Permit 1�
CITY OF TIGARD • ELECTRICAL PERMIT
° a
PERMIT
ISSUED 10/31/2008
COMMUNITY DEVELOPMENT
DATE ISSUED: 10/31/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103AA - 01901
SITE ADDRESS: 10585 SW WALNUT ST ZONING: R - 4.5
SUBDIVISION: COTTONWOOD PLACE LOT : 004 JURISDICTION: TIG
PROJECT: HELMER
Project Description: Reconnect for furnace.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
GARRY HELMER WILLAMETTE HVAC
10585 SW WALNUT 3075 SW 234TH AVE. #206
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: Contact #: PRI 503 - 628 - 6841
FAX 503 - 848 -2597
FEES
Description Date Amount Reg #: ELE 34 346LHR
[ELPRMT] ELC Permit 10/31/200! $46.85 LIP 56951
[TAX] 12% State Surchar 10/31/200! $5.62 SUP 4025LEB
Total $52.47 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 1; s • ays. - • ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952-141-0010 through sA - = .00 -.100. You may obtain copies of these rules or direct questions to OUNC at 503.2 6.6699 or 1.800.332.2344.
Issued B : / / 2 Permittee Signature: V
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
L ^
SIGNATURE OF SUPR. ELEC'N: � I ' / '� i.. ` 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.
r
Electrical Permit Application E FOR OFFICE USE ONLY
Received
City of Tigard
RECEAI DateB : /G 3/ a Permit No.: Fe.d fl�.OQI / 2
UPI 13
125 SW Hall Blvd., Tigard, OR 97223 y
g Plan R eview
i C l
P hone: 503.639.4171 Fax: 503.598.1960 0 ateBy: Other Permit:
T 1 G A RD Inspection Line: 503.639 r -r 503.598.1960 �te Ready Jurir ® See Page 2 for
Internet: www.tigard-or.gov G`1TY ` 1 1 i i; i ed/Method: ( Supplemental Information
TYPE OF WORVIL °"' ®I � r
PLAN REVIEW
❑ New construction ® Addition/alteration /replacement Please check all that apply (submit 2 sets of plans wfttems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ 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 ❑ Commercial-use agricultural
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A", "E", "I -2", "I -3 ",
Job no.: Job site address: 10585 SW 49'6"' Av �� �R(.Wf.0 e £� ]]�� ', J)' 100HP or more. occupancy.
"` ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage fur more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Gary Helmer ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential sell le %multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Reconnect Furnace Limited energy, multi-family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Gary Helmer 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 10585 SW 106 Ave Over 1,000 amps or volts 454.65 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
g A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, I 46.85 2
first branch circuit
Address: Each add'1 branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal panel, or limited -
Business name: Willamette HVAC
energy panel, alteration, or
Address: 3075 SW 234 Ave Suite 206 extension. Describe: Page 2 2
City /State /ZIP: Hillsboro, OR 97123 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 628.6841 Fax: (503) 848.2597 Investigation per hour(1 hr min) 62.50
CCB Lie.: 56951 Electrical Lic.: 34346CRE uprv. Lie.: 4025LEB Industrial plant per hour 73.75
/ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: •
Print name: Mike Sicard / Date: 10/29/08 Plan review (25 % of permit fee)
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE
Print name: Mike Sicard Date: 10/29/08 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T( I I /05 /COA1/WEB
CITY OF TIGARD .- e
BUILDING DIVISION PERMIT #: ELC2008 00612
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/31/2008
Phone: (503) 639 -4171 f�l
Inspection Requests (24 Hrs.): (503) 639 -4175 •__..
INSPECTION WORKSHEET FOR DATE: 11/5/2008 TIME: 7:01AM PAGE: 15
SITE ADDRESS: r CLASS OF WORK:
10 785 SW WALNUT ST
SUBDIVISION: COTTONWOOD PLACE LOT #: 004 TYPE OF USE:
PROJECT NAME: HELMER
DESCRIPTION: Reconnect for furnace.
OWNER: HELMER, LARRY PHONE #:
CONTRACTOR: WILLAMETTE HVAC \ e-'. PHONE #: 503-628 -6841
Inspection Request Scheduled For: Date: 11/5/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 077678-01 503 - 422 -1991 Y
Corrections /Comments /Instructions: 9
-
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 v6e) L.< Date: `t ril Phone #: (503) 718- e v