Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00471
T E G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/07/2012
Parcel: 1 S133DB12300
Jurisdiction: Tigard
Site address: 11380 SW PALM PL
Project: Ford Subdivision:3CHOLLS FERRY ROAD TOWNHOME: Lot: 49
Project Description: (1) branch circuit for push/pull gas furnace
Contractor: A TEMP HEATING & COOLING INC Owner: COHANCIUC, ZITA Z
16000 SE EVELYN ST 11380 SW PALM PL
CLACKAMAS, OR 97015 -9519 TIGARD, OR 97223
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 08/07/2012 $56.18
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 08/07/2012 $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 5 - 001 -00 0. You may obtain a py of the rules or direct questions to OUNC by calling 503.232.1987 or 1.8000.3
Issued By: v `�.- Permittee Signature: D' J P PPU e ► l
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.
R ECE1E Electr per mit A lication
Rcc / Permit No.: 6i_e_ O/ -- co i
City of Tigard AUG 0 7 2012 Dar : I �"
_ 13125 SW Hsu Blvd„ Tigard, OR 97223 Plan Review Other Permit _ —
' Phone: 503.639.4171 Fax: 503.598.1960 DarrJBr. �� ant Ell Sea Peke 2 for
C f � OF flGARG D5 Reedy /ey. i,: a Ell ea Pa 2 f
r I ; u Inspection Line: 503.639. �1 PP N ar; �„ d; _ _
Internet: www.tieard.or.g ti l i - rtiVI '.' PLAN REVIEW
' TYPE Oir WOItIC Please chuck vu that apply (artbmtit; set, of Dlaae writaroa clucked below):
A ddition/alteration/feplacement Cl Soe vice or feeder 400 amps or more ❑ Building over h en a stories.
CI New construction and boatyards. Other: where t available fault currant ❑ �
[] Demolition ❑ _ — nxcads 10.000 amps 3t 150 volts or Floatime budding►•
CATEGORY OF CONSTRUCTION less to ground, or extends 14,000 ❑ Commercial-use agricultural
d
I_ and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. Instal build siou
❑ Multi-family ❑ of 75 KVA or
0 ❑ Fire p inup.
Master builder lJ Other: 0 eig prae y s larger separately derived system.
_ — —
JOB SITE INFORMA AND LOCATION ID MinimMinim of new motor load o ❑ w E", "1 -2° "1.3 occupancy.
ItOHP or mare, ❑ Reoroational vehicle pants.
Job no.: IA 042., Job site address: 11129 SW J0. ,M 1 r ❑ Six or more residential unite. ❑Supply voltage roc more than Q M Heabb•eare faeilitiny. 600 1, voltage
CitylSCStt IZIP_� �� of.. q Tom? ❑ [] Hal9rdaus locations.
' " : Cl Servioo feeder 600 tulips or morn. Suite/bldg /apt no.: Project name: CO �p J 6 FEE SCHEDULE
lnescri s. 'coal �
Cross scree /directions to job site: New residential single - or multi - Gamily dwelling unit.
Includes attached garag 4
1,000 sq. R. or less
168.54 _ _
Lot no.: 33.92
Subdivision: Ea, sal 500 sq, R or portion
Limited tplerta' re 75.00 2
'fax map/par no.: (with m sq. R)
DESCRIPTION OF WORK - Limited effigy. multi-tiinitly 75,00 2
II S kill l et k/ 5‘,- ( residential (wrt1 ahovo s4 ft 1 _
b c�V� (� [ 1 C J Vf ( Services or feeders installation, alteration, and/or relocation 2
200 amps or less 100,70
-J C n d_Ct ( N 34a. � 201 amps to 400 amps 133.56 2 , �
TENANT PROPERTY OWNER ❑ 200,34 `]
401 snaps l0 6U0 =Ps 2
601 ;imps to 1.000 amps _-- 301.04
Name: ‘ m C• i &,.i fc l t/ 552.26 2
C Address: I 3 $ I t ? ' } m 1 Ce Over 1,000 traps or volts Temporary services or feeders installation, alteration, and/or
Pd r q - 3
a {_
relocation _
Phone: ( ) 59.36 l
�
City /State/GIP: a C e G "l _ -
J Fes: ( ) 200 m pg or less 201 amps to 400 amps t2.oB 2
Owner installation: Th installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
lama nom alteration. or extension, r panel
Date: A. Fee for branch circuits with 2
Owner S)gnatttre: C T above service or feeder fee, 7.42
APPLICANT ❑ CONTACT PERSON each branch circuit
_ H. Foe for branch circuits without 5 6.18 Si, 13usincss name:
• v :.4. .1' _ r u i. , I. n r • h 1, service or feeder fee, fast E 2
branch circuit 7.42 2
Contact name: • 16000 SE Evelyn St. Bach add' l b�eh circuit -
rr'..: • t G Miscellaneous (s ervice or feeder not Included)
Address: 1 ... t t Each m;tttufettured or modular 67.84 2
City /State/ZIP: dwe ' . service a0d /or f eeder 67,84 2
7 Reconnect only
Phone: ( ) Fax:: DJ ) 5 pump or irrigation circle 67.84 f
tom,, N, p Sign or online ligh 67.84 , 2
J I r
CONTRA TRA - OR Signal circuit(s) or limited - energy e 2 -
panel, alternrion extension.
Each additional inspection over allowable in a o t he above
•
Business name: :. ti :I _ l • : a l r a rat, • .I r 1. 66.25/ hr
16030 SE Evelyn St. Additional lnspeCUOti (1 hr min)
inves (t hr min) 66.25/ hr
Address: 1
leFTP..: 0 , Ill. 7
industrial plenr(l hr min) _
City/State/ZIP: GSn-01.A Inspections for which no fee is 90.00 / hr
Phone: ( ) Fax: (503) �� 2-41.0 s ifieal listed h br m in
ISZEMMII Electrical Lic.: C C Suprv. Lie.: Z t q 1 ELECTRICAL PERMIT FEES Subtotal; 5. l �r
talc required: , — Plan review (25%of permit fcc):
Suprv.lectrici$r sigma u! +�
r - , State surcharge (12% of permit Pee); (P ' -7 K
t s. t � AEUMEM
Print name: ' 0 .' d 1 TOTAL Pk.RM1T FE
r � .. - ibis permit application expires if a permit is net obtained within 180
Authorized signatur ;�� days eRer it has been accepted as complete
Date:
r + �� v m ' Number of uispo':tions allowed per permit.
p
Print name: 6 t- �••`� s � � o � r
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'F TEMP
HEATING & COOLING, INC. = • a • •
(503) 650 -501
A 16000 S.E. Evelyn Street FAX (503) 650 -50
Clackamas, Oregon 97015
^ FROM: �
X TO: (' O4
ATTN: Qf (h
DATE: 141/13_
PHONE: TIME:
T FAX _ # OF PAGES:
E R
URGENT
A JOR REVIEW
PLEASE REPLY
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