Permit •
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CITY OF TI ELECTRICAL PERMIT
1 111- ,. . �� Permit #: ELC2012 -00441
- -• COMMUNITY DEVELOP
Date issued: 07/25/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 7/25/2 A01900
Jurisdiction: Tigard
Site address: 13969 SW LEAH TER
Project: Hosoda Subdivision: HILLSHIRE SUMMIT Lot: 4
Project Description: (1) 200 amp service and (2) branch circuits for sun panel, outdoor and indoor receptacles.
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Contractor: BEAR ELECTRIC Owner: HOSODA, GORDON & CENDRINE
PO BOX 389 13969 SW LEAH TER
DONALD, OR 97020 TIGARD, OR 97224
PHONE: 503 - 678 -1355 PHONE.
FAX: 503 - 678 -1108
FEES
Quantity Description Date . Amount
1 ea Services or Feeders - 200 07/25/2012 $100.70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 07/25/2012 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/25/2012 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 • ; 0166' 90. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.2321987 or 1.800.332.2344.
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Issued By: Permittee Signature: �n/ .1 i L L
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 503.639.4176 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.
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JUL 23 2012(MON) 07:52 Bear Electric (FAX)5036781108 P.002/002
Electrical Permit A lication FOR OFFICE USE ONLY ;teethed 0? City of Tigard 1 � � DxdBv: Zj� /2 ; ' No. � / _ -- ; 79
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13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.7182439 Fax 503.598 J 2 3 2012 Dale/Bv: Other Permit _ _
TI GAKD Inspection Line: 503.639,4175 Dare Keadynty: SI Ste Puce 3 for
Internet; www.tigord -or.gov gFrI.IG SID NwifiedIMd)xrl; Sapplemenm) Information
'TYPE VISION 'PLAN. REVIEW ,
Please check all that apply (submit 2 sets of plans wiuems checked below):
❑ New construction Additio erotica/replacement
nt
❑ pemplili ter: 0 Service or feeder 400 amps or more ❑ iluildiag over three stories.
when the available fault current 0 Marinas and boatyards.
' CATEGORY OF CONSTRUCTION • easeeda 10,000 amps at 150 votes or 0 Floating buildings
less to groun& or exceeds 1000 0 Commercial -use agricultural
1- and 2-family dwelling 0 Commercial/industrial D Accessory building amps for all other installations. buildings.
ulti - family ❑ Master builder ❑ Other'; 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency > em. huger separately derived system.
• D Addition or new motor load of 0 "A ", "I'. ", "1.2'Yi -3 ",
Job no.: I Job site address: '3 t ..1J_[.ccd,\_ rn i IOOHPormute may.
v' 0 Six or more residential units, 0 Recreational vehicle park..
City/State/ZIP: a (AT / , � ❑ H faeilioies. D than
Supply voltage for more an
r / l Z 0 Hazardous locations, CI
volts nominal.
Suite/bldg. /apt. no.: Project name: e9S0 ,b 1 9" 0 Service or feeder 600 amps or more.
-PEE SOIEDULE
Cross street/directions to job site: ' p• I Oar. I pee J Tom, I •
New residential single• or multi- family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. R. or less 1 168.54 4
Ea add'I 500 sq. fl. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
(with above sq. fl.)
o(5
�Q D ' r� �C* , Limited energy, multi-family 75.00 2
'3 V.\ e residential (with above sq. ll.)
Services feeders installation, alteration, and/or relocation
C... C1 amps or less / 100.70 ICD.r() 2 •
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Cl ,: i or t • . OWNER ..I .. i .TENANT ; ' ..: 201 amps to 400 amps 133.56 2
Name' s' Q l 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: . S - 9$16T Over 1,000 amps or volts 552.26 _ 2
City /$tate/71 P. Temporary services or feeders installation. alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
• 201 amps to400 amps 125.0R 2
Owner installation: This installation is being made on property that 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new. alteration or extension, pe panel
Owner signature: - Dale: Fee for branch circuits with
=• . ..... : • ] A abov ser or f ee d e r f ee, ( 2
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- ._.:_- =. O °G7V°T` 0 7.42 " 1
. � - - - each branch circuit � '
Business name: B. Fee for branch circuits +virhour
service or feeder fee, first 56.1 R 2
Contact name: branch circuit
Each add'I branch circuit 7,42 _2
Address: Miscellaneous (servke or feeder not included
Ci /Stale/Z1P: Each manufactured or modular 67.114 2
t3' dwelling, service and/or feeder
Phone: ( ) Fttx:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
L.. y; ,r.. -: - - : :' 'CONTRACr'Oft -r;3 "i' ;..:- - .. - - Si rcuit(s)orlimited-enerby
.. _. . . Signal a
i3usiness (� E.- ��
1�` ' - 1,� r _panel. ;thermion, or extension. I Page 2
_ "' • `'G , ` ` C1 C _ - Each additional inspection over allowable in any of the above
Address: \D r Q Additional inspection (1 hr min) 66.25/ In
City /State/ZIP: n a I U q - ci Investigation (1 hr min) 66251 hr
A \ Macula! plant (I hr min) • 711.18/ hr
hone: C,,,'7C,.'t - ITS Fax: -i ) 3 .-.. I Los Inspections for which no fee is 90.00/ hr
ii �' J specifically listed%, hr min)
f CB Lic.:� .Cyak Or Electrical Lie.:7A--IO'` Suprv. Lic. : b 2S :,ri ' ' '• . .REP/MT :P S. ''` = ...
A Suprv. Electrician signature, required: Subtotal: ` \ 5 ..1 ,,,e j
Flan review (25% of permit fee): ( , „ , ,
1 Print name: Re \{ Datc:1—Z3^ ( Z State surcharge(12 %ofpermitfee): p(
\ `-� ``--"'� TOTA1, PERMIT FEE: an s Alb t
Authorized signature: i •� l �J t_ a y,C This permit upplies600 aspires If a permit is not obtained within 160
days after It has been accepted as complete.
` Print name: Date: • Nmub r of inspections allowed per permit.
1: 1Bw1dinp \Permits\LLC- PermitApp.duc 07/01 /10 44n.M.t51
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