Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
It 111 COMMUNITY DEVELOPMENT Permrt ELR2011 -00227
Date Issued 10/26/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 23113A600300
Jurisdiction Tigard
Site address 16037 SW UPPER BOONES FERRY RD 200
Project Oregon State Bar Subdivision FANNO CREEK ACRE TRACTS Lot 38
Project Description Data telecommunications system
Contractor LEAR ELECTRIC CO INC Owner OREGON STATE BAR, THE
5140 SE CIRCLE AVE 16037 SW UPPER BOONES FERRY RD
PORTLAND, OR 97236 TIGARD, OR 97224
PHONE 503 - 849 4723 PHONE
FAX 503 -661 -6389
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/26/2011 $75 00
12% State Surcharge - Electrical 10/26/2011 $9 00
Type of Use COM
Class of Work ALT
Total Number of Systems 1
Audio & Stereo N Boiler Controls N
CCTV N Clock Systems N
Data & Telecommunications Y Fire Alarm N
HVAC N Instrumentation N
Intercom /Paging N Landscape /Irrigation N
Landscape Lighting N Medical N
Nurse Calls N Protective Signal N
Security Alarm N Other N Total $84 00
Other Desc 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 -0090 You may obtain a cop of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By Permittee Signature . /./ _L`i
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 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
10/24/2011 13:10 5036616389 LEAR ELECTRIC CO INC PAGE 02
RECEIVED
Electrical PermitApulicafon. OCT 24 201 1 U1; .Mlt1/,jI.,r,i
City of Ti 1�m H.. _
— 13125 SW Hail Blvd.,Tlgard,OR97723 CITY OF Mk _:' tea. __._ " /I —U 717
r r.,;.:r IlhJns 501639417w159e.196oD DIM wl ovQPam
Internet. www.tigmdor.gov tied /Mama ant Has Pee 2 far
In, "{ t sapplemroml lefmmalny
q ' 8a ` ;:::: 2,yer 1 4 16 R -` f 4 I �Y , � f r}`;:.w - }rµ+.:4,T1 zez ,� ^w -m5� ,`�T) - ^77, l71-7,7114- T ,taTi :w
wat _u 8c ¢ u�_ .ev . .�s .'"S...re �., .,d- ,..�e�S sd < s" t_.,26:".. as irraa.°� t_ «i�r o`.S „:V. i.
❑ New mnstmetion S,Additiodaltetndonheplacement Pteam Wok all eat apply (abut /sets of pivo teas checked baba).
Dame
n* 0 soe a feeder 400 amps a more ❑tWadaaa tlnee .mdes
o U Demolition ii �"`"V 4 ^ - , r where the enviable ink current ❑ MMrj, ani buenn&
y? ,'S„ a'.'.,aF7.:3!�,4 5;..��,�t : er:45a4:31 �:.v�n's3�'.e� uS£tu h '�lal '. I,wJ S esudel0A too ror ❑ r thnge.
❑ 1 - and 2-family dwelling 74 Commanial/industrlet 0 Accessory building rm m8r edl ode er ox m ins. ❑ Cgm ing s . ma pimdaust
e ter odaerasssismne. buildings.
El ❑ Master builacr ❑ Other niLe Paine
�yG �., ❑1naura1aot7dethrd
� K i.� .`° sis�t S �.j.3 11 :1 4,f tits, -416 �,. N1/2,2 � v �.s' ` ^r �, : ^, .n, ❑eo of newm ' I2 ..y'sien
"=• �'1�++ "_ �`�i ".�''� 2 aae
O nea,oan al mw mo ao r 7ma ere ❑`n', °F; °I- x ^r ^,
Job oo : "— 5 q q Job site address: ( (our 31 SO Upper r Q helot amour oo rpaa�
"1' •✓OOM1¢5 ❑9xwa rea[domfnl voitr L1 R.,.,.m.,�at aemak paler:.
�\ J V
Cily/Stebe2lP: ' r ( q a✓ d i ie c '713 f-( Ferr y to( ❑Halave Meiners 13 sawlyvenom Er mote man
1 �� ��I7n(L ❑ them.,. locations. 680 oohs nominal
Suite/bids/apt. no.. a Oa I Project name. "r1 2- r ❑Service m feeder 600 amps or more cAA
Cross street /dmeaions m job site• 8 cal (d, 0 A - Fa n no Cret (L .. -� "� ro ' ant; "�
New residential single- or nudd- family dwelling ®It
Includes attached garage.
Subdivision: I Lot no.: 1,000 92.11. trims 168.54 4
Tax map /parcel n0.: Ea add'I SOOa¢ t argon= 33.92 5
r r Limited cagy, residential
E ;..16 ` ' :;.t'b.v icE n:`.,3Mi% 2 ., a 4-a 4N- A..y ' vats za V i � I.;1 .1 ^ea` „.i,. (wl algvear t) 75.00 2
/� .),.., : � .. 1 -ate. Limned cagy, .amity
vik C( f .S87c/ e✓✓h residential (with abevea9 8) , I 1590 2 I
/ Services or feedas hnstalls& alteration, andesr relocation
200 amps or lea 100.70 2
s aw . :
, P . 1';413 i 1 t+= � 4:7,Xe r i `sr p97,3 .? s l Zr, ,a ''' �T . V �-- �fiI`::n:
e h.. ••Oe•: :4)4, v.LaL:.tr ` i§%i u>"Fk.:1, ick-ii 201 amps / 400 amps 133.56 2
Name 401 amps m 600 amps 200.34 2
601 amps to 1.000 an= 30104 2
Address.
Over 1,000
amps or vole 552 .26 2
City/State/ZlP: Temporary services or feeders luamllatlon, ahn
eWm, and/or
relocation
Phone: ( ) I Fax: ( ) 200 ampa or Ins r` 5936 1
Owner Installation: This installation is being made on property that] awn which is not 201 emps 400 amps 1 125 OS 2
intended for sale lease, neat, or exchange, according to ORS 447, 449, 670, and 701. 401 emre m 594ampe x 168.5. 2
Owner signatu e: Date Branch 4 branc a -new. alteration, or extension P Pane
Owner
x 91 yb't r: r\a T�pTrF rR as -z r- A Fee tor breech awaits with
hr �. gv. ....ass _ ;15'2 ,7 4' 4r t s €1 M2)5s?f'c 1" � ..,..:b A ahova amaaor re "la tbe 742 2
seranvL
Business name S. Fee e tor bbranch h circuits dreaib
Contact name: pima feeder �fst 56.18 2
branch cucoit
Address. Fadr ad81 branch circlet 7.42 2
afuodianeces (service or feeder not included)
City/State/ZIP:
Each manuawhaedor 6784
dweilma, service andlor Medea 2
Phone ( ) I Far : ( ) Recormcl may _ 6784 2
B- Amp or irrigation circle 2
.iz - hi l pt's L V.7.i ` tai et2:•Is,�,9'..3J:.2.(4'K,,, °s .'l1:',d�,'xlY`s10..,.ai` ¢ signorcdi „ 67.84 2
.r `" Sigaa(enariKa) _
Business name: Lear Electric Co. , Inc. Panel, alteration, w mttemm. ( 2 �5 2
Etch additional hrepecden ova allowable ha any of the above
Address. PO Box 573 Mdrhona' Mir-aeon (aannul) 6615/ hr
City/Stata7JP: Gresham, OR 97030 °eahatdm(iur`m °) 66.25/ hr
Indnstdalptent(1 hams) 78.18/hr
PbQe1e( 665 -9840 Pas(503) 661 -6389 Inspections tbr which no tee is
99.00/ hr
CCB Lac.. 555ggg • -. , .. 1 lined hr min ^.. ,
--
52278 ElectricalLic.26 -411C Suprv.Lao.: 7g �`.tsas',-,'.2' `57 i -' ,• -__.
Suprv. Electrician signs regmrm: r re-,„/21-7 // Subtotal '
i —+ Plan review (25% of . - .1 fcey
Print name: David mfPIll ord
a I I I State aaabmge %nf pawn reel 9 —
Autbori rgnature: //y� // TOTAL PERMIT FEE: t 0)
�° /7.9•1 j/ Mb permit application antrada parent a not°Melo tlin 180
Frintnm David Mumford Date. IU — a - 4 — • dare after It been accepted as complete.
• Nomba ofhapccdaa domed per parch,
t PaaoAtpdar mire /10 440- 46IS111Po'C@@wP0
10/24/2011 13:10 5035616389 LEAR ELECTRIC CO INC PAGE 03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for a ll residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
• Other: r. _
r..,^s"'lar aZ- F i,li: ;(, r.�� p4.NW, L�,c"' -2�st:
Fee for task commercial $75.00
system
(SEE OAR 918- 309 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Rogation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other _!
Total number of commercial systems: _
"No licenses are required. Licenses are required
for ali other installations
t 07/01/10