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Permit CITY OF TIGARD ELECTRICAL PERMIT q : 'I C OMMUNITY DEVELOPMENT Permit#: ELC2009 -00450 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/03/2009 Parcel: 25101 DC04000 Jurisdiction: Tigard Site address: 7500 SW TECH CENTER DR 110 Subdivision: Lot: 0 Project: Tyco Project Description: (1) branch circuit for forklift charger Owner: FEES WALTON CWOR SOUTHRIDGE 12 LLC Quantity Description Date Amount BY TTA/EPROPERTYTAX DEPT 325, PO BOX 4900 1 crt Branch Circuits 09/03/2009 $46.85 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 09/03/2009 $5.62 Electrical Contractor: BEAR ELECTRIC PO BOX 389 DONALD, OR 97020 PHONE: 503 - 678 -1355 FAX: 503 -678 -1108 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $52.47 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: /A{ , / ./ P/� 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 603.639.4175 by 7:00 a.m. for an inspection that business day. 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- O1- 2009(TUE) 11:33 Bear Electric (FAX)5036781108 P. 001 /002 be ,t rli . • Electrical Permit Applicatio '. ', ' • - "4 E FOR OFFICE use ONLY City of Tigard SEP 0 1 2008 a p - rettait Dta_ e2 • • —# i S0 for �11 13125 SW Han Blvd.. Tigard OR 97223 Tana brew Other Permit Inspection line: 503.639.4175 4 ug b39.4Ig 50339839 5 i V OF �' IDARD H rra 400 �rI ��+a A, N rw� / � to See Pa4e 2 Tl In1crn w%rw.Norgov ala'6_ 11`y� DIVISION mlRrletlod; SupplemenralWormrooe • TYPE OF WORK PLAN REVIEW • Phase chock oU that ripply (submit 2 vas of plats *rams chocked woo; Q New construction ,® Additio /elter�tiorJr�plaatanent Q Sav is or feeder 400 amps or more [Padding over three stories. ❑ Demolition 0 Other: wtme the available Gwlt totem ❑Marinas sad boatyards. CATEGORY 01P CONSTRUCTION eaeeeds10.000anrpsat130 villa or D Flowing buildings. lusts amuad.or 14.000 (3 1:1Commerelaktee apiculmral Q I- Mid 2$amilydwelling 0, Commercial/industrial 0 Accessory building amps Dar a0 other iretatlatians. battdiap. ❑Multi- family J Muster builder ❑Other. OMc pomp. QImnllstloa 0 Addition sr m -A' separately 12 . desired • JOB SITE : INFORMATION AND LOCATION • DAdditianofrcwmosartovtof La "A "."E".'1.2'"I•) ". Job no.: o s t0019r a irate. occupancy. I Job address J� >< �� ; Qe P C' . (, su or m ore reaidemisl uoke- a Recreational %thick parrs. C1ty/$trttelZlP: ` ■`� ' ( C \--1'1- Ittalthvare ei ❑Sappy vehapeformore Mao (] Ilantdoxrs locan 600 oohs nominal. Suite/bldg./apt. no.: i r e Projectnalne 1 0 f2) aSer%i.-eorfeoder FEE SCHEDULE Cross street/directions to job site rasa 1 ©® • New residential single- or multi -family dwclliag unit. Includes attached garage. Subdivision: t 1:000 sq . R or less 145.1 4 n.:fl1Q Eo. odd! 500 sq. R. or portion 33A0 t • Tax Map/parcel no.: _ limited energy. residential 75.00 2 • .;•. - . . 'J: - .4»ESCRI TION• : OF WORK . :.. . • (wkb above sq. R] ^ ( y LimItod energy. multi•fnmily 75.00 2 � t ^ 1_n \\ (L ` )S�t t tl ore C �^ L>`c\4 \ `r 1 tatidealtial_(wiIh above sq. al . Services or feeders installable ahvroIiot�n and/or relocation �hC1- P rc, 200 amps or Is 8030 2 , '0 rites 1r. OWNER ..j: , p TENANT 201 amps to 400 amps 106.85 2 Nam= 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address Over 1,0 Warps arvolts 454.65 2 , City/StottJZIP: Temporary services or feeders tnstaltatlon, alteration, and/or r a Phone ( ) ' I Fax: ( ) 200 mops or Is 11 66.85 1 Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended 4 4 7 , 7 0 1 . 401 amps to 599 amps 133.75 2 Branch cirtulls - new. alleraIlon, or esteosion,Eer pant Owner signature: Date A. Fee for branch circuits with .0 APPLICANT I. 0 CONTACT •PFRSON above service or feeder fern 6.65 2 each branch circuit Business names B. Pee for branch circuits without service or feeder foe, ` 46.85 YD. 2 Contact name first branch ambit , Address: Each add'I branch circuit 6b5 2 . - Miscellaneous (service or feeder not Included) City/Stoic/ZIP: Each manufactured Or modular 90.90 2 dwelling, service and/or finder Phone ( ) Fax:: ( ) Reconnect only 66.85 2 E-mail: Pump or iriisation citric MI 53.40 2 • . , . CONTRACrOR Signor outline lighting 53.40 2 Business name= Bear Electric, Inc. Signal M=61(0 or limited* energy panel. alteration, or Address: PO fox 389 Ten. Clescribm Paget 2 + City/Stato/ZIP: Donald, OR 97020 Each addiliotal Inspection over allowable In any (tithe above Per inspection 62.50 Phone (503) 678 -1355 I Fax: (503) 678 -1108 nvcsugttionper houro lvmini 62.50 CCB Lie.: 20919 l Electrical Lie.: 24 -107C V I - Suprv. Lk.: /.4(1,(1,\ h'dusttial plant per hour 73.75 • ELECTRICAL' PERMIT FEES Suprv. Electrician signature. required: Sttbrowl: • • ' Print ram ate _ Plan review (25'6 of permit fa): .1\ � 1 W� t1 --11 ���o- �1_O State sutehame(12%of permit fix): Authorized signature �', • D •TOTAL PERMIT FEE: Date This permit applicati espins If • permit it net obtstned wittin Ise Print name days after Ir hat been accepted a complete. Number of impactions allowed per permit. tvaoacIeeMemtrrHWAhmowoom• to • .r.t.tersetrr m =MINED •