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Permit CITY OF TIGARD ELECTRICAL PERMIT 2 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00293 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/16/2009 Parcel: 1 S134BD07014 Jurisdiction: Tigard Site address: 10800 SW 115TH AVE Subdivision: ENGLEWOOD NO.3 Lot: 203 Project: Corwin Project Description: Install /alter (3) branch circuits to reconnect gas furnace, relocate heat pump, and add service receptacle. Owner: FEES CORWIN, STEVEN G & JOYCE L Quantity Description Date Amount 10800 SW 115TH AVE 3 crt Branch Circuits 06/16/2009 $60.15 TIGARD, OR 97223 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 06/16/2009 $722 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 $67.37 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 1.800.332.2344. I ssued By: at 1 Permittee Signature: N 0 �j� Al ) • OWNER INSTALLATION ONLY 111 111"`��� 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. 23/21/1996 09:28 503 - 678 -1108 BEAR ELECTRIC PAGE 01/02 t a Electri Permit Applicat RECP FOR OFFICE USE UNLI ,.� City of Tigard Or 43 Permit w.: .. 2 (1 3 14 13125 SW Hall Blvd-, Tigard, OR 97223 I UN 1 5 2009 Plan Revifew Other Permit ? Phone. 501639.4171 Fax: 503.598.1960 Date . llo�tion Line 503.639.4175 Date XemiY /E3y: Jura: H Sts Page 2 for TIG.�1t17 N `t ) CI Svppltmenrxltnforafatloo Internet: www- tigard•or.gov \ TYPE OF WORK PLAN REVIEW . Pteax check all dui apply (submit 2 sets of plies w /usenet checked below ❑ New construction ® Additionfalterationfreplaccrrlent ❑ Service 0, feeder 400 amps or more 10 Building over three stori o Demolition ❑ Other. where the available fault current ❑ Marinas Bad boatyards. CATEGORY OF CONSTRUCTION exceeds 10.00) amps at 150 volts w l] Floating buildings. le.4 16 ground or exceeds 14.000 ❑ Commercial -use agricultural ® I- and 2 family dwelling © Commercial/industrial ❑ Accessory building amps far all other esullitictls. buildings. 0 Fire pump- 0 Installation of 75 KVA or 12 Multi-family 0 Master builder ❑Other 0Em«gency system. Large! tely dewed system, JOB SITE INFORMATION AND LOCATION ❑ Addition of motor otor twd of © - A • '. "E". "1 -2". •• I -3" I OOHI' Or more. occupancy. Job no.: Job site address: 1 C� OA F j� A v �J ❑ Six or awes rte drntisl units_ ❑ Recreational yehiek parrs , -� ^ � © liw a Uhctc facilities. ❑Supply voltage far mote than Ciry /Stare W: ( cc). (1 1 223 ©Itardorts locations, 600 volts nominal_ SuiteibidgJapt. no.: ( Projtxt name ❑ Scrvix at feeder 600 amps or mete. FEE SCHEDULE Cross street/directions to job site - t>e.rtvtea 1 Of, I —- er, I T abl New residential single- or multi- family dwelling unit. Includes attached garage. _ Subdivision: Lot no.: 1,000 sq. ft. Urints 145 4 E. add -1500 sq. it or portion — 33 -40 � 1 Tax map/parcel no.: , Limited energy, residential 75.00 2 Cis::. ;) IPTION :OF, WQRK with shout . is Limited energy. multi- family 75,00 2 c c c' Cr \ \ CSiz, VI. C` V s a t 1 e rrSideritial (with above Sq. IL) Servic or f•eders icstallatlQD, alteration, and/or relocation IL . ,, • 41,11 ` t, �1k. t tL • • • t«. , • 200 amps or less 8030 12 .: II PROPERTY- OW R .... 0 - AM' 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Nettle: - 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts _ 454.65 J 2 Temporary services or feeders Installation, alteration, and/or City /$tatelZlP: _ relocation Phone: ( ) Fax: ( ) 200 amps or less 66,85 1 201 amps to 400 amps 100.30 2 Owner Installation: This installation is being made on property that I own which is not 401 amps to 599 amps 133.75 2 intended for sale, Lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alterat or eslcgtlon, per panel Owner signature Date: _ A. Fee for branch circuits with 0 APPLICANT ' above service or feeder fie, CONTACT PERSON 6.65 2 each bculch circuit Business name B. Fee for branch circuits -. wilhouI Service or feeder fee, i 85 I ` ! 2 Contact name: fast branch circuit 4 j Each add'I branch circuit 6.65 . • 2 Address: - _ Miscellaneous (_service or feeder not Included) City /State/ZIP: Each manufactured or modular 90.90 . 2 dwelling, soviet and/or feeder . Ph one: Fax:: ( ) Reconnect only 66.85 2 ( ) � — pump or itiigttian tittle 53.40 2 E-mail; � CONTRACTOR Sign or aniline lighting 53.40 1 Z Signal ci or limited - Business name Bear Electric, Ins. energy panel, alteration, or extension. Dcscnlre: Page 2 2 Address: PO Bar 389 __ City/State/ZIP: Donald, OR 97020 . Each additional Inspection over allowable in any of the above Per inspection 62.50 Phone: (503) 678-1355 Fax: (503) 678 -1108 Investigation per hour (I hr males 62.50 CCB Lie.: 20919 I Electrical Lie.: 4-1 07C upty. Lie.: 4 1S - Intl strialstant per hour 73.75 _ CAL PERMIT FEES T — ' Nil _ Subtotal: Suprv. Electrician signature, required: U < — J Plan review (25°% of permit fee): Print name: , , ► � M • • f I : I I — State surcharge (I2% of permit fee): 7 „, 72 , Authorized signature; TOTAL PERMIT FEE: tail, Thu permit application expire if a permit is riot obtained within 180 Print name'. Date; days after It has been accepted u complete. — • Number of inspoclroas allawrd per permit_ 1. stialuePsrup40 etr.no,>.SAte.dar 0513 06 440 w155(11 C IStSo