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Permit CITY OF TIGARD ELECTRICAL PERMIT 11111 ° COMMUNITY DEVELOPMENT Permit #: ELC2012 -00154 Date Issued: 03/22/2012 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S 102CB04000 Jurisdiction: Tigard Site address: 13485 SW BARNUM DR Project: KOCH Subdivision: BARNUM PARK Lot: 1 Project Description: (2) branch circuits for A/C and furnace. Contractor: BEAR ELECTRIC Owner: KOCH, VIRGINIA L PO BOX 389 13485 SW BARNUM DRIVE 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 03/22/2012 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 03/22/2012 $7.63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total . $71.23 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 copy of the rules or questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: � _ — ermittee Signature: ■rorapr 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 503.839.4175 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. MAR 21 - 2012(WED) 09:58 Bear Electric (FAX)5036781108 P.001 /002 Electrical Permit Applicati is Er I\ IC 1:012 OFFICE USE ONLY i V La D City of Tigard Ord : 3 i.� . . . 13125 SW Hall Blvd., Tigard, OR 97223" A 2 1 201 ' p1® Review Phone: 503.718.2439 Fax: 503.598,19 D Other Permit: TtGnKD Inspection Line: 503 ,639.4175 CITY OF -r IGA D H - for Internet: www.tigard- or,gov No tifeedrMahod: Supplemental Information .., _... - .' ' " ' . • 'TXPE •OF:i®RKhi ` • : := . , . : 'SION - . _. -•. . ... : ,. 2'A,:AN :REVIEW _ _ , .. • ❑ New c onstruction ® Addition/alteration/replacement Mate diet* all t apply (submit 2 sets of plans w/hema checked below): ❑ DCn1011ti0I1 ❑ Other: ©Service or (heeler 400 sumps or mom CI Building over them stories. _ where the available fault manna CI Marinas real bmsyerds. :.__ - _'; , ?"4'. `:. `.-:. • ::.' : CATEGORY OF: ,CONSFRuCrION "i _ ' ` . -= exceeds 10,0110 amps at 150 volts at 0 Flaming buildings d wellin • less w t��d, a meads 14.000 0 Commercial -see epliwltuml El I- and 2-family g ❑ Commercial/industrial ❑ Accessory building amps for alt ether inerauatlons. buildings, ❑ Mull- family 0 Master builder ❑ other: D Ms pip- 0 Inaallatioa of75 KVA or B ]NPO RMA'CIt31V _. , .. - p Emergency system. ImaR sepmatey derived system. .�::;;� ; „, . O •$I73L .AND:LOCil' IONS,: ; ., =.4Ti� p Addidonofnew motor load of ❑ "A 1.2 - I.3", Job no.: 1 Job site address: 13485 SW Barnum Dr. 1ooxPearmore. occupancy. 13 Six or more residential emits 0 Recreational vehicle parrs. City /Stute/ZIF: Tigard, OR. 97223 ❑Health -care Whim O Supply voltage for mare than O in loeetlmts 600 volts anminal, Suite/bldg./apt. I Project name: 0$ rs4ce feedat600 amps or ore, arsaaeaweseee401:1vS ®IItEt � - r.:;':r'' '-:s'a.:,:�; Cross street/directions to job site: D.erbtiem P I Fr. 1 Tatar I • ” New raldentlal single, or mold-family dwelling Halt. Includes attarbed garage. Subdivision: J Lot no.: 1,000 sq. ft. or lean 168.54 4 Pa add'1500 sq. is or portion 33.92 1 Tax map /parcel no.: Limited energy, residential V :r �:;t_Ta:: - q 1 +:. • s_ • ¢, 75.00 2 :. - .,; „ .. _ �DB9eR1�77oN `oF :�_.,, �,_.;.� (will' above sa. n.) _ Limited energy. multidranlly 75,00 2 A/C or heat pump and electric furnace. residential (with above so. Ii.) Services or feeders lnsmllatloa, alteration, and or r docillon 200 amps or less 100,70 . 2 Y•�. 4f'I RQ 4:0;7 li4,r . 4 _ -.__ .10 s v x. u : 2°1 amps to 400 MPS • 133.56 2 401 amps to 600 amps 200,34 2 Name: 601 amps to 1.000 maps 301,04 2 Address: Over 1.000 amps or volts 552,26 2 City/State/ZIP relocation Temporary services or feeders Installation, alteration. and/or Phone: ( ) J Fax: ( ) 200 amps or less 59.36 1 201 turps to 400 amps 125.08 2 Owner instaladoa: This instailution is being made on property that 1 own which is not intended for sale, lease, rent, or exchange, according to ORS 447.449.670, and 701. 401 amps Io 599 amps 16834 , 2 Branch Owner signature: Date: A. Fee o circuits— nc clients with extension. per panel _. _ , s @ �- -„_ F�--t��, above service m feeder fee. 7.42 2 ..., . .•. ... . •. z� . •. __ ._.._,:4J$��/!!a4A� achbtaech Business name: B. Fee for branch circuits without - service or feeder ft e. first 1 56.18 56.1 2 Contact name. hmnch circuit Bath add'l branch ciruol 1 7,42 7.42 2 Address: Mlcellanexlus_(sc or feeder not !Waded) City/Statc/Z1P: • dw�eu�servicice aand/orr feeder 67.84 T 2' Phone: ( ) Fax:: ( ) Reconnect only 67.84 2 Pump or lnignlion circle 67.84 2 E - mail: ,tit •:,:^' ri• ' _Tg riCONtRAACTOR'! _. SIKHorouditte 67.84 2 �� sil;zaal cut' trit(s) or limital- eocrjty Butlinesn name: Bear Electric, Inc. panel, alteration or txteosion. parts 2 2 Each additional Inspection over allowable In any of the above _ Address: P.O. Box 389 Additional Inspection (I hr min) , 6625/ hr Investigation (1 lir min) 6623/ hr City/State/ZIP: Donald, OR. 97020 Industrial plant (Ihrmin) 76.111/ hr Phone: ( 503) 678 -1355 Fax: ( 503) 678 -1108 Inspections for which no fee is 90.00/ hr Faeeiflcally haled ('h hr min) CCS Lic.: 20919 I Eleetrical Lie.: 24 -107C 1 Suprv. Lie.: 48818 F' 4' "�°'•-' i.te ER ._ +" Suprv. Electrician signature.:, required: subtotal: 63.60 - �.,•.. Plan review (25% of permit fee): Print name: Stephen Shepherd • Date: 3/21/2012 State surcharge (12% of permit fee): 7.63 TOTAL, PERMIT FEE: 7123 Authorized signature: 7b1e permit application aptra i ■ permit b not obtained within 180 Print. name: Dole: days after It has beer ampere! at complete. • Number of inapeetime avowed per parnut. Inawildindenvetrul.C- PomlAep.doe 01/01110 440.461i'11lAd/COMIW13D