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Permit NI y CITY OF TIGARD ELECTRICAL PERMIT .. COMMUNITY DEVELOPMENT Permit #: ELC2011 -00500 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued: 09/13/2011 . Parcel: 2S 103B B02900 Jurisdiction: Tigard Site address: 12148 SW 125TH AVE Project: Hughes Subdivision: BROOKWAY Lot: 29 Project Description: (2) branch circuits to reconnect heat pump and gas furnace Contractor: BEAR ELECTRIC Owner: HUGHES, GARY A & SANDRA L PO BOX 389 12148 SW 125TH AVE DONALD, OR 97020 TIGARD, OR 97223 PHONE. 503 - 678 -1355 PHONE FAX 503- 678 -1108 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 09/13/2011 $63 60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 09/13/2011 $7 63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71 23 Required Items and Reports (Conditions) J . 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 cordance wi 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 A ENTION Oregon la quires you to follow the rules adopted by the Oregon Util .. a ion Center Those rules are set forth in OAR 952 -001 0010 th ugh OAR 95 01 -0 0 / / � You may obtain a copy of the rules or direct questions to O -'d rL 32 1987 or 1 800 33 n , Issue By: J� C 41L- l Permittee Sig _ i' `� c 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' 4I 1 7, �F l,-4 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. SEP 12 - 2011(MON) 13:19 Bear Electric (FRX)5036781108 P.001 /002 Electrical Permit Application FOR OFFIC ✓ ONLY , - City of Tigard V ' l ° dnved • / II Permit No: E�o2otl • • D Moslem p 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review t i . Phone: $03.71&2439 Fax: 503.596.1960 SEP 12 2011 Daie/B : Q her Permit: T1GAlY1] Inspection Line: 503,639.4175 DateRcadyBy: FA 9eePage2for Internet www_tigord- or.gov ` Notified/Method: Supplemental Information -�• •• 4 + N m r 'M,�ww n xrk -r , _ _ C Tin R - ';9i „- r "�''• L" °t r �' ^,- � ; � :� � -'1i " � � " " gg + �, ! ;1�+ � l - y- �^' r., : A ter'" rl1 �, I - . .: ".7 M" e' .,Awr i' a '.I"!t'P1'iOlr� W1D %''�.., �� - �, � � ,." a" � �!, " . .., - _ . x-.." . , 'n t ": � 1"Ci.:�, ...����rl� a+.r,ra •�kFr` f�+t "� © New construction w Add ,R011/8lterati0n /fCpl0.Cement • .• - - • Please check all that apply f aubntit :vs or plans. wincing checkedbelow): Q��; ❑ Servlceor feeder 400 amps ormore 0 Building over ibtec stories. ❑ Demolition where the available limit currant 0 Marinas and boatyards. -1 ' : 44,,. " ,i F a ;,ti iT,,K "it y exceeds 10,000 amps at 150 volts or ❑ Floating buildings ;CA,T�GQRY'�OF. COIN ........ � "`"°� M '� ,�.r." " x a nd 2- family dwelling (] Commercial/industrial �' .,fir f i1 ry ".-w n ,,.. bx rW _ _ ,�w4" ,4u .-- rn -„ r �. , less to ground, or exceeds 14,000 ❑ Commercial-use agrlcullural 1 - ustrial 0 Accessory building amps for all otherinatalladonR buildings. � Multi-family ❑ Master builder ❑ Other 0 Fire pump. ❑ Installetloe of 75 KVA or lJ lilt 1L f Y .,, „r r. s w - ❑ mrgati sym. lar aeprntely ori s amtl � M ; asl r :i "' i " Q ,.*Ii-,!7T>r11'IATICi 'r1 A d 11a 0 '!' 1" "G E14,'"^. `: ❑Ad t i oCnew ste mator load or ❑ -7 - P " - % " , Job 14� slit address: 100HP or more. occupancy. 1Zl 1_ S_ V . y"` Pt) e. . ❑ Six or more residential units. ❑ Recreational vehicle parka_ City /State/LU ': � � ,+ CI) - 1 .4 0 Health -care facilities, ❑ Supply voltage for mom than l 1 Hazardous locations. 600 volts nominal. Suite/bldg./apt no.: Project name; (-Ili Co /-f-S ❑ 5ervico or feeder 600 amps or more. iN1 .: *i �,s ?t :: ;i: !a:: *SarEDUiftygagar Cross street/directions to job site: ne.rlpaea I Qty_1 Fea J Twat 1_2_, — -` New residential single- or mull- family dwelling unit Includes attached garage. Subdivision: Lot no.; 1.000 sq. it or less 168.54 . 4 Ea. add'l 500 so. ft or portion 33.92 1 Tax map /parcel no., Limited energy. residential ko .n '.3, ,iia i::,. - _',tt:::T4",':0....; Cre:l ""' e,Seti.I'itle CCIF4W 1JR 01as " _ 0 ':c` s 4�` ( above s9. R) - 75.00 2 ,,,. - - - w - ° " ' Limited energy. multi-family C R . s w r • % is ' . residential (with above sq. R.) 75.00 ,, Services or feeders Installation—alteration and/or relocation el _ ,% t tt -.., 200 amps or less 100.70 2 „. "M .. _. t , "tc GS 'A: O� "."';1, :� riN" °' 1 " ; ash" I ' " 1 . , ;r i . 201 amp") 400 amps 133.56 _ 2 401 amps to Name: aptcy ei- � 4- !moo X1-45 " 601 amps to 60 00 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/Slttle /ZIP: Temporary services or feeders lnstallatIon, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 1 59.36 I L 201 amps to 400 amps 125.00 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for side, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits new alteration or extension , er anel Owner signature: Date: A. Fee for branch circuits with M s ' ,* above service or feeder fcc, • tdtiM i, „t?ilir, is °:�: a ottY t.i ' s. am wt `,M�1, rl��lr"R I!I '1� 7.42 2 each branch circuit Business name: D. Fee for branch circuits without service or feeder fee, tirat , r Contact name: brunch circuit . 56,tR ` 2 Sash edd'l brunch circuit I 7,42 7, 2 Address: _ Miaeellaneons_(service or feeder not incinded) l /$foie /Lit . Each manufactured or modular ' ' ' dwelling, service and /or feeder 67 2 Phone: only 67.84 2 1 hone: ( ) J 1`ax :: ( ) Pump or irrigation circle 67.84 2 E-mail: _ Sign or outline lighting 67 2 Frog' I'Rr'a , a 6 ° " "C,O11ip` RA” ' IO -- l " `)'" l " : ' -. si circuit(s) or limited energy Business name: t. • Panel, alteration, or extension. Page 2 - 2 rrr•��� " "" Each additional inspecdon over allowable in any of the abov Address: t) Additional inspection (1 hr min) 66,25/ hr Investigation (1 hr min} 66 :5/ hr City/statdzlP: L �� 1 C - \ (')'� In plan (1 hr min) 78,18/ hr Phone: (SO • w l ax: ( 8 ; - inspections for which no fee is 90.00/ hr _ 4 s mcillcall listed ('h hr min CCB Lie.: 20r , S Electrical l;ic.:' L{ -1M , Suprv. Lie.: L \% \S .,,,... ,, , '"fit l ,.0.R19.(flan S . Suprv. Electrician signature, require -� -- s Subtotal: �p ,r0[� - i'� � Plan review (25% of permit fee): ` ' r Print name. it II Datc:O • 1'2.^1 State surcharge (12% of permit fee): 4?) ]l t 1 ik! .* & ° 1l.! Al a+ � � TOTAL PERMIT FEE: ` Authorized signature: ~`� " This permit application e:pirea if a permit is not obtained within 180 Print name' ` Date: days after it has been accepted W Complete. • Number of Inspections allowed per permit. t:\Duddmg\PermttscPLC•Penn"tApp dos 07/01/10 440.4615T(1I /05 /COM/WPB