Permit 1 14 a CITY OF TIGARD ELECTRICAL PERMIT
2 - . COMMUNITY DEVELOPMENT Permit #: ELC2012 -00402
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/03/2012
Parcel: 2S109BA01900
Jurisdiction: Tigard
Site address: 13969 SW LEAH TER
Project: Hosoda Subdivision: HILLSHIRE SUMMIT Lot: 4
Project Description: Install A/C and service outlet Must be placed within the 5' minimum side yard setback and approved rear yard
setback.
Contractor: BEAR ELECTRIC Owner: HOSODA, GORDON
PO BOX 389 13969 SW LEAH TER
DONALD, OR 97020 TIGARD, OR 97224
PHONE: 503 - 678 -1355 PHONE: 503 - 534 -6162
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/03/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/03/2012 $7.63
Type of Use: SF Electrical
Class of Work: OTR
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 � obbt � ain � a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. A
Issued By: ) 1 itk..t.L.L/ , ti 4-1.4.-t Permittee Signature: VA A PPU e_1471A kM
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.
JUL 03 2012(TUE) 10:07 Bear Electric (FRX)5036781108 P.001 /002
- Electrical Permit Applicat G IV IUD
FOR OFFICE USE ONLY
City of Tigard 11E5111M3Eil Permit No. , 1... /oZ9
w 13125 SW 11011 Blvd.. Tigard. OR 972311.1 0 3 2012 Plan Review ,,
Phone: 503.718.2439 f ux: 503.598.1960 Darn . also """"1, u/Oko t O>-'
TIC A R D Inspection Line: 503.639 CITY OF TIGARD Date Ready/fly;
y/
I
IETPAHEEIRMI
nternet www.tigsrd -0r.b BUILDING DIVISIOa1 Noll fiedlMCnh •
TYPE OF PLAN REVIEW • 0 New construction ® Addition /alterttion/replacement ' Mime ebeek all that apply ( w sets ufplans whims checked below);
0 Service or feeder 400 amps a mac 0 Building over three stories.
0 Demolition ❑ Other: where the available fault curttal 0 Marinas and boatyards.
. • CATEGORY OF CONSTRUCTION. exceeds 10.000 amps as ISO tolls or 1D floating buildings.
less to ground, Of exceeds 14,000 0 Cormnereiat- use agriculture!
® 1 -and 2- family dwelling 0 Commercial /industrial ❑ Accessory building snips lbr all other installations. hnildiest.
❑ Multi.rumily ❑ Master builder 0 Other. OFire Q lbstallaiitxt of 75 KVA or
-
JOB SrIT NFORNtA'riCiN AND LOCATION O 444 p en of system, Inge" separately derived system.
❑ Addition of new motor load of 0 - A - , "E". "1.2 - , -1-3-,
Job no.: Job site address: 13969 SW Leah Torrace 1001IP or mom mcnistrwy.
❑ Steer more sesidentialunits. ❑Racreraatienal vehicle parks.
City/State/ZIP: Tigard, OR 97224 0 Health -mue facilities. ❑ Supply voltage for snore than
0 Hazardous locations, 600 volts nominal.
Suite/bldg./apt. no.: Project name: SHC _0 Service or feeder urnpe or mare.
Cross street/directions to job site: o .. FEE SCAEDULE I :v . . . I •rot L_
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision; Lot no.: 1,000 sq. fl. or less 168.54 1 4
Ea add'I 500 sq. f. or portion . 1
!'ax map /parcel no.: L imited energy. residential 75.00 -
2
' . . -.' DESCRIPTION OF WORK '• . .... .. .. .- .. (with above sq. R .1
Limited energy, multi - family 75.00 2
AC & Service Outlet residential (with above sq. fl.) I
- Services or feeders lnsiallatlon alteratlon, and/or relocation -I f 200 amiss or less 100.70 2
l0: PROPERTYr:OWNER ,I]- rvNAttrr7±„ . _. 201 amps to 400 snips 133.56 2
Name: Gordon Hosoda • 401 amps to 6410 amps 200.3 2
_ 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeden Installation, alteration, and/or
City/State/ZIP; relocation
Phone: ( ) Fax: ( ) 200 amps or less 59,36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449. 670, and 701. 401 amps to 599 amps 1611.54 , 2
Branch circuits- new, alteration, or extension, perJranel
Owner signature: Dale: A. Fee for branch circuits with
.- , , above service or feeder fee.
':',1'..
0' APLICANT' - I] CONTACT'�1PER50N
- - = _ = 742
each IIrulch circuit
It Pee for hranelt circuits without
Business name: It. ur feeclrr Ire, rust
1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 1 7,42 7.42 2
Address: _ Miseellaneoug (service or feeder not included)
• Each manuPacturcd or modular
C! /StatclL!!''
ry dwelling, service nndiar feeder 67.84 2
Phone: ( ) Fux: : ( ) Reconnect only 67,84 2
Pump or irrigation circle 67,114 2
Email: permitso@bearelectric.com Sign or outline lighting 67.84 2
.. -. -- .a: .,; : -. — :CONT'RACT'OR- : r � . - , - .... : :.. . _ , - -. - .... • Signal circuits) or limited - energy
Business name Sear Electric, Inc. psttPl, aheratinn, or extension. Page 2 2
Each additional Inspection over allowable In any of tiro above
Address: PO Box 389 Additional inspection (1 hr min) 66.25/ hr
- City/State/ZIP: Donald, OR 97020 Investigation(] hr min) 78..18/ hr
Industrial plum (1 hr min) 78.1818 / hr
Phone: ( 503) 678 -1355 Fax: ( 503) 678 -1108 Inspections for which no fee is 90.00/ hr
specifically listed (t4 hr min)
CC/3 Lic.: 20919 Electrical Lie.: 24 -107c J Suprv. Lie.: 4881s pct °.'KLECl7uCa - PERMIT ZEE& a ._ — kt 6 " /.. ::
Suprv. Electrician signature, required:
Subtotal; 63.60
Plan review (25% of permit fix):
Print name: Stephen Shepherd Date: 07 - 03 - 12 slate surcharge (12iHr of permit fec): 7.63
TOTAL PERMIT FEE: 71.23
Authorized signature: Tbla permit application expires If a penult le not nbrasord wlthio 180
days after it bra been accepted as complete.
Print name: I Date: • Number of hapcmione allowed per permit.
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