Permit CITY OF TIGAR®
� ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2010 -00394
Date Issued: 07/30/2010
T i GAR) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102CC04100
Jurisdiction: Tigard
Site address: 13695 SW CRESMER DR
Subdivision: Lot: 0
Project: Kouzes
Project Description: (2) branch circuits for A/C and service outlet.
Owner: FEES
KOUZES, ROSS T & Quantity Description Date Amount
KOUZES, LISA A, 13695 SW CRESMER DR
TIGARD, OR 97223 2 crt Branch Circuits 07/30/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/30/2010 $7.63
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 $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 OAR 952-001-011 -. - • stain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: a v 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.
07/28/2010 16:48 503- 678 -1108 BEAR ELECTRIC PAGE 01/02
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^ City of Tigard
13125SWNe T 1 adB .
`� Blvd.. Tigard. 9y2z; 'UL �, ��'� 7 9e �� �hWa.: o_ c,�3
Phone 5 03.639.417! Fax: 503 598.1960 ` ' cP evrow
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'' � , . '. ` Internet Line: �� CZ!) I. '.,�„ /�g ' athaPcna;t: u �Llo /0 —CO 0 la Sce1'+�2 c.
TYBB OP WORK 1 ra�ce� rssrmrmatlaa
-
O New co"ielion RAddidon/alkration/replecerno� 4 ( j � l � o cheek all +aw y j Am whims throe tbelow):
❑ Demolition 0 Other: C c1i > LI a or amps ni mere 0 Building over v where the availably fault outwit D Marinas and boatyards,
CATEGORY OF CONTROCTIO
NV exceeds 10,000 drape at Ise wits re I] Herein 6tdpdings.
1 - and 2-family dwelling ❑ Commercial/industrial ttrial ❑Accessory building less to wound, or moods 14,000 C1Coma ial -uoa aericatmAt mom
o Multi- family ❑ Master builder ❑ other: o far sn other iastallalfoam, buildings. � d lartallatiau an J[YA or
JOB SITS INPQRSIA r.,,', y r 1t I' ' ION - O Emergent, system. Iola apataleir derived systees,
Job no.: Job site address: OAMit o anew motor load of p "A",, 13". °t•2'; 4 I,3 -,
511 Ca r'rysp - 19r. i^. p si:, Or mom residential fmigt, El RIXTOfftiOlial vnbieie garb.
Gty/StatdZlP: 1 1 ' CK9ro1 OR q - 2:2:3 T] Ilealtb•ee„e raw7aras Of** whose she *tore tarts ,
C! Ha
Suite/bldg/apt. Hamden' locations. 600 volts nominal.
g./apt. no.: Project name:' i/l,c�(�I ? 5 T�9erviye mreeder 600arom or ttmre.
Cross streedditxctions [o job site!: DUILE
twinioimrrlalte
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New residential tingle. or multi-badly. dwelling unit.
Includes attached garage.
Subdivision: Lot : 1000 sq. R. or lest I= 163 -54 -d
Tax map /parcel no. add'I S00 sq,1t or portion 33.92 II
DESCR�AQN OF WORK � (wiul above s i d tsss� gal 75.00
`� Y ` Limited energy. multi -Tamuy 75.00 2
1 residential (with above skit)
Services or feeders laslaWitoa therathuy sodf or relotedan -
200 amps or less 10070 �
Q PIWPERTY OWNER 0 'MAW 201 amps to 400_8m — 133.56 . • 2
Name: z - 401 amps to 600 tamps 20034 - 2
-- 601 amps to 1.00 drays 301.04 2
Address: Over 1,000 amps or volts - 552.26 , 2
City/State/ services cr feeders inslnlilton, at teratlou, aadlor
relocation ...
•
200 or less �_ 59.36
Phane: ( ) I Fax: ax: ( )
1
Owner installation: This installation is baits g made on ptnperty ih� T own which is apt - 201 amps to 5 9 9 amps 125.08 s
intended for sale, lease, rent, or exchange, according to ORS 447.449, 670, and 701. 4ot = w amps 168 S4 2
Brandt circuits - stew al m ft _. nioa, Ned
Owner signature: . - Date. _ 1_ Foe Ibr brtmch clietdts wk*
0 APPLICANT q COI4 TACF abawe service or feeder fns, 7.42 2
each hmndl circuit _
Business names B. Fee for branch circuits *Mora
service or feeder fee, fim
Contact name: branch circuit SGl B , 2
Eacb add, branch circuit , S _ 7.42 . s 4 2
Address: Mhcellaaeous (service or feeder not iaeinded)
City/State/ZIP: Each marmtacpgod err modular 57,84 2
dwelling, service sndior facie!
Phone: ( ) I Fax:: ( ) R000nnect only 67.84 2
E-mail: pump or irrigation elide 67.84 2
1R Sign or outline Ilghiing 67.84 2
Si dtcttit(aj or timitedeeergy
Business rum r p mei. alteration. oretmmuion. Page 2 2
/� rj� Ea h additional lmndoe ee over allowable la aiy of the above
Address: R1 °jI . iii , t� 0 . _ . ►ECii,,. Additional inspection(I brmin) 1 _ 66.251br
( � �� lavestlgatica(1 hr rain) 66,25/
City/SbrieJ.LIP
y � " `"'� Industrial plant (1 hr min) 78.181 hr
Phone: ( to lf1 1 A. Fax: • 1 ) (1/401 , `. Inspections for which no fee is 9000/ br
CCB lac.: `AV y Electrical Li - ' l ` *. Suprv. Lic.: r spaiftealAr listed (t5
� , � � S � mbar Fes, , t
Sutprv, Eltzbnieian s' • . re, required: ` r Subtotal: / , f v
RiiitliiiiW 1��1 / 8 8,! Ri� L. / r Date: ' ter Stale sot Chergo (1295 of permit fx) _ F,•vIli 6,3
Authorized signature:
Tom wear FEE: t -1$ I . �-3
- 7bb Perm* application rapine Ira perms es not o ..... r- wdrhta tan
Print name: 1 18te: - y dap after• u ham been unyrpsed as complete. -
1 Namber ot'impyede= allowed part :mak
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