Permit
4 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2009-00364
0 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 0712212009
Parcel: 1 S 134DB11500
Jurisdiction: Tigard
Site address: 11000 SW BRENDEN LN
Subdivision: DAKOTA GLEN Lot: 17
Project: Olsen
Project Description: Add/alter (2) branch circuits for A/C and service outlet.
Owner: FEES
SCRIVNER, RACHEAL & Quantity Description Date Amount
OLSON, JOSHUA, 11000 SW BRENDEN LN
TIGARD, OR 97223 2 crt Branch Circuits 07!22/2009 $53.50
wo/Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/22/2009 $6.42
Electrical
Contractor:
BEAR ELECTRIC
PO BOX 389
DONALD, OR 97020
PHONE: 503-678-1355
FAX: 503-678-1108
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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.33 2344.
Issued By:--- Permittee Signature:
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.
JUL-20-2009(MON) 15;34 Bear Electric (FRX)5036781108 P.0011002
v
17 USE ONLY
Electrical Permit Application', 011 OFFICE
City of Tigard °"wB ?crmil Ho.: C An
c
13125 sw lln Blvd,, Tigtid. OR 97223 J U L 2 0 2 0 i. t
phone $03.634.4171 Fax: 503 59B, 11960 rl= Otber Pcrarit. 1~
jr,
s Inspection Unc. 503.639.4175 Dow Radyml. t See pace 2 for
]Memel: www.tigazd-or.gov ~f { 19o1iftedhdetltod: StrP carat Infarmatbo
TYPE OF WORK PLAN REVIEW
❑Nrwconsrruction 0Additiotdaltmdon/ooplmxmcnt ru=echoekail tharapply(submitZseogfplasacs1itt+uscheardbesawg
OSwke ar feeder 400 amps or more ❑ tluildingever shtrr stories.
0 Demolition ❑ Mcr, whete tba avsil.'sble fault cw=nt Q Marirr+saod boaryatda
CATEWRYOFCONMUCCION ca%vU10OMamps at150volts or OFlwtia¢b+iwivP,
less b pound, or exceeds 14.000 Q C91114W9C141-cat agtkUlTUMI
2 I- and 2-family dwelling O Commerciat/industrial ❑ Accessory building aa„pa for oil other imtattatioas, bvild4wL
Multi-family ❑ Muster buiidcr ❑ Other: C3Fitt Sump. Q Installation of75 KVA or
JOB: SME MiF~ORMA77ON AND LOCATION Cl En-~n o srstrtn- tors"r scperculr derived syt rcrr~
QAdditlanofncwmotor load of Q"A".
100111?
Job no.: lob sift address \\0Q0 or mart. oecupawy.
Q Six or Marc towemial units. 13 Rcttcstioml vchkk- parln.
City/Stattlzlh: ❑ linbheare raciliries. 13 Supply witav far more lhao
❑ (l -taus tatatiom. boo volts nominal
Suildbidg.Japt. no- Pmjrxtname ❑Savittorfca4tr600am or more.
FEE SCHEDULE
Cross sireet/dimetions to job site" b. s.. Tsar
Mew rtsidentlal sln&l or multi-family dwelling unit.
Includes attached taraltc.
Subdivision: Lot no.: 1.000 . A. or less 145.15 4
Ea. add'l 500 sq. it, or portion 33.40 1
Tax mnp/parml no-: Limited cnaQy residMiat
:1wG'1a~'I [OId. lair VNORK . with above , ft 75.00 2
Limited cru:rp•, multi-family 7500 2
residential whhabow . it
Servieesor fteden Installation, alteratlo ond/or relocadan
t 200 amps or Icss 80.30 2
❑ 'PROPERTY OWM - ❑ TENANT 201 am to400 amps 106.85 2
Name: 401 amps to 600 arrip-S 160.60 2
601 amps to 1.000 amps 240.60 2
Addr=, Over 1,000 amps or volts 454.65 2
City/StatCIZlla: Temporary services or feeders Installation, alleratlott. andfor
relocation
phone ( ) Fax: ( ) 200 amps or Itxs 66.85 i
owner installation: This installation is being made on property that I own which is not 201 am to 400 wFq* 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 am to 599 am 133.75 2
Elranchcircults -newalterarion areswnslosser anet
OwntYYibItatttCC Data A. Fee for branch circuits with
APPLICANT ❑ CONTACT PEM11 above =vice or fecdcr fee. 6.65 2
each branch circuit
Business name S. Fee for branch circuits
Contact name" without service or feeder f= 46.85 q Lo '16 2
first branch circuit
Address: Each add't branch circuit 6.65 to, 2
hilscdlnncoua scYvlec or rscder nail uded)
City/State/ZIP: Each manufactured or rnodutar
dwellin service snd/nr frcder 90_90 2
Phone: ( ) Fax::( ) Rmvratoet only 66.85 2
E-mail. Pump or micatitmcircle 53.40 2
CONTRACTOR SI oroutlinchouing 53.40 2
Business name Bear Electric, Inc. energy y p panel. . alteration. anel or i;on, or
ncry( ar
Addre= PO Box 399 cmension. Oescnbe: Pagc2 2
City/StntdZIP• Donald, OR 97020 Earb additional Inspection amallowoble in any of the about:
Per i ian 62.50
Phony (503) 678-1355 I Fax: (503) 678.1108 lnvestiplion per hcur(t hr min) 62.10
CCB Lie-: 20919 Electrical Lic : 244070 Suprv. Lic.. M Indussfial cant pcr tour 73.75
E ECr's11C AL. PERMrr FEES
Suprv. Electrician signature, requircd: ` 5ubtow-
Plan review (25'X. of permit kx):
print nturtc Dafe: ~-'~--0 5tatesurehaere (12°.'a ofpartril foe):
Authonxcd signature: TOTAL PERMIT FEE:
This permit appltealioneaplrea lr a pcrtole Is not obt4iaed wirbin 189
Print name: Bate: drys whrrlr bus been accepted as complete.
• Numberofirapocliansalbwedl+rrpermh.
tsuit *'hM0tWELC.A0mkw 0c a313tl& 4to461 3 FitI MCOMWFtt
,- CITY OF TIGARD
ELECTRICAL PERMIT
1 q
s COMMUNITY DEVELOPMENT Permit #: ELC2009 -00364
a s Date Issued: 07/22/2009
T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S 134DB11500
Jurisdiction: Tigard
Site address: 11000 SW BRENDEN LN
Subdivision: DAKOTA GLEN Lot: 17
Project: Olsen
Project Description: Add /alter (2) branch circuits for A/C and service outlet.
Owner: FEES
SCRIVNER, RACHEAL & Quantity Description Date Amount
OLSON, JOSHUA, 11000 SW BRENDEN LN
TIGARD, OR 97223 2 crt Branch Circuits 07/22/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/22/2009 $6.42
Electrical
Contractor:
BEAR ELECTRIC
PO BOX 389
DONALD, OR 97020
PHONE: 503 -678 -1355
FAX: 503 - 678 -1108
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 1 work is not started within 180 days of issuance, or 1 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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.33 2344.
q P ,___..,
Issued By: r -l il� P ermittee Signature:
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.
CaII 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.
JUL- 20- 2009(MON) 15;34 Bear Electric (FAX)5036781108 P. 001 /002
v.
- y
fQR OFFic, ,. U1 ;a ,
Electrical JPe1-m6tAppliCatio \I E '' `�,a.;�
? Received
City of Tigard • (C2o0 ` O�st/�/
i t
," Data) . � )! Pctmii No
13125 SW Hall Blvd., Tigard, OR 97223 JUL 2 0 .0 U J
Plan Review
. i p
Phan 503.639.4171 Fax: 503598.1960 Thidn . 0hber � 4ir l/ 0 d I ' 6. •
7SGAIeq it m vwwti l 175 CITY � O � FTlGARD ta;> d: f'' See Paev2for
RUILD1�CtiDlVf J I O � '= 1 (( Supplemental Warrantor'
TYPE OF WORK L4 i PLAN REVIEW
❑ New construction E) Addition /altcruiionkeplacemcnt i' ck& an that apply (iubmitZ gees of plans wlit4131+ehee►Ed bu.l
❑ Service or feeder 400 amps or more ❑ Building over three =ties.
0 Demolition ❑ Other where dm available fautl current 0 Manna* and boatyards.
CATEGORY OF CONSTRUCTION vaned► 10.000 amps at 150 velars: ❑ Floating %/Wins, •
less to grouted, or exceeds 14.000 0 Commercial-um' agtieotausl
gl 1- and 2-family dwelling ❑ Commaraal/ ndustrial ❑ Accessory building a for all ether instillation. buildings.
Multi - family ❑ Master builder 0Other. ❑ Fire pump. QInWllatianof7SKVAor
JOB SITE INFORMATION AMW LOCATION Q End 6. lew larger apatotaly derived swan _ ❑ Additio n of stew tooter bad of Q A". - E'. - 1 -2 ". "1 •J ".
Job no.: Job site address: l l 00a 1 () !� • I OO or man`. tictupa4 q
�A l.k I] Six or mote taideatial uniu 0 Rcenational Wink parks.
City/S%41 "lP: ` ❑ Ileal,heaee Preilities. 0 5upply voltage for more than
• • - ❑ l laranlous location. 600 volts nominal
Suitc/bldgJapt.no.: Projrxtnaznc: 0 Scvireor feeder 600 ampler more.
FEE SCHEDULE
Cross street/directions to job sitc a.rrTiptiod 1 art, 1 Sr". 1 T.+rt 1 •
New residential single~ or nwhi.family dwelling unit.
Includes attached enrage. _
Subdivision: I Lot no.: 1.000 sq. R. or less 145.15 4
Tax ales i Ea. add 500 sq. 11. or portion 33.40 I
P/! era - Limited energy. residential
.;DESCRIPTION—OF YORK . (witb above so. R.) 75.00 2
Limited energy, multi- family 1 75.00 2
POCA1 NE A )cos- ■s\- cx 1 cr,p nre4 residential (wish above s9. it.) _
^_�
Services feeder lnstatlntlon and/or rdoeado
. ��\ C.e_ �li_4 C"-C. 200 amps or less 80.30 2
-0 PROPERTY OWNER .° 'I . ❑ TENANT 201 amps to400 amps 106.85 2
Name 401 amps to 600 amps 160.60 2
601 maps to 1.000 amps 240.60 2
Address: Over 1.000 ampler oohs 454.65 2
City/Sewall': Temporary services or feeder Installation, alteration, and/or
relocation
Phone ( ) i Fax: ( ) 200 amps or less - 66.85 , I
Owner Installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 10030 2
intended for salt, lease, rent,. or exchange, according to ORS 447.449.670, And 701. 401 amps to 599 amps _ _ 133.75 _ 2
Owner Si lt!! a pp1� (trench circuit : - now alteraian, or e:Ieniton,,per panel
l _ _ A. Pee for branch circuits with
0 APPLICANT ~ J O CONTACT PERSON above service or teeter fee. 6.65 2
each branch circuit
Business name B. Fes for branch circuits
without service or feeder rec. t 46.85 L4 (0t 2
Contact nano; first benneh circuit
Address: Etch add•( branch circuit 1 1 6.65 (Q. (f{,, 2
Atiscellancous (service or feeder not include )
City/Stale/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90 - 2
Phone: ( ) , Fax: : ( ) Reconnect only _
66.85 2
E- mail: Pumper irrigation circle 53.40 2
.. - CONTRACTOR Sli or outline lighting , 53.40 2
Business name Bear Electric, tern. Signal cireuit(s) or limited-
energy panel, alteration, or
Address: PO Box 389 extension. Describe Page 2 2
City /State/ZIP: Donald, OR 97020 Each additional los. cetion over a ltowoblc In an of the above
Per inspection 62.50
• Phone•. (503) 678 -1355 I Fax; (503) 6784108 Investigation p er hour(' h m in) 6 2-50
CCB Lic-: 20919 I Electrical Lic.: 24 -I07C Suprv. Lie.: L11 ...,k Indusrrial plat %Pcrhour 73.75
sttIr-rRICAL PERMIT F1EES
Suprv. Electrician signature. required: `- — Subtotal:
Plan review (25%ofprnnit fee):
....„\e
Print name" �� .Date T1 - ^�q
`.t >` �� e � State surcharge (12% of permit fee): lo2
Authorized signature: TOTAL PERMIT FEE: •Cf z
` MIA paean appikatlon If a permit is not obtained within Ha
Print name ...� Date: days deer It tans been arecplyd u complete.
Number or inspections a lowed per pehnl4.
1 . 6vit4lag•Pamae' ELC.PatnWy,p4se 0123 06 Oro.46151(1105CO\IWED