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Permit
CITY OF TIGARD ELECTRICAL PERMIT s : COMMUNITY DEVELOPMENT Permit #: ELC2012 -00395 T l G A. R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012 Parcel: 1S133AD05700 Jurisdiction: Tigard Site address: 12925 SW HAWKS BEARD ST Project: Garrison Subdivision: AMART SUMMER LAKE Lot: 101 Project Description: (2) branch circuits for elec furnace reconnect Contractor: BEAR ELECTRIC Owner: GARRISON, GARY PO BOX 389 12925 SW HAWKS BEARD ST DONALD, OR 97020 TIGARD, OR 97223 PHONE: 503 - 678 -1355 PHONE: 503 - 953 -2151 FAX: 503 - 678 -1108 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 06/28/2012 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 06/28/2012 $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 95 - 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. 4 Issued By: Permittee Signature: Al , PL C.-4 / Q� 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. JUN - 28- 2012(THU) 10:44 Bear Electric -- (FAX)5036781108 P.001 /002 t Electrical Permit Application RECEIVE FOR OFFICE USE ONLY City of Tigard JUN 2 8 2012 Rea"' Permit No,; a LC _ , a--(10 MS NI 13125 SW WaII Blvd„ Tigard. OR 97223 Plea Ittvrcw Phone: 503.718.2439 Fax: 503.598, I g6p��rg�� {� +� yIV � r • Dwe/By: Other Penni G,20 (a- Qv . 1 13 �` V l Inspection Line: 503.639.4175 re Kcedyltsy: Jens: la See Pagel foe T1 °''r`D Internet: www.tigard- or.gov BUILD /NtG1 D5VISI I'!tow/method: CQ Supplemental Infarmadoo • TYPE OF WORK : PLAN REVIEW CI New construction ® Addition /alteration/replacement please check all that apply (submit acts gallium w/uenle chewed below): ['Service or feeder 400 amps or more © Building over Three stories ❑ Demolition ❑ Other: where the evmtable (nett current ❑ Marinas and boatyards. . CATEGORY OF CONSTRUCIlON exceeds 10.000 amps at ISO volts or ❑ Floating buildings. less to groun or exceeds I4,000 O Commercial -use agricultural • Is 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other, Cl Fire pump. 0 lneiallaiiou of 75 f:V A or 0 Emergency system. larger separately derived system. JOE SITE INFORMATION AND LOCATION • D Addition of new rooter load of 0 -A ". - E"."1-2". "1.3 - , ace on Job no.: Job site address: 12925 SW Hawksbeard St. psi.. ore residentiet units. O itec vehick parer. City/State/ZIP: Portland, esr OR 97223 Olieelth.o facilities. 0 Supply voltage rim more non El llanidous locations. 600 volts nominal. Suite/bldg./apt. no.: I Project name: SHC Service or feeder 600 amp: or more. .. . . ' ....: . . L . . = rPEE,SCHEDULE • Cross street/directions to job site: nwrrfsrt•o lam. I taw. l tae I - , New residential alngle or multi - family dwelling unit. Includes attached garage. Subdivision: I Lot no.: - 1,000 sq. 11. or less 1611.54 4 Ea, add'l 500 s0. A. or portion 33.92 1 Tax map/parcel no.: Limited energy, residential (with above R 75.00 2 . ' :: . ' DESCRIPTION OF' WORK' : s`7; t.imired energy, mtdti -l=ily 75.00 2 Elec Furnace - Reconnect HP residential (with above sq. tl.) ' Services or feeders Installation, alteration, andlor relocation 200 amps or leas r 100.70 2 ._ -... _ IJCPROPERTY .. .. .., .. .:....... :OWNER � : � -' _ • ... 0 TENAPI 201 am to 4 00 amps 13 'u 56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,00n amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Ciry /StatI:21P: Treloc emporary services or feeders Installation. alteration, and/or - Phone: ( ) I Fax: ( ) 200 .imps or Icss 59.36 1 Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 1 68 4 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. sal amps to 599 amps 1 s 2 Branch dreolts- new, alteration. or anemia!, panel Owner signature: Date: A, Fee for branch circuits with . _ 0 — s, above servlee or feeder fee, :..,. . , ... ;AP,RJ.2CANT; . _ . 1'}.:....._ ='t 0>3CONTACT — each klatch cirmil 742 2 Business name: B. Fee for brunch circuits without service or feeder fee, lirsl 1 56.18 56.18 2 branch circuit Contact name: Each add'1 bmncll circuit 1 7.42 7.42 2 Address: • Miscellaneous (service or feeder not included) Gi /State�LlP: Each manufactured or modular 67.84 2 tY dwelling, service and/or feeder , Phone: ( ) Fax: : ( ) Kewwnnecionly 67.84 2 Pinup or irrigation circle 67.84 2 E -mail: PE" ITS @BEARELE - Signoroutlinelighting 67.84 2 ._ .. '- ;' :;: • '' .'. .::. ; ,.:::' • .. ' CON'IRACrOR.. ,_ .. • - :..: _. - . Sign e! citeutl(s) or limited - energy • Business name: BEAR ELECTRIC, INC. panel. atdon, or extension. Page 2 2 Each additional !affection over allowable in any of the above Address: PO BOX 389 Additional inspection (I hr min) 66.25/ hr Ciry /Statc/ZIP: DONALD, OR 97020 Investigation (t hr min) 76.28/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( 503) 378 -1355 I Fax: ( 503 ) 678 -1108 Inspections far which no fee is 9000 / hr specifically listed ('A hr mint 13 Lic.: 20919 I F,locfrical Lie.: 24 -107C ‘Lie.: 4881$ ' - iiie "= ir:C17tICAZ _>i!ERieni REBS = - ,.€.::. -- T.- - subtotal: 63.60 Suprv. EIes:lriciun signature, required: l .,„ Plan review (25% of permit fee): 7.64 Print name: STEPHEN SHEPHERD I Date: 06 -28 -12 State surcharge (12% of permit fee): TOTAL PERMIT FEE: 71.24 Authorized signature: - This perm appuutlao npirra If a permit Is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Nnmhero f inspections allowed per permit. 7 pr 1:1Bmk5I lt'enrwnI.C.PvnuuArp,doc a7/01/10 440.4e15T(11/05/COM/WEB 1 (' 4' r