Permit n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00625
T 1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/01/2012
Parcel: 1S136CB08800
Jurisdiction: Tigard
Site address: 11084 SW 81ST AVE
Project: Dees Subdivision: HERB AND PEGGIE'S PLACE Lot: 26
Project Description: (2) branch circuits to install A/C and service outlet A/C must maintain 5' side yard setback and approved rear yard
setback
Contractor: BEAR ELECTRIC Owner: DEES, DANIEL L SHIRLEY M
PO BOX 389 11084 SW 81ST
DONALD, OR 97020 TIGARD, OR 97223
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PHONE: 503 - 678 -1355 PHONE:
FAX: 503 - 678 -1108
FEES
Quantity Description Date, Amount
• 2 crt Branch Circuits'wo /Purchase 11/01/2012 $63.60
Specifics: Service or Feeder.
1 ea 12% State Surcharge - 11/01/2012 $7.63
Type of Use: SF Electrical •
' . Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
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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 •5 - 001 -00'0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 1987 or 80v/
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1.800.332.2344.
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Issued By: 4� / �� Permittee Signature: DU 0 ok-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 603.639.4175 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.
OCT- 31- 2012(WED) 15:17 Bear Electric (FRX)5036781108 P. 002/002
Electrical Permit Application RECEIVED FOR OFFICE USE ONLY
City of Tigard
R eceived 2 /
Dnte/Dv: / (1 t Permit No CL a.2DI o. - do (e
" 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
s C ' Phone: 503.718.2439 Fax: 503.598.1960 P r. T 3 1 2012 Datelnv: Other Permit:
TIGARD Inspection Line: 503.639.4175 DateReady/by: fa See Page 2far
Internet: www.tigard -or.gov CITY OF TIGARD Notified/Me t od: tin S. Supplemental Information
TYPE OF vBpIILDING DIVISION PLAN REVIEW
❑ New construction ddttion/Ahemlion/ replacement Please check all that apply (submit E sets of plans writems checked below):
❑ Service or feeder 400 amps or more ❑ building over three stories.
❑ Demolition Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps nt 150 volts or ❑ Floating buildings.
less to (pound, or exceeds 14,000 ❑ Commercial -use agricultural
'k it ..
1- and 2-family dwelling ❑ Co
aster builder lde usari:ll ❑ Accessory building amps for all other installations, buildings.
Multi - family ❑Master blds ❑Other: ❑ Firc pump. ❑ Installation of 75 KVA or
17 Emergency system. larger separately derived system.
JOB' SITE INFORMATION AND LOCATION ❑ Addition of new tumor load of ❑ "A ". "F', "1.2 ", "1 -2",
Job no.: Job site address: 40 • • I (1 10.011P or mare, occupancy.
I cell 2 `� „ CI Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 1 ❑ Health -care tieiiirics, Q Supply voltage for more than
4 /' O H1221410111 local ions. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
.FEE SCHEDULE
Cross street/directions to job site: Desert .. • . rMM. Taw -
r t New residential single- or multi - family dwelling unit.
■ \ 1 Ia.- ( Includes attached garage -
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'1 500 sq. It ar portion 3192 1
Tax map /parcel no.: Limited energy. residential •
DESCRIPTION OF W r RK' . (with above sq. f1.1
5.00 2
.. Limited energy, multi- family 2
�� ■ IS 4.) ..e.., residential (with above sq. fl.) 75.00
Services or feeders installation, alterat on relocation
200 amps or less 100.70 2
' ❑ PROPERTY. =OWNER • ,1 Q. TENANT • 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
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) l Pax: ( ) ' 200 amps or less 59.36 I
Owner installation: This installation is being made on property that ] own which is nut tot amps to 400 amps 125.08 2
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 - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with -
above service or feeder fee, 7 42 2
=:_:❑ t1PPJ.ICA�!17:. -.:; ❑ CON!'ACI.:1'I;)ZR.SON: ' ' each branch circuit
Business name: B, Fee for branch circuits withour
service or feeder fee, first 1 56,1 R C,/_ •' Q 2
Contact name: branch circuit t//YY CJ
Each add'( branch circuit ( 7.42 -7.4
Address: Miscellaneous (service or (ceder not lncluded)I
City /5ttddZlP Each manufactured or modula
dwelling. service and/or feeder 67,84 2
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Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail:
- Pump or irrigation circle 67.84 2
7 ,':: ' CO NTRACTOR 1 or outline lighting 67.84
_ _ Sian t 2
r � k G �' - E ach additi i of the above over allowable in an e
Business name: Z C panel, altera or extension. Page 2 2
Address: ` ,+. ` -' r el Additional inspection (I hr min) 66.25/ hr
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City /StAIe/ZIP: e i ` ri- • r it It , O Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
PhoneVZ (r7 9_ i Fa x " Co 7 i I 0 i Inspections for which no fee is
V lJ L N ¢ eeific illy listed (i4 hr m191 90.00f hr
CCB Ire.: /1 Electrical Lic.: ' r `Q uprv- LAC.: - = 5 - C' , k'RMIT,T
Suprv. Electrician signature, required: 1` C. Subtotal:
•- ` Plan review (25% of permit fee):
Print name' / I1 ADatc: $ 01 f � Stale surcharge (12 %of permit fee .
TOTAL PERMIT FEE: 1 1
Authorized signature. G.
T
— his permit permit 1
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Pe expi res If a it Li not obtained within 181)
Print name: Date: • dnys after it basbem accepted as complete.
• Number of inspections allowed per permit.
t:inuildineennits\L.LC- PennhAt 07/01 /10 440 46157(1 t/05 /COM/wv.H