Permit CITY OF TIGARD ELECTRICAL PERMIT
I N I • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00562
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/26/2012
Parcel: 2S114BA02500
Jurisdiction: Tigard
Site address: 9770 SW SERENA WAY
Project: SHC Subdivision: PICK'S LANDING NO.2 Lot: 114
Project Description: (2) branch circuits for NC and service outlet
Contractor: BEAR ELECTRIC Owner: BEACH, JAMES 0 JR AND
PO BOX 389 MARMIAN K
DONALD, OR 97020 9770 SW SERENA WAY
TIGARD, OR 97223
PHONE: 503 - 678 -1355 PHONE:
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 09/26/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/26/2012 $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 952 - 001 -0090. You m a obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 11.800.332.2344. -�1
Issued By: Permittee Signature: D Li b4PPLI C 4/ I D 4,.
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.
SEP- 26- 2012(WED) 10:19 Be E..L,c.tric I FOR OFFICE USE ONLY
_
Electrical Permit Applicati �� _ (FRX)50367B1108 P.002/002
, 2
Rtxeived S Permit No.:
City of Tigard Dates q /la T EyC,ZDI S - DOSb L
13125 SW Hall Blvd., Tigard, OR 97223 SEP 2 6 2012 flan Review Other Permit:
Phone: 503.718.2439 Fox: 503.598.1960 Date/av:
TIGARD
Inspection tine: 503.639 ' yL1 Dat Read /B : 63 See Page 2 far
Internet: ww.iigard.or.gov �) �� ' ° � N w i fie d/M tl h o d :
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Mil Supplemental information
flop
XAddition/altenition/replacement TYPE OF * 0I& ' 8k'• - ,� ' PLAN REVIEW
❑ New construction Please check all that apply (submit j sets oratans wrdteau checked below):
0 Service or feeder 400 amps or more O Building over three stories.
❑ Demolition ❑ Other . where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps ai 150 volts or D Flawing buildings.
let, to ground, or exceeds 14,000 (] Commereinl•use agricultural
I and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
amps for all other installations, buildings.
❑ N ulti- family 171 Master builder ❑ Other. OFire pump. 0 Installation of75 KVA or
JOB SITE INFORMATION. AM) LOCATION
0 Emergency o f new mo tto m, • larger separately
". 'l-T'. derived system.
0 Addition of new toad of 0 "A "E " "1 -2 " "1 3 ",
Job no.: Job site address: 100HP or more. occupancy.
R�l7Qy5yJ _ e�no, l.,�o y SW M tllare tCSIde111L7I units. ❑ Recreational vehicle parka.
City/State/ZIP: d ,, / a 1 Z Z O Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: 4 G D Service or feeder 600 amps or more.
FEE SCHEDULE •
Cross street/directions to job site: _Oesaiptioa i Qt.. I sr. I Tatar I • '
- New residential single- or multi - family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
^
- Ea, add'% 500 sq. It or portion 33,92 1
Tax map /parcel no.: Limiled energy, residential
75.00 2
DESCRUP7ION OF=WORK - : . • • • - (with above sq. H.) -
a - L energy. multi - fancily 75.00 2
J� .i S /� \ (_� 6 ,, residential (with above sq. HI _
G•� `r Services or feeders installation and/or relocation
_ 200 amps or less 100.70 2
❑ PROPERTY OWNEIL .::. - i t . 1 . . ,:,Ca 17 NNA:1 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: • Over 1.000 amps or volts 552.26 • 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: P:
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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or =change, according to ORS 447, 449, 670, and 701. Branch eircuib – sew, alteration. or extensbu,zr panel
Owner signature: Date: A. Fee for branch circuits with
feeder f
above service or iced cc,
❑. APPLiCA]V l -.. �: ❑ NTA
:.COCT PER90N . ` : _ each branch circuit 7 2
Business mime: B. Fee for branch circuits without
service or feeder fee, first ` 56.18 %.
Contact name: branch circuit
Each min branch circuit 1 7.42 7.4 Z., , 2
— _Address — — - Mlaeeltaneoaa(tlerviee.or feeder oot•ineluded) —
City/State/ZIP: Each manufactured or modular 67.84 2
Iy : _ dwelling,.serviee and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 -
Pump or irrigation circle 67.84 2
E.-mail: Sign or outline lighting 67.84 2
1." "TT: ... .. _:CONTRACTOR : . . : . _... •
.- . .- .., Si circuil(s) of-limited-energy
r 1 panel, alteration, or extension. _ Rage 2
Business name:
ZC 4►,Y ,� eL - �Y��. -� Each additional inspection over allowable in any of the above 2
Address: Q )( ' eC Additional inspection (I hr min) 66.25/ hr
City/Stale/ZAP: ) 1 0 �O
Investigation (I hr min) 66.25/ hr T
4.11+ �� U Industrial plant (t hr min) 78.18 /hr
Phtme) G $ 1 ' Fax: (,661- Gs,78 — it g Inspeclium for which no fee it 90.00 / hr
s cif listed %, hr min
CCl3 Lic.: ZQ q ( l Electrical Lie.: z4. I p C. Suprv. Lic. = , 4 a 8 is z =`.r: . ELECTRICAL PERNtEPFILFS • •' ` ' T ...
d Subtotal: f,3,( C.)
Suprv. Electrician signature, requi • . . -
/ Plan review (25% of permit fee):
ln
Print nae3 �� 5 , . , 4 mac: 9 1 �/ r 2 State surcharge (12% of penult fee): 1, (05
Authorized sigllatttro ` ` TOTAL PERMIT FEE. : 1 t . Z'3
This permit application expire if a permit is not obtained within 180
l name: Date: • days after it has been accepted as complete.
Number of inspect ion% allowed per permit.
1: tamldim / Permitstl:LC•PnmitApp.dve 07151 /I11 440 46157(11I05lCOM/wtn