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Permit CITY OF TIGARD ELECTRICAL PERMIT o • _ COMMUNITY DEVELOPMENT Permit #: ELC2009 -00248 T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/29/2009 Parcel: 1S125DA06800 Jurisdiction: Tigard Site address: 1 9585- SW- 69TH:AVE) Subdivision: KINGS VIEW Lot: 54 Project: Project Description: Install /alter (5) branch circuits. Owner: FEES HAACK, WILLIAM H & MICHELLE N Quantity Description Date Amount 9585 SW 69TH AVE TIGARD, OR 97223 5 crt Branch Circuits 05/29/2009 $73.45 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 05/29/2009 $8.81 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 $82.26 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0100. You may obtain a of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: � , p Lty Permittee Signature: Q. . �, c C OWNER INSTALLATION ONLY j'Y The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the Job site until completion of the project Approved plans are required on the job site at the time of each inspection. �> _.03/01/1996 09:14 503 - 678 -1108 BEAR ELECTRIC PAGE 01/02 • • M Electrical Per-------iow-1Fr.F v\IED „ ,i__) .--;t1 A'r l i , • FOR or>i�icz USE (y.i..) City of Tigard Received FiC7«R•00248 13123 SW Hall Blvd, Igard, OR 97223M 2 6 2009 _ Permit r • Phoom 503.639.4171 Fax: 503.598.1q�j OhmiBv; OtherPtem¢ T f G A R U Imp:Mimi line 503.639.4175 - -- D ale ReadytByr 1 0 see Page 2 for w lmemer: ww.dgaad.urgov CITY CF I IGARD Naiftd+$earod Supplement') laformatlet 7” � \!U Cl/1 IOPI — • - TYPE OF *IRK PLAN 'REVIEW ❑ New convection ® Addition /altcration/rcplacemlant Ple ail due apply (lebmit a sets of ptsas w/iiems checked belowh ❑ Danol'ttioa CI Other: O Service or feeder 400 *pips or more O Beading ever duce stories. where the available fault CU= III O Milan sad boatyards. 7 ---- - CAI'BRORY CF CONSTIWC11Wt escoeds 10.000 amps a, ISO vela or O Mooing boadiogs. • IN 2-family dwdliD toss to gr or s 14.000 0 Coam el-use erg ieulwar I - and 2 - Y g ❑ Comntacial/industrial ❑ Accessory building El Mtttd- fanttly 0 Master builds amps for . other imratlatierts Ii uI buildings. ❑ Other: O Fite pump Q lastamtioa of 7$ KVA or JOB S1TE 1 NPORtMA1170Ii AND Ii0CA770N 0 y system. larger separmey denied system. � Q {~ Ave. /� O Addniaa of sew many lead of O - A' "E-, `1.2".-0.3". Irm Job no.: l Job site taddres q C � .D ` O ► : , i unites O Recreational vehicle packs. Cily/SlaIu/ZIP: : 0 • r * — I —I-12 O Nearrtfarc F cilides. 0 voltage for more than ° Q Ir ideas locations. 1000 volts Wominal. SuitelbldgJopt. no.: Project name O Service or feeder 600 amps or tome. ' FEE SCREIRILE Cross sttaNditsaions to job site 1 tor.) Fee f Tay/ • New residential tingle- or multifamily dwelling gait. Includes attached garage. Subdivision: Lot no.: 1.000 sq. R Or test 145.15 4 Tax map/parcel no.: SOO sq. >; orptulion 3140 Limited end, residential 75.00 2 . .. . . • r';r ; , . OPI. :0F. WORK . .. . • ... (with above 611. ft) Plr, rj o 1 3 C'c�c`», . Limited energy m lsw mold-family ) 75.00 2 Semites or feeders lmtallatloo aad/ar relocation 200 amps or less 80.30 2 r•`© PROPERTY OWNER ....j '%I. . C] TENANT .. • • _ 201 amps to 400 amps • 106.85 2 Name 401 amps to 600 maps 160.60 Z Ate 601 amps to 1000 amps 240.60 2 Ovcr 1,000 amps or votes 454.65 2 City/State/ZIP: Temporary services or feeders Intonation, alteration, and/or relocation Phtnta ( ) 1 Fax: ( ) 200 An nr less 66.85 l Owner installation: This installation k being made on propaty that I own which is not 201 amps O 409 aulPs 100.30 2 intended for sale, lease, tent, or cdidlangv according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 _ 2 Brandi deceits _ new. alleradot. or extension, err panel Oran signature Dorm A. Foe lbr branch circuits with • .. 13 A>iP11t.ANT . ` • •.I O CONTACT' - above service or fad fee, 665 2 branch circuit Business name: B. B. Fe for branch circuits Contact tiara= widow service or feeder fce firm March Circuit 1 46.85 I i:)IZ 2 Address: Each addT brmchciaeuit 4 6.65 2(O,l1 2 Mludlaneaas (servlee or feeder aot Included) City/Smte/ZIP: Each amaufaetured or modular 90 - 90 2 dwelling. service and/or feeder Phone ( ) I Fax:: ( ) gocoffi only 66.85 2 E -mail: Pumper litigation cirvlc 5140 2 .h: •. , CONTRACTOR Simsoroutlinclighting 53A0 2 Business ntamG Bear Electric, ins Sisal circuit(s) or limited - energy panel, alteration. or Address PO Box 389 emulsion. Dace= Page Z 2 City/State/ZIP: Donald, OR 97020 Each addirlonal laspeciion over dtlowable la anr_of the above Phone (503) 678 -1355 I Fax: (503) 678-1108 Pa r at i o n 62.50 investigation P brain) 62.50 V CCB Lic.: 20919 Electrical Lic.: 24 -107C � Lic.: L ! • S Industrial pbattperbaur 73.75 Electrician signature, required -. - ) ELECTRICAL PERMIT n1 - Supra. E ec r� y , 5 - � Plan � Subtotal! 'f Jr review (25% of permit fee): Print name Il` pp •, _A 1 • f. & St Datc: - ► *II Stsac sarchargc (12°4 of permit fee) e t, TP iiii Authorized signature: TOTAL PERMIT FEE 2 Pont name: (Date: Tab permit ap pBneim expels If a permit & net obtained viable' 180 drys Warr It hits been =copied as eampldr. • Number of i. p ctioas allowed per permit. Le adarPonabsEIC.iam3Appdee OS23OS 440.61ST1,I OSCOSI