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Permit
r, -� aad (�� I� rour\G) • �2Q�r�v��.c o CITY OF TIGARD ELECTRICAL PERMIT C COMMUNITY DEVELOPMENT Permit #: ELC2009 -00158 T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/10/2009 Parcel: 2S112CC12000 Jurisdiction: Tigard Site address: 15676 SW 82ND AVE Subdivision: LANGTREE ESTATES Lot: 52 Project: lundberg • Project Description: Install (1) branch circuit for a /c.4/14/09 ADDED (1) branch circuit. Owner: FEES LUNDBERG, RENATE J & ROBERT L TR Quantity Description Date Amount 4150 GLACIER LILY 1 crt Branch Circuits 04 /10/2009 $46.85 LAKE OSWEGO, OR 97035 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 04/10/2009 $5.62 Contractor: Electrical 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 $52.47 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. u may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: . — P mittee Signature: i ll� • IN • T • CATION ONLY The installation is being made on property I own which is not tended for sale, lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N 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. 1 N u k -, , L . Y --to - l J J \ � \ \ v'�` \' 1 t \ • t .-1--k-- . L.-- T ^ k.---)k....) l D B, Electriibli9e -) A lice ''�� FEiVE b FOR OFFICE USE ONLY City of Tigard • _APR 1 O 2009 �'trla.• _ ?_C 5 . /1 • 13125 SW Ilan a1vd., Tigard OR Pl at Review Phone 503.639A171 Fax: 503.5 Other Permit T I G A R to Inspection line 503.639A 175 l�l 1 T OF TIGARD Q dy' t"'° See page: for Inter www.tigard .orgov BUILDING DIVISION _ Natifmirmed.d. -- Supplemental Informed= TYPE OF WORK PLAN REVIEW - ❑ Ncw construction IN Addition/alteration/replacement Please drcdc all that apply (submit j alts of plans whams checked lrelOwl: 0 Service or fader 400 amps or mote 0 Building over Three sorties. CI Demolition ❑ Other. where: the available fauh email Cl Madam and bwtyatds. C P TECORY 01.f CONSTRUGTlON exceeds 10,000 amps at 150 volts or O Floating buildings. less a wcannt, or eacceds 14.000 ❑ Commercial-use agrieularral 'I I- and 2- family dwelling ❑ CormnerciaVindustrial ❑ Accessory building a mps for an other uaamtians. buildings. El M i n d - f a u m i1 y D Master builder ❑ Other O F i r e Pump- D lrma Werra of 75 KVA or 0 Eoxrgeacr system. lama separately derived system. JOB SfIE`,(INFOl1MA7ION mu lOC;ATION O Addition army motor bad of 0 "A ". "E: "1- x ". "1.1'. Job no.: Job site addrtxx y ^d F W or more. ate, .• 1 d . b D six or seen residential units 0 Reaealioeal wilier pad*. /StatealP: [� C 0 Hahb rare I•acitities. D Supply w�Dc for mre than \ (�f} � a (� / K 4 `-1 �� 1 D I laardow beatieal. 600 volts nominal Suite/bldgiapL nto.: Project name: O Savix or feeder 600 armor ettne. _ _ , FEE SCHEDULE Cross street/directions to job sitC D ege,svtau . . rm.. ) s . 1 +eai'T New residential single- or multi- fadlydwelling unit. Includes attached P.arone. Subdivision: I Lot no.: 1,000 sq. R. or less 145.15 - 4 J Ea. add'I 500 sq. ft. jportion _ 33.40 1 fax map/pa n:el an _ Limited energy, residential (whet above sq. R) 75.00 2 Limited energy, multi-family 75.00 2 111 r, \ aID r ♦ r ■ a 112 .+, lia residential (with above so. IL) A al - Senders or feeders last9Battaaialteratiou, and/or relocation _ ' Y 'C ki !is. 0 .Il `M.� ` I ai il .' 200 amps or less 8030 ! 2 :.`0 PKOl'ERrY' OWNER TEN 201 amps to 400 scups 106.85 2 Name: 401 amps to 600 amps 160.60 2 . 601 amps to 1.000 amps 240.60 2 Addy Over 1.000 amps or volts 454.65 _ 2 City/Stale/ZIP: Temporary services or feeders instane Ion, alteration, and/or relocation Phone ( ) I Fax: ( ) ZOO 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, least, rent, or exchange according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 , _ 2 Branch circuits- new, alteration, or extension. Der panel Owner Signature Dates A. Fee far branch circuits with .. AP.PUCANr.... • .j _ • 0 CONTACT .PERSON above service or feeder fee. 6.85 2 each branch eneult Business names B. Fee for branch circuits without service or fender fee, 46 85 2 Contact name lust branch circuit Address: Each add'l branch circuit ( 6 .65 (p ( 2 Miseetlaneons (service Of f eeder scot included) City/State/ZIP: Each manufactured or modular 90.90 2 -- dwelling, soviet and/or feeder Phone ( ) Fax: : ( ) Reconnect only 66.85 2 E-mail: , Pump or irrigation circle 53.40 , 2 .fVDfYRiIOR Si Sn orotaline lighting 53.40 2 Signal ciscuit(s) or limited - Business name Bear Electric, lac. energy panel, aluxation. or Address PO Box 389 - =tension_ Describe: Page 2 2 City/State/ZIP: Donald, OR 97020 Eneb oddlelooal iaspeailon over allowable to any of the above Per inspection 6x•50 Phone: (503) 67 81355 Fax (503) 678 - 1108 haycgugptienperhour(' he rain) 6250 CCB Lie: 20919 I Electrical Lie.: 24 - 107C I Suprv. Lie.: q R g 13 Indust"a1 platu perhour _ 73.75 ELECFRICAL' PERMiT PEES Supay. Electrician signature, required: Subtotal: Ip t g:t, - Plan review (25% apermit fee): Print name: }-p k ,h lb v -. (� ('j'' Dates �..-I (�_.(' ) State surcharge (1296 of permit foxy a - 79 � Authorized signature: `� 1 - TOTAL PERMIT lids permll application tapir's ifa permit to revobtelned .,tt in tae Print rut= ( Date: days ante It bes been aceepied as complete. /� � -/ j • Number ofitepalinm altawcd per pemtir 7 1 Ntluaefozri1/4aan'Ve• RRdseof4300 440- 061SItu L CITY OF TIGARD ELECTRICAL PERMIT Per ``7= ' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00158 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/10/2009 Parcel: 2S112CC12000 Jurisdiction: Tigard Site address: 15676 SW 82ND AVE Subdivision _ LANGTREE ESTATES Lot: 52 Project: lundberg Project Description: Install (1) branch circuit for a /c. Owner: FEES LUNDBERG, RENATE J & ROBERT L TR Quantity Description Date Amount 4150 GLACIER LILY 1 crt Branch Circuits 04/10/2009 $46.85 LAKE OSWEGO, OR 97035 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 04/10/2009 $5.62 Contractor: Electrical 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 $52.47 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 AR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: through Q C Q/'-J. Permittee Signature: S OWNER INSTALLATION ONLY 1 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'N 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. . RECEI Electrical Permit lica ! FOR OFFICE USE ONLl' 7 Loo a oq - Permit ten.: Obq • `. _ e City of Tigard cows . I + 13125 SW Hall Blvd., Tigard, OR 97223 pp R Plan R ev i ew t]dxr fnn�: e 2-00 • _ 00 I S3 Phone 503.639A171 Fax 503598.1960 onte'e lL !a Sa Page 2 tor It>sp d : www unc 503439.4175 Cu S gag TIG ■ ' i ` Date y Supplemental taforceagen Y I G A Ii D Wand: .tig udar gav _ TYPE OF , _ • PLAN REVIEW Please asc eh all that apply (submit x of v/items chocked below): ❑ New eottsmtction r ® tt Addition/altetationhvplatxmtvtt 0 Service or feeder 400 amps or mow 0 Building over duce stories O Demolition U Other: — where the available WI cumin 0 Mari* a and boatyards. meats 10,000 amps al ISO volts or 0 Floating battings. C rJ [lORY top C'ONSLRUC�•IOPI to vowed, or exceeds 14.000 0 Commocial we agricultural E 1- and 2- family dwelling 0 Commercial/industrial ❑ Accessory building mica for an other inu nations. to of 7s It vA or Muster builder ❑ Other: ri F pump• finger separately ti n of desired ry te,a ❑ Multi- fatttily ❑ ©taee a," sY to- or ❑ - A". "E"."1•2"."1 rive JOB SIIIE INFORMATION AND LO TION _ LI motor 10011" or Wane. o 'a - Job na: Job site address: 15W1 �.. - AV_P1 ❑sits or More resideralal wits. a %Neational vehicle packs. —� 0 Health are facilities. 0 Swot( voltage far more !has OW/Slate/ZIP: 7 ■ (" ' I n 9 1 �-- © lfa Discus. boo wits iomiwL �'i '^ (] Service or trader 600 amps - mere 5uite/bldgfapt. no: V ptOJeCI t�tftc: �l 1(1Cl K 10 _ FEE SCHEDULE _ • Cross greet/directions to job site J ' nit err era. t:.11-1-11. n rs New residential single- or multi -Gummy dweiring unit. includes attached garage• Subdivision: Lot no.: �� 1,000 sq le ss 145.15 4 _ Ea, Iu1d'I 500 so. It or portion 33.40 1 Tax map/parcel no.: abo idattsal _. 75 00 .. ?` y CRlp11 4 . ... e denergy, ,muulti -family 75.00 limit 2 B WO • (wit +.; �.. .. -!".4: Limited 2 residential (with above sq. 11..) M ,t, ~ Sendces or feeders lastanallo alteration4 and/or relocation 200 amps or less 80.30 2 ,, -L' 0 TEp 201 amps to 400 amps 106.85 PROPF,R7'X' OWR - 4101 amps to 600amPS 160.60 2 Noma 601 amps to 1,000 amps 240.60 2 Address± Over 1,000 amps or volts 454.65 z • Temporary services or feeders Installation, alteration, aadfar City/State/MP: _ _ relocation 1 Phone ( ) Fax: ( ) _200 amps or ices 66.85 rtwtdc on property that 1 own which is not 201 asap to 400 ad1Ps Mill 10030 j- 2 Owner for sale, l Installation: This i or l xc h is being 401 a mps to 599 amts 111111111M1111111111 2 intended for sale, lets0. rent, exchange, ORS 447, 449, 670, and 701. Branch circuits - nevv otterniton, or extension. p .r panel _ Owner signature _ Dale ___—_ A. Fee for branch) circuircuits with abotrc service or feeder fee, 6.65 2 LCANr. 0 CONTACT mum cad branch circuit , Business name B. Fee for branch circuits p,, r wil6orri ery service or (ceder fee, 46.85 4 aJ+(+v' 2 Contact name first branch circuit Each rdd'I branch citrv 6 6$ 2 Ate; Miscellaneous (service or feeder not included) - Each manufactured or modular 9090 2 City/State/ZIP: dweling, saviee and/or fader Phone: ( ) Fax:: ( ) Recomtact only 66.85 2 Pump or irrigation circle • 53.40 2 E-mail: or outline lighting 53.44 2 .:. COId3RACIOIi Signal ciradt(s) or limited - Business name: Bear Electric, Inc. energy pawl, abolition, or 2 extension. l3escritre: Page Z Address: PO Box 389 Each additional ft/bicolor' aver allowable be nay of the above City/State/ZIP: Donald, OR 97020 — Per ire 6 2.50 Phone: (503) 678 -1355 Fax: (503) 678 -1109 mnvttrtigaflon per heart' hr mint 6250 .. lads Plant per hour 73.75 CCB Lie.: 20919 Electrical Li 4 -107C • 1• l_ .. s ACA=; PERMIT FEES _ required: - ,� Subtotal: a o a 5ttprv. Electrician signature, �,_ i , Plan review (25% of c� it fee). Print mine: k ' ILO • , 'i �.�i :� +i Data . —1—C) State surcharge 02% of permit fee): 5. *Z•. t TOTAL PERMIT FEE: 41 _ Authorized Sig rratYre _ tt on res If r 1a not abenl.t,d Addis ISO ra�tFV><< Thlf permit app tica expl perm) D ate days after It has been accepted as rnmpletc. Print name • Number or impatiens allowed perpermir- aa0 -161 site I o5 WHIM; t:�arad�•t�ia atv��tw,dae 0515 06