' O eccupano City /State/Z1P: 1 ale ( O a Q r] r� �'� ❑ Sik or mom residential units. ❑ Recreational vehicle Purace. { " L ❑ riealth -care (Radians. Supply voltage for more than Suite/bldg./apt © Hozarduaa locatiutts. 600 volts nomimJ, no.: Project name; Co Ci ❑ Service or feeder 600 amps or more Cross street/directions to job site; ~ — + � • FEE SCHEDULE Dere"pG°° I oty, Be ram • New reaidentlal single- or multi - family dwelling unit. -- Includes attached garage. _ Subdivision: of no.: 1,000 sq. ti. or less 168.54 Tax map /parcel no.: Fu,- '- '1"-- — Ea, add'! 500 sq. ti or portion 33,93 1 DESCRIPTION OF WORK Limited energy, residential /� I l (� _ (with above sg. ft.) 75.00 2 I b e�avAt� C i �"u l } , S(� ' J I 1 - 1 6 ! Limited energy, =Warmly J residential (with above sq. Ft) 75.00 2 v r -C S�� L t �. Services or feeders installation alteration, and/or relocation 200 amps or less 100.70 2 ,f. PROPERTY OWNER Q TENANT 201 amps to 400 amps 133,56 Name. 1, l'1 Alna CO,S'cJ. 4oltunpsta 200.34 2 • Address: rl r7 , 60! amps to 1,000 amps 301.04 2 J L. 0 0 %114.R.... I Z (ft Lr r /\I e, Over 1,000 amps or volts 552,26 2 • City/State/DP: in r i.2-2-3 Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or teas 59,36 _ , I Owner installation: This installation isb ei in ng made on property that 1 own which is not 201 amps to 400 amps 125.0e 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168,54 0 Owner Signature; Date: Branch circuits - new, alteration, or extension, per panel kj A. Fee for branch circuits with I ❑CONTACT PERSON above service or feeder fix ,ch braocb circuit 7.42 2 Business name: " j3 each . Fos for branch circuits without — Contact name; service ur feeder fee, first 1 36.18 D 1 fy 1� SE Evelyn St. brunch cin:uit 2 ?al.. ess: Each adds branch circuit 4 n3- 454 •51314- Mi acellnneoas (service or feeder not included) City /State/ZIP: Each manufactured or modular - d 8iina. service and/or feeder 67.84 2 Phone; ( ) Fax:: (f a3 ) f S & I D Reconnect only �_� 67,84 2 E —mail: Pump or irrigation circle 67.84 0 • CONTRACTOR Sign or outline lighting 67.84 2 Business name: Signal circuit(s) or limited - energy panel, alteration, or extension. Page 2 2 Address: 1 Evelyn _ Each additional inspection over allowable in any of the above Additional inspection (1 hr min) 66. k City/Statc/Zjp; OaCRama4 OK 91U15 Investigation (1 hr min) 66.25/ hr I , .1 1 . Industrial P one: ( ) l �S, plant(' hr min) 78.18/ hr Fax G01) 55 'i .. brit tO inspections for which no fee is CCB Lic.: ' r v medical] listed 'r4 hr min 90.00 / hr ,b Lic.: 2 t q ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: 3, . 1 Print name; ' b r ,ti" s•- Plan review (25% of permit fbc): ' • a ` ' State surcharge (12% of permit fee): . , Authorized signatur TOTAL PERMIT FEE; Print name: 1 r .,l„�s c This permit application aspires if a permit to not ' within um r t= e, e -1 r Date: 5 / 'i 1/ f ( 1 • Number of inspections allowed per permit. Ban dan g 07 /01 /10 40 0. 4 613701/0SICO PAM[ E0 39tid 9NIlti3H d 131 V 066ZL55E0S Et7 :01 ZTOZ /tZ /50