Permit •
CITY OF TIGARD ELECTRICAL PERMIT
t COMMUNITY DEVELOPMENT Permit #: ELC2012 00612
Date Issued: 10/25/2012
IIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S111CC11600
Jurisdiction: Tigard
Site address: 10465 SW HIGHLAND DR
Project: Westland Subdivision: SUMMERFIELD NO.4 Lot: 167
Project Description: (3) branch circuits for A/C, service outlet and electric to gas conversion.
Contractor: BEAR ELECTRIC Owner: WESTLUND, HAROLD & BEVERLEY
PO BOX 389 10465 SW HIGHLAND DR
DONALD, OR 97020 TIGARD, OR 97224
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PHONE: 503 - 678 -1355 PHONE.
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 10/25/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/25/2012 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports (Conditions)
"•.y . 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 52- -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
r .
Issued By: Permittee Signature: ijN
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
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SIGNATURE OF SUPR. ELEC' Date:
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LICENSE NO.
L.
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.
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OCT- 25- 2012(THU) 09:38 D (FAX)5036781108 P.002/002
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard P E T 2 5 2012 Received
ates °/p darn cnnilNo.: 67 _ , 02 - 406/
il h
• 13125 SW 1'10II Blvd., Tigard, OR 97223 p� Plan Ravi
Phone: 503.718.2439 Fax: c1.1'i' ( TIGARD Dataly: Other Permit:
Inspection Line: 503,639 121 See P■ 2 for
TIGARD
Internet: www,tigard- or.gn��l DIVISION �C� Supplem ta Information
TYPE OM WORK PLAN REVIEW
Please check all that apply (submit Z sets of plain w /items checked below):
❑ New construction Addition/alteration/replacement
la Service or realer 400 amps or mote ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault current CI Marin;rs and boatyards.
CATEGORY OF CONSTRUCTION mceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,u00 CI Commercial-use agricultural
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
Multi - family ❑Mosier builder ❑ Other: ❑ I'irc pump. ❑ installation 01'75 KVA of
.—
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. separately larger scpa.2 derived system.
❑ Addition o of new motor load of l7 "A ", "F. ", "1.2 ", "1-3 ",
Job no.: Job site address: 1 A {p SA 1001t1'ormore. Mcwwt1
t �lih� O Six or more residential units. ❑ Recreational vehicle pmks•
Ciry /State/ZIP () k 1 q- 7 Z CI Hcahhi. rc faciloies. O Supply voltage for more than
e ` ` CI I la::lrtlolls toptiatts taro volts nominal.
SuitclbldgJapt. no.: 1 Project name: �J t.+ , O Service or feeder COD amps or more.
1 1, - - ` ' PEE SCHEDULE
Cross street/directions to job sitc: v_ � \A� .e �}`I�Y�(� thsertaato I Q7. I — Pee. j Toter LE
��v YYY 1 1>!d><� 111���..•rrt��� New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ti. or Tess 168.54 4
flat- udd'l 500 sq. n, or portion 33.92 1
Tux map /parcel no.: Limited energy. residential 75.00 2
- • . ..DESCRIPTION Orr WORK (will, above sq. n.)
r•
^ Limited energy multi-tinnily 75.00
A CC. t r ` Qs., ` G ve • , � residential (with above sq. 11.1 Q ` I `' Services or feeders installation, alteration, and/or relocation
G 200 amps or less 100.70 2
• ..... _ ._ PFJiTY OWNER
. - - ❑ TENANT • . 201 amps to 400 snips 133.56 2
Name: GJESTL / *6 1, 401 amps to 0 amps 30.04 _ 2
601 amps to 1,000 cump9 301.04 2
Address: .'4 - ivy' Over 1,000 amps or volts 552.26 2
City /SttttelZiP: Temporary services or feeders installation, alteration, and/or
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 168.54 2
Branch circuits -- nrw alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
-c ..7=f3•:..1:' _ : _ above service or feeder fee
7A2 2
APP ]ZCANT - + �ON7'A►CT `PE1tSON.: =:
Q each branch circuit
Business name: 13. lee fur bnincit circuits without
.. service or feeder fcc, first 56,1 A - .1 2
Contact name: branch circuit ✓W
Each add'I branch circuit z 7,42 '4.94 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: /State/LI l': Each manufactured or modular 67.84 2
ty dwelling. service and/or feeder
R only 67.84 2
Phone: ( ) Fax:: ( )
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
: - - � : _ :;_ ' -. -:: CONTRACTOR."
.. = .:� = -- ��� • . •- . , - -- - Signal circuit(s) or litnitrt4energy
Business name: St?.d1.lr 1QG L �.� _panel,u , orextensinn. , Page 2 - 2
T —L Each additional inspection over allowable in any of the above
Address: ?() - Additional inspection (I hr min) 66.25/ hr
_ Investigation (I hr aria) 66?5/ hr
City /State /ZiP: � 0 _ n r\ 1_ �` �� ` Industrial plant (1 hr min) 78,18/ hr
P - I - ) .--/ = t ...t Fax: 7e„_ I I f O e 1 . 'ens for which no fee is 90.00/ hr
'Scull listed h hr min
7�Lq
CCB Lic.: _ Electrical Lic.: 4 .101 G Suprv. Lic.:,da 86 \ " =.: • -- . _ y fl ICIii.:PERR;MIT - FEES ,t. • .. 7. . -
leak Subtotal: - 1 t<
Suprv. Electrician signature, required
- '-i1w r itj Plan review (25% of permit f
Print num v j Date: State surcharge (12% of permit fee): C a , S Z /
�:�.* ` `�i
■ Pak TOTAL PERMIT FEE: q • eel
Authorized signatur
This permit application expires If permit Is not obtained within 180
days name: Dale: d after It has been accepted as complete.
N umber o inspcctioas allowed per permit.
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