Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00310
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/08/2011
Parcel: 2S 113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 120
Project: State Farm Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37, F
Project Description: (1) branch circuit
Contractor: LEAR ELECTRIC CO INC Owner: G &S FC LLC
5140 SE CIRCLE AVE 16083 SW UPPER BOONES FERRY RD,
PORTLAND, OR 97236 STE
TIGARD, OR 97224
PHONE: 503 - 849 -4723 PHONE:
FAX: 503 - 661 -6389
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/08/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/08/2011 $6.74
Type of Use: COM 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 0 ' 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. L /
Issued By: t // A Permittee Signature: � /--77e
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.
06/07/2011 11 :03 5036616389 LEAR ELECTRIC CO INC PAGE 02
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mit
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QTlew o�slnictiott Addition/alteration/replacement
Cl Service orfmdez400ampsormore CI Building OWIbreeatarlos.
❑ t ernohtion 0 Others wbrre the ava,7able fault anent 0 Madras andbo tyarda.
. N•{ r. y L T -r c o `Y`� t: - i' t' ,T'f?� 7 21. • -ti � '5+i s �Eda ID,° 112178 at 150 volts or CiP1°°�+�6 rlir*
[ear to mod, ar exceeds 14400 ❑ Cemmereiel --use agrioatpnal
❑ i - and 2- family dwelling y-e Commercial/industrial 0 Accessory building amps OM' an other installations, buIIdings.
❑ Multi-family ❑ Master builder ❑ Other Qr1rcomp. Dinstaflatton of 75 KVAor
7l-r� - *fir t �^ah, '`Y -5.-i 7s- .(, ii 'P ` , r ,r.- ❑Mier Ys}wm. lam' separately system.
r ..E '` Tz.ti5�. �`A41, ,,�:,,,, tax'` ,� .- i t1. c=i . a y.±. .ail, .A.1.1- . ❑Addit enofnew motor load of O "A " E ; I- 2"...1_3"
Job no.: I t.- 4 j.3 Job site address: I (0 01{ 3 S (,0 U
pp
100He or mom.
C � ( f ❑ Mx or more r t mite, C1 Recreational vehicle parka.
HeaMi.care SeiMiee. O voltage for
nominal. nominal. mom than
p Nanadoea locations
City/State/ZIP: T l it r c( , O � 1`L ( ❑
Suite/bldg. /apt. no.: i,,1„0 I Project name: &k Le F - O ice or feeder 600 anew or more.
Cross street/directions to job site L
New resldentiat single- or mold-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. b, or less 168.54 4
Ea, add'I500 sq. ft. or portion 3192 l
Tax map/parcel no Limited energy. reeideatial 75.OD 2
�,n ..�,. 5 1"Ftm � e ', p n t3 at; o r , � J o Viii -- i ij c r ; -to: ., y ^ Fa: (wl abo Sq. t)
...i.�:.. w a.L ..:VAr ..1d - -- , _a aa..... 'i., , , ' " .l . Limited energy, multi family
75.00 2
residential (with above so. 8.)
l�f T.� /f (r) Q vT�r lQ /V �)C / s' %• S ees or feeders installation, alteration, andlor relocation
200 amps or leas 10 2
2
�Y i.? '�Ei �x i ', T, "V'' t�Met"` j,7.1� z
"' �ssx : 1 • Z:r;i �" •" ,, ,rt' ',�e2 133.56
1 i S l c t i , din a; h 92..E 5 • `i2 1:.•.5. € rr 201 emp9t04f1118ID
Name: s _ _ ,<r x s ee : t.n�,�r_ > A . �� ,�, . 401 arils to 600 amps 200.34 2
Nom: 601 ampato 1,000 amps 301.04 2
Address: over 1,000 amps or volts 55226 2 /
Temporary services or feeders Installation, alteration, and/or
City/State/11P: relocation
Phone: ( )
I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps izs.08 2
Owner installation; This installation is being made on property that I own which is not 201 amps to 599 amps 168.04 2
intended for sale, least, rent, or exchange, according to ORS 447, 449, 670, and 701.
Eranch —Dail} alteration, or extension, panel .
Owner sagnattm: Dater A. Fee for branch clanks with
�r �' n t r ^ ^' y a c ' 3 zt a service or feeder ions,
�s >nFy - ?; � ,fi � v1 , , 1 ` .' r{� L ) c ar ti - each branch circuit
7.42 2
£i�u,l .... - 4 A5 . , ._ yi��;,l x �L.tiL L._C. JL`}J�L'J�... S➢�¢� Ina k..a�.1!_a�3.,,G:�
Business name: B. Fee for branch cheeks without
service or feeder bee, first 1 56.18 a . I. 2
Contact name: branch circuit
Each edd'1 branch circuit 7,42 2
Address: Mist Ilaneous (service or feeder not included)
Each manufactured or modular
City /State/ZIP: tl
dwelling, sery liar 67.84 2
Phone: ( ) I Fax :: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign outline lighting 67.84 2
:s� ,,rs tip , 9.^v,,. , ,� -,,,, J' """, �. y. " -�a .�' fi�gcr,'?,
r,t, , .1i2.0 i '.rn a� ,..:..'�;s�.�s L �. '1t..� ��,.,!.. � °. �' �s..a.xl ' `a as s.c..,., z. is: ;`- : Signal aam11(s) cc limited-energy
Busineaename; Lear Electric Co., Inc . Each a te atoo 1'anen 2
Each addltlonal Inapecdiota over allowable In any of the above
Address: PO Box 573 Additional inspection (1 hr min) t 6625/ bar
City/State ': Gresham, OR 9703 0
Investigation plant (1 ht min) 66.25/ hr
lndastrialplant(1 bests) 78.18/hr
P i t o n s : ( 5 0 3 ) 665-9840 I F a x : (5 0 3) 661-6389 inspections forwhich no foe is 90. 001 h
listed brmin
60/CCB Lie, 52278 I Electrical Lie: Su Lic.: ` F n �c "'� C F * ' E ..'1 `,.1,T <> ri fix;
2 6 - 41 1 C pay. 3 7 S � r},.... .� � .1 ,.=
Suprv. Electrician si r Subtotal: (e l 9/
`.,,.,..r. Plan review (25% of permit fee):
Ptintna David umford I ,—, t I State surcharge (12%of permit fee): C,( — t
a... / i�71.r d-ef / TOTAL PERM FEE: tad. _ Cl t
A SO
ttdt� e ��'� � This pe rmit application expires tf a permit b not obtained Make Ian
- David Mumford Date: 1Y -- 1 - ( 1 •Number of u alowed perpermit, complete.
F j �J
07/01/10 440461rr(1l/os/coM/adsa (Q a ��
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