Permit •
. ;*r
CITY OF TIGARD ELECTRICAL PERMIT
11 11 1- COMMUNITY DEVELOPMENT Permit #: ELC2009 -00371
Date Issued: 07/24/2009
TWARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S111DC07200
Jurisdiction: Tigard
Site address: 9410 SW BRENTWOOD PL
Subdivision: SUMMERFIELD NO.9 Lot: 492
Project: Jarnagan
Project Description: Reconnect furnace & install new heat pump circuit
Owner: FEES
JARNAGAN, HAROLD G Quantity Description Date Amount
9410 SW BRENTWOOD PL
TIGARD, OR 97224 2 crt Branch Circuits 07/24/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/24/2009 $6.42
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 $59.92
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 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.
AL AL t i 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 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.
( 1JUL - 23 - 2009(THU) 13:29 Bear Electric (FRX)5036781108 P.001 /002
i
n
Electrical Permit Application FOR O FFICE USE ONLY -
ECE City of Tigard ' U '�'D Penni C/ 440 a - OD 31
.11 „ 13125 S 1(a!1 Blvd . T;gan) OR 97123 t 1 pun Review —
Phonc 503.639.4171 Fax 503.596.1960 andor Other Permit: _ _ ___
Tic ,�
Inspection Line. 503 JUL 2 3 2009 Ruckcadyifly ii to sm Fate 2 for
Internet www.tiga d- or,spv Naifledikfmhod; l Supplemental Informaikia
TYPE OF WORK CIT I IGARD W
(3 New construction Additian/alteratiot�t n i DIVISION rinse check all that apply (submit lien of plans w ,NCan checked below):
0 Service or feeder 400 amps or mote 0 11uilding over three stories
❑ _ D e m o l i t i o n ❑ Others where the available fault current M a th e s ! . sandbaaryaats-
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO wits or ❑ naming building
less to ground. or cameda 14.000 Cl Comateteial.ow agricultural
.1E4 1- and 2•family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations, buildings -
o Multi- family ❑ Master builder ❑ Othcr 0 Fire puma. Q installation af7S Kvn or
JOB SITE -INFORMATION AND LOCATION 0 E mt* ❑ Addition g<n o system. f new larger rcva i.2". -I • .3. ". rysccma
of manor idad of Q "A ". 'C:'1.2 ". ") 3 .
Job no.: I Job site addles$ A a� ,-,y wont or more- oedelssttay-
_ 1 LUC ` , , �R L -c on er mom rbLlentiat unita. I:1 keetestienal vehicle parks,
City/StoIe21P' 'n(, S - Cl —I �-1-./ ❑IIeaturcalerxllldes 0 s voitace far mate than
1 ❑ I tnatttow beldam. 600 volts Itommst_
Suite/bldg./opt. no.: [Projectnamc 0 Scnccor feeder 60 pa or nrare
' FEE SCHEDULE
Cross saw/directions to job site l.., . rYn 4 r... Mal •
New residential single- or maltl- Iamlly dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. IL oriels 145.15 4
EA.. add'l 500 nil. or portion 33.40 I
Tax map/pared no.:
Limited 75.00 2
.'DESCRIPTION OF WORK (with above eq. a.)
m � ` k L e
Limited energy, multi-family 75.00 2
VC e�•\ NA A` 1� t \` ')e\ s) lRsiC liZidential (with above sq. f.)
Servlees or feeders Initallatta alteration, and/or relocation
tnl 4 '�\ `• r � c tom. a _ 200 amps or lass I 80.30 12
:-Z1 OPERTY• OWNER J El TENANT 201 amps )o400 amps 106.85 2
Name 401 amps to 600 amps 160.60 2
— . 601 amps to 1.000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
CityrytatedZIP: .w Temporary services or feeders instaltation, alteration. and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less _ 66.85 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps 1o400 amps 100.30 2
intended for sale, horse. rent, or exchange, according to ORS 447.449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits new, alteration, or estenstan, ;or pa ne[ -
Owner signutute Date — A. _
A Fee for branch circuit[ with
0 APPLICANT 1 0 CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name B. Fcc for branch citeults
Contact nun= w/ hour service or kaki' fc4 I / p �
fust brunch circuit 1 46.85 ` �L rr)J 2
Address: Each add'! branch circuit I 6.65 (Cr tfn 2
-- - Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modutr
dwellin fee
k ; service and/or feeder 00,90 2
Phone. ( ) f Fax :: ( ) Recormon only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
. ., CONTRACTOR • Sign tor outline lighting 53.40 2
Business nom Bear Electric, Inc. Signal citcttit(ts) or limited-
energy panel, attention., or
Address: PO Box 389 extension. Describe: Paget 2
City /State/ZIP: Donald, OR 97020 Each ■ddlttonal Inspection ores' allawnh'. In an • of for above
Per inspection 62.50
Phone: (503) 67 8-7355 Fax: (503) 678-1108 Investi lion - hour(' le min) 62.50
CCB Lie.: 20919 Electrical Lic.: 24 -107C prv. Lie.: industrial plant pea haur 11. 1.
ELECTRICAL' PERMIT FEES
Suprv. Electrician signature, required: t � J -- Subtotal: 53 , ) c, •
Print name 4 _1 _J11 F' Is • VA • - Dater'(- Plan review (2596 of penult fee):
State surcharge (12% of permit fix): , t_tin e--I2
Authors cd signature: TOTAL PERMIT FEE ,, C12
Print name 1 Date: Thi permit appiteatlan expires if • penal[ to not obtained rirhla tau
days after It has been accepted at complete.
• Number of inspections allowed per permit.
1:136ildhpt'Rrmbi ELC- Perio••••got et2306 4.40461 51(11 OS co tv!tn