Permit CITY OF TIGARD ELECTRICAL PERMIT
11 .. COMMUNITY DEVELOPMENT Permit #: ELC2012 00228
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2012
TIGARD 9 Parcel: 2S 112AC01801
Jurisdiction: Tigard
Site address: 14965 SW 72ND AVE
Project: Oregon Bolt Subdivision: FANNO CREEK ACRE TRACTS Lot: PTS 45
Project Description: Reconnecting RTU.
Contractor: BEAR ELECTRIC Owner: SANTA FE PACIFIC REALTY CORP
PO BOX 389 201 MISSION ST
DONALD, OR 97020 SAN FRANCISCO, CA 94105
PHONE: 503- 678 -1355 PHONE:
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 04 /20/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/20/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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 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.
01/01/1996 04:14- 503 = 678- 1- 1 -08 - -- - - -BEAR ELECTRIC -- -- — - - -- PAGE - - 01/02 - - —
Electrical .Permit Application, FOR 01 :I-IC.4. USE ONL\ •
City of Tigard Dete/B APR 19 2012 Recend . y :��
13125 SW Hall Blvd.. Tigard, OR 97223. elan Review Other Permit: '
Phone: 503.7182439 Fax:- 503.598.19 0'IW OFTIGk D teat : :
]uspection Line: 503.639.4175 BUILDING DIVISIOP! Pam RcldyBy. 83 See Page 2for
I : ! ; ,\ li 1 Notified/Method: Suppiem� Information
laternet www.tigard-or.gov - ,
TYPE OF WORK PLAN REVIEW •
El New construction IN Addition/alteration/replacement Please check all that apply (mbmit 2 sett of plans w /items checked below):
❑SWiceorfccder400 amps ormore C] Building over three eoncs.
❑ Demolition ❑ Other: , where the avafabie fault talent • ❑ Marhns aid boaylatds.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or C] Floating burlditrgs.
Iess to ground, or exceeds 14,000 0 Cotnmeit:iat.usc agricultural
❑ 1 - and 2 family dwelling ® Commercial/ industrial ❑ Accessory building amps fbr all other installatloes. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or
• ❑ Emergency syrtem. larger separately derived system.
JOB SITE INFORMATION AND LOCATION _ ❑ Addition of new motor load of ❑ `A ". "E". '9 -2 ". _1.3_,
Job no.: Job site address: 14965 SW 72nd Ave. 100HPormore. occupancy.
0 Six or OWE rraideatial units. ❑ Recranional vehicle paila.
City/State/Z1P: Tigard, OR. 97223 0 He lix ardous locations. ❑ 600 to� for more tt,a,
• Suite/bldg. /apt. no.: Project name: m I
At r (t ❑ Service or fodder 6 00 amps or more .
FEE SCHEDULE
Cross street/directions to job site: oaertmtloo (eq. l vet. I Toter l •
- New residential single- or multi - family dwelling unit •
Includes attached garage.
Subdivision: Lot no.: 1,000 sea. R or lids 168.54 4
Ea add'! 500 sq. ft or pardon 33.92 I
Tax map /parcel no.: Limited energy; residential 75.00 2
DESCRIPTION OF WORK (with above act ft)
Limited energy, multi=famil 75.OD • 2
Reconnect 3 phase unit. residential (with above sea. ft.)
• Services or feeders installaline. alteration, and/or relocation
200 ampe or less ' 100.70 ' 2
• 0 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 13336 2
--- 401 amps to 600 amps 20034 2 ,
Name 601 stripe to t,o0o a mps 301.04 , _ 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders Imarallatiou, alteration, and/or
Ciry /State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less t 25A8 2
201 amnia 400 omps
Owner installation: This installation is being made on property that 1 own which is.not 401 a to 599 amps 16834 2
intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, r panel
Owner signature: Date: A Fcc forbranch circuits with
shove service or foods fee. 7.42 2
❑ APPLICANT F ❑ CONTACT PERSON - each branch circuit
Business name: - . B. Fee for branch oircaits without
service or feeder fee, Ent 1 56.18 56.18 2
branch circuit
Contact name: Each udd'I branch circuit 7.42, ' • - - '2
Address: Miscellaneous (service or feeder not ine1,i -
Each matmfacened or modular `67.84 2
City/State/ZIP: dwelling, service and/or feeder
Reconnect only 67.84 2
Phone: ( ) Fax:: ( ) — Pump or irrigation circle 67.84 , 2
E -mail: Sign or midi= lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
,panel, alteration, or extension.. Page 2 2
Business name: Bear Electric, Inc. Each additional inspection over allowable in any of the above ,
Address: P.O. Box 389 • I Additional inspr aiotr (1 br min) 66.25/ hr
Investigation (1 hrmin) 66.25 / lir
City /State/ZIP: Doneld, OR. 97020 • ! Industrial plant (1 hr min) 78.18/ hr
Phone: ( 503) 678 I Fax: (503) 678-1100 • Inspections ibr which no fbe is . 90.00 / hr
Scan listed f hr nrin
CCB Lie.: 20919 I Electrical Lie.: 24-1 07C Suprv. Lic f� ELECTRICAL PERMIT FEES
�, 1 � r I 'Subtend: 56.18
Suprv. Electrician signatt re quired: Plan review (2596 oepermit fee):
Print name: 67,4, ,8y{ �) STT-e y t" Date: 4/19/12 State surcharge (12% of permit fee): 6.74
ii TOTAL PERMIT FEE: 62-.92
Authorized signature: This permit application expires if a permit is net obtained within 180
day. after It has been accepted as complete.
Print name' Pate: • , Number of sp
iacctions allowed per permit .
V nawermit\BLC -P mliApp.doe 07/.01/10 n.0- 46lsrilr/05/COM/Wn - .
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