Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00146
Ti G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/22/2011
Parcel: 1 S134CA00507
Jurisdiction: Tigard
Site address: 11125 SW 119TH AVE
Project: FABIAN Subdivision: PANORAMA NO. 2 Lot: 18
Project Description: (1) branch circuit to reconnect furnace.
Contractor: BEAR ELECTRIC Owner: FABIAN, GOLDA
PO BOX 389 11125 SW 119TH AVE
DONALD, OR 97020 TIGARD, OR 97223
PHONE: 503 - 678 -1355 PHONE:
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 03/22/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/22/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 OA' • - 001 -0090. You may obtain a copy of i e rules or • ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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 the next available inspection date.
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.
MAR - 21- 2011(MON) 14;35 Bear Electric (FRX)5036781108 P.001 /002
Electrical Permit Application FC.112 OFFICE. USE ON L1'
City of Tigard 1r,i, c;41 n,w„11,; .› tiarll s inewlemEstz
" 13 125 SW I lull Illvd" Tigard, OR 97323
Phone; 301.639,4171 lux: 501598.1960 IfflillinillIME other PcmiIt
TiGARD
Inspection Line: 501.634.4175 Dale Kvi $ty; See- l'a8e2for
1111Crllct www.tignnfwr.guv N1 Iicdr�tcdtod: / r Supplemental infbrnatlon
° .1t I 445: i ' t,.,rK +, ,,x,., e i .. OF7 pout A7 .J w7t . . I ,1 " , ) ,r' Ofilla hRC °fP Ii A`[` R1yitw , , ,,, --- 4.,,,„,,,,
0 New construction ® Addition /alteration/replacement meme owe enthatuprl) Norm z9a% oi Plnm t in:ms00:km'urhxrl:
❑ Service or feeder 4110 wraps or more ❑ Building over three stork&
❑ Demolition 0 Olhcr. _ t.hcrcthe utuiluhttfduh CI Marino and l>twtyinds.
,''`' 01:" dial riiM'",,4 ,1,taid`7ze:oR (j ;A1t3TRtiOti*
,, i'''' , .''''.4'.0'."' . ' 4 ii.1 a cods III,Out)ampslit 130 stillstlr ❑wtr
I'In
-- ie., w y n,tu+ct,tx,•scwds 14siou ❑ Commerclal•use agricultural
rg 1- and 24t:mlily dwelling ❑ Commercial/industrial 0 Accessory building amps Iii all other installations, buildings.
In Multi-Cum ily In Master builder ❑ Olher 1 pump. ❑ Installation .fi3�K or
x,;: r+ W ,a, . ; rY��• r X •i , ... r F 1" .rle- ou, s uri. y u t y .e y
t,'l ,3, it0;i1 QRJ1Ir1"TJC1, ; Ciii0 fiQ " "° " `' ❑ I" o o cr m t system
M�.�; IM:ti Q r� a "�+r1r,I.. �.� a. ' . N a' +t +� w. �"�� ' ❑,1dt{ilkmut'nrtc await. load ot' 0 "A ", "{; ". "1- 2 ", "1•1 ",
1 vs 4 \\O p,�g, 1001 II' tw'morc, atc i u tio '.
lob no.: 11aU S11C address: a su or mare residential unit ❑ Rt;cm vehicle parks.
City /State /ZIP: -- , cA� 4 ❑ l I Ith"are faunitk� ❑ Supply whose tbrmon; than
Ll [ 1 l 7 tanlnk +uw lotsn 61/11 satire nominal
Suite/bldg./apt. ao.: ` -JS_ Ptttject name: ❑ ~caner or reels ('116 amps or tram.
-
Croiis rttreeti lirections to job site: uemniplii »r l I r re-,. I 'I MO I •
New rettitlentinl single- or multi - family tJwclltng unit.
includes attached gilnigu.
Subdivision: I Lot no.: 1,000 sq. a. or less 161.54 4
Ea_ add•I 500 sq. 0. ur porlitm 33.92 1
Tax map/parcel no.: I, 4:nery , resldct+llul
�, "• x,rx, -. w r p a trl! nlulvestL11.1
7s.nn 2
(� ' - ^Li (with
energy, multi - campy 7t OU 2
Y'CP co_t\a2 r�+ldcntial (with shave sq. 11:)
`" Services or feeders Insmllation ItiM relocation
2110 Iliu or less 100,70 2
, , J" , attifi ' '1+"1w" ., b ,i : ,a :I pros i g Hd , " 201 limns to 400 amps , 133.36
401 11IIIps to 6(10 maps 200.34 2
Name: 60I uumn, to Latin amps 301.141
2
Address: Over 1.000 amps or volts 532.26 2
CiL iSlnfciZl P: Temporary werviees or feeders blot 'illations allerutklu, and /ur
Y relocation
i I
Phone: ) Ftlx: ( ) 200 amps or less 59.36 I
201 amps to 400 amts 125.01 2
Owner installation: This installation is being made on property Hutt I own which is not
intended For sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701. 401 amps to 549 snips 161.
• Brunch circuits- new, alteration, or extension, per pa ncl
Owner s1I;11atL , Date: A. Fa: for brunch ClrcuIts with
1 ,:„ ,,, w � t#1k � 7. above service or feeder fee, ,
„» 3 , a w i + !l ( "�"`la kERYRI 7.42
a each branch. circuit "
Business name: a Pegs for brunch circuits without `Q
�., service or feeder lee, first I 56.18 516 TS 2
Contact name:
brunch circuit
Each udd'l brunch circuit 7.42 2
Address: miuecitnncoue (seiviee or feeder not Included)
Each namutuct ircd to ntudelar
City /State /ZIP: dwelling, rcrviccundlor (:7.44 2
IMP
Phone: ( ) J Fax:: I ) Reconnect only 5 7.1.1 2
Pump er irritlaliott click 67,14 2 - E- mail: 11 r .,,.Y p e w X Sign or outline lighting 67.84 2
„ C ten rx�i p, tit . _
.,.r r11�Ff °^�I,i�tia !�1 `l�f.:.u,�,.: %ice, ^,�, ., M' ' a :::... ' Signal CiKUit(x) or limited-enemy Business name: (] y �� panel. alteration, nr extension. _ Pagc 2 2
�`� c+ 7 '-`201..j 1 X.e--- Eneh Jiddltioaal Inspection over allowable in tiny or the above
Address: #, I . -
Cih�iSlulePLl /� Additional inspection il. hr min) GG .251 hr i
O�\� l 1 , - -I� invcsll f:' hrmin) -... _ 66 hr _...... - ...
l': '
hu lu strie! plant (I hr m in) 78.11 / hr
-
Phone: `
5 r � ` prix: (‘,5 pes toms Ior which no fee is
= '�-/ i - ` 2 / ��� nv a iticelI good 4; I+r mbl 90.00/ hr
CCB Lie.: i Co Electrical Lie.: 2 V i Suprv. Lie.: L.4 ` ► 1 ` .,.„.. :i " b `* uc.m. , • a, 1 ' . , a r ? z ' 'Arm
5uittotol: t . 1 w
Suprv. Electrician signature, required: ,r Plan testers t y _S t6 or permit I'tx 1:
Print n
Authorized �n c s 11 Date: '� \�` State surcharge (121* olpermit feel: I,..0 , IA
TOTAL PERMIT Ff;F: 1.02,
Authorized :ill!,11:1tture: Thit penult u plitalioo expires If i, permit. is net obtained within 110
dugs miler11 has -telt occtIJt 11$ complete.
Print name: I (att)c: * Number ol 'lnvertinnsatlowedperpermit,
I \ t.d IdhpAlkrm 117411 /III 4•10-1h) S 11113a'A9 nn WI iH