Permit •
CITY OF TIGARD ELECTRICAL PERMIT
o • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00532
T I G r1 R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09113/2012.
Parcel: 2S112CA05900
Jurisdiction: Tigard
Site address: 15287 SW THURSTON LN
Project: Sauby Subdivision: ASHFORD OAKS Lot: 13
Project Description: (2) branch circuits for NC and service outlet
Contractor: BEAR ELECTRIC Owner: SAUBY, JOSHUA A •
PO BOX 389 15287 SW THURSTON LN
DONALD, OR 97020 TIGARD, OR 97224
PHONE: 503 - 678 -1355 PHONE: 406 - 690 -4990 •
FAX: 503 - 678 -1108 -
FEES •
Quantity Description Date Amount .
2 crt Branch Circuits wo /Purchase 09/13/2012 $63:60
Specifics: Service or Feeder
1 ea •12% State Surcharge - 09/13/2012 $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 OA 2 -001- 090. You � may
e_. obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Jt&2 Permittee Signature: Qij APP .J f4T7 Oki
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 603.639.4176 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.
SEP- 13- 2012(THU) 11:55 Bear Electric (FAX)5036781108 P.002/002
Electrical Permit ApplicatioOrktIVED FOR OFFICE USE ONLY
City of Tigard ..) Red 4/ , it 3... Permit No.: g��►� w
IIIII 13125 SW 1.1011 Blvd., Tigard. OR 97223. 1 3 2 2 1Man Review
- ' Phone: 5113.718 2439 Fax: 5113.598.1460 Dace/lly: Other Permit' Wire, a01d. - 00167
TIGARD Inspection Line: 503.639.4175 CITYOFTIGARD DaloReady/By: A fa See Pagel far
Internet; www.tigard.or.gov t4otilied/Method: uppkmenn
St Information
_ RI III DING DIVISION __ .
TYPE OF WORK • PLAN REVIEW •
❑ New construction 1,33 Addition /alteration/replacement Please check all that apply Isubmit a sets of plans w /ilems checked bellow!:
Demolition ID Other:
El Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and baalyards.
CATEGORY OP CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less In ground, or exceeds 14,000 ❑ Commercial -note agricultural
23 I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. httildinas.
❑ Multi - family ❑ Mastcr builder ❑ Other: ['Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition anew motor load of ❑ "A", `E ", °I 13
Job no.: Job site address: 15287 SW Thurston Ln 10 or ri mm ore. occupancy.
❑ Six r ote residential units. ❑ Recreational vehicle pa ILL
City /State/ZIP: Tigard, OR 97224 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suile/bldgJupt. no.: j Project name: ❑ Service or feetkv 600 amps or more.
- - • . • '-FEE SCHEDULE .
Cross street/directions to job site: L ",1 P I T 1 •
' New residential single- or multi- family dwelling unit.
Iedudes attached garage-
Subdivision: I Lot no.: 1,000 sq, (1. or less 1611.54 4
Ea. add'I 500 sq. ft or portion 33.92 I
Tax map /parcel no.: _ Limited energy, residential 75.00 2
DESCRIP1014 OF WORK • ' (with above sq. 11.1 _ ,
Limited energy, multi- family 75.00 2
Ac & Service Outlet residential (with above sq. 11.)
Services or feeders installation, itleration, and/or relocation
200 amps or less 100.70 _ 2
. D PROPERTrOWNER • i;:.:: !, . . . 0 _;.... • 201 amps to 400 amps 133,56 2
401 amps to 600 amps 200.34 2
Name:
.. - 601 amps to 1,000 amps 301.04 _ 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) j 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 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. alteratfoa. or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
. feeder above service or fee,
1� =.. . CANT r 1� _CON7AC1f..:1!Ett80N: - 7.42 2
= ... - •- - � - each bunch circuit
13u,sineSS name: Ii. Fee for brunch circuits without
service or feeder fee, first t 18 56.18 2
Contact name: branch circuit
Each add'I branch circuit I 7.42 7.42 2
.... .. Address* _ ....... ..........._ ._.._.. ........... ..... ....__._.._.. ...._ _ ........_ .. ..................- Miscellaneous•( service- ordeedernotlncladed)..--
F.ach ch manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) j Fax: ' ( ) Reconnect only 67. 2
Pump or irrigation circle . 67.84 2
E-mail -
Sign or
. . _ .. • : ..... .:. . , : __.. .. :: .; ...., .:..;. CONTRACTOR:- _ :- _:_= . Si
.. - ._.. ._ -- Signal circuit(s) r orlimited-anew
Business name: Rear Electric, Inc perm!, altentlion, or extension. Pie 2 2
Each additional inspection over allowable In any of the abov
Address: PO Box 389 Additional inspection (I hr min) 66.25/ hr
Ciry /Statc/ZIP: Donald, OR 97020 Investigation (I hr min) 662x/ hr
• Industrial pram (1 hr min) 78.18 / hr
Phone: (503) 678 -1355 Fax: (503) 678 - 1108 ` Inspections for which no lee is 9o,na/ fir
specifically listed (h hr min) , ---,�-
CCB Lic.: 20919 Electrical Lic.: 24-107c Suprv. Liu.: 5259S • 'c -j;. _;:sTLECtwG!►I PERn11T• PEES ; : --_ -
Suprv. !electrician signature, required: 2, / Subtotal: 63.60
.e.+. 4/ Plan review (25% Of permit fee):
Print mime: Eugene Szekely 0 Aate:v9 - 13 - 12 State surcharge (12% of permit fee): 7.63
TOTAL PERMIT Fl?E: 71.23
Authorized signature: - This permit application expires If a permit Is not obtained within 11W
Print name: Date: days after It has been accepted as complete.
Number of inspections allowed per permit.
l:\ Auilding1PermitsUd -e.t'antitApp.dnc u1r011iu 140. 46157(11 /05/COM/IVLD