Permit a CITY OF TIGARD ELECTRICAL PERMIT
III
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00209
Date Issued: 04/10/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1S134DA02200
Jurisdiction: Tigard
Site address: 10850 SW NORTH DAKOTA ST
Project: Nelson Subdivision: NORTHERN PINE Lot: 6
Project Description: (3) branch circuits for a /c, furnace and service outlet.
Contractor: BEAR ELECTRIC Owner: NELSON, ED & STEPHANIE J
PO BOX 389 10850 SW NORTH DAKOTA
DONALD, OR 97020 TIGARD, OR 97223
P
PHONE: 503 - 701 -9815
PHONE: 503 - 678 -1355
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 04 /10/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/10/2012 $8.52
Type of Use: SF Electrical -
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
Total $79.54
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. ATTENTI n law requires you to follow the rules adopted by the Oregon Utility Not�cat' Center. Those rules are set forth in OAR
952- 001 -0010 rough OAR 9 2 -00 0. u may obtain a copy of the rules or direct questions to OUNC by callin 03. 32.1987 or 1.8000 33 .2344. ,
Issued By: Permittee Signature: �O /" ° ` C .2 lam4 - g-t.1
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.
PPR-06-201 2(FIRI) 15: 1.9 Bear Electric (FAX)5036781108 P.001/002
Electrical Permit Application , FOR OFFICE USE ONLY
City of Tigard RECEIVED Received Lifir Permit No.: &Zo •
II 13125 SW Hall Slut, Tigard, OR 97223 Plan Review '
' Phone: 503.7182439 Fax: 503.598.M 6 2012 Onie/T1v: Other Permit: 1-ftedom -evao
TIGARD •
Inspection Line: 503.639.4175 Dale Ready/By: 63 Sec Page 2 for
Internet: ww.tignrd-or.gov Notified/Method: ri SaPPlemanal Infannation
CITY OF TIGARD
. .. TYl'E RY IY DIVISION - ''. : . . . - 11"ItEviEw . I. . ...
El New construction IN Addition/alteration/replacement Please cheek all thin apply (submit 1 sets of plans Wilerns checked below):
0 Service or feeder 400 amps or more El Building over three stories. . 1
El Demolition 0 Other: where tbe available fault current 0 Marinas and boxyards.
r -",:. - . • :••= : 7. 7 ""CATECORY :01 •••••- .-.• :.'2. • :, ' t - .:7 exceeds 10,000 amps at 150 volts or 0 Floating buildings.
kss lo mend, or cute& 14,000 0 Commercial-use agricultural
El I and 2 dwelling U Commercial/industrial 0 Accessory building amps for all other installations, buildings.
CI Multi 0 Muster builder D Other 0 Fire pump. 0 Installation of 75 KVA or
• - .
syst
.. . .. . . . . '; 0 Emergency em. larger separately derived system.
;..,1• . ifi . : . !"..: - 7, : :• :
,.: ' - -- .: ..s300itE diNFORMAnOrl ..:AND LOCATION. :. . .:.,:::.. ,.; *.';, -. . :.y,'. . :1 .t, 0 Additi of ncw motor load of CI -A“, -E..1.2“ -1,,r
100HP or o. occupancy,
Job no.: I Job site address: 10850 SW North Dakota St. CI Sill or more residential 111O14. 0 Recreational vehicle parks.
0 Heaitb-eare finalities. El Supply voltage for more than
City/State/ZIP: Tigard, OR. 97223
°Hazardous loonier& 600 volts sominal.
Suite/bIdgJapt. no.: I Project name: i\I ti,50 f■-) 0 %vice or feeder600 =PS or MOM.
;ig...::77:'.'
Cross street/directions to job site: besalptlso I INN I Fee. I Milli I •
,
New residential single- or maid-amity dwelling unit.
Includes attached garage.
Subdivision: J Lot no.: 1.000 sq. it. oriels 168.54 4
Ea. add'l 500 sq, ft. or portion 33.92 I
Tax map/parcel no.: Limited CIWITh residential
75.00 2
ii.Rollt*I2Wq DESCRIPTION OF. :'...1:1Pg: .;.4z.g,.,:w-io* (with above B A . ft.)
Limited energy, multi-family
75.00 2
NC or heat pump, gas furnace, and a Service.outlet. miclanial (with above sq. ft.)
. Services or feeders installatIon r alteration, and/or relocation
_.,----_---
200 amps or less 100.70 2
tElaXI:a400-Mtrki.*N.W.4 ....111;.........!...:W IMNIPWINiilE 201 amps to 400 cm" 133.56 2
N . 401 amps to 600 amps • 200.34 2
ame:
601 amps to 1,000 amps 301.04 2
Address: . Over 1.000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/StatefLIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on property that I own which is not I 1
intended for sal; lease, rant, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 anirts 168.54 2
Branch Cirrnib- new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits tridt
tUNEMEntl:AikaTUI-#.!*•• .
above smice f fee
each brunch circuit 7.42 2 •
Business name: • B. Fee for branch circuits without
. .. service or feeder (cc. first 1 56.18 56 2
Contact mune: branch circuit
Each WWI branch circuit 2 7.42 14.84 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 I 2
City/State/ZIP: dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.54 2
Pump CIT hrigation circle 67,84 2
E Sign or outline lighting 67.84 2
-.-- .A4WIffirtir - • . -:*W .:..
if.siME .______ - ., ... COIC:RACTORn •.:•:. •:::. g:... Signal circuit(s) or limited-energy
Business name: Bear Electric, Inc. panel, altemtion, or ectension. PaIM 2 2
Each additional Inspection over allowable in any of the above
Address: P.O. Box 389 Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/21P: Donald, OR. 97020
• industrial plant (I hr min) 78.18/ hr
Phone: ( 503 ) 678-1355 I Fax: ( 503 ) 678-1108 Inspections for which no fcc is
90.00/ hr
secifically listed ( hr min)
COB Lic.: 20919 I Electrical Lie.: 24-107C I Suprv. Lic.: a S'S", 5 , Ifgrfflr.4gx‘..._.1F - MUCII1310i1a113tMlIVEEK - ZEM:
Suprv. Electrician signature, required:
Plan review ( Subtotal: 71.02
25% of permit
-- i * • 4 /12 State surehame (12% of permit fee): 8.52
Print name: e tosA.c. 52
• TOTAL PERMIT FEE: 79.54 iit
Authorized signature:
This permit application expire If a permit Is not obtained within
days drier It bas been accepted as complete.
Print mime: I atc. • Number of inspections allowed per pannil.
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