Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 00661
• 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
T 1GARD Parcel: 2S110AD09200
' Jurisdiction: Tigard
Site address: 14817 SW 109TH AVE
Project: Shearer Subdivision: BRAMBLE BEND Lot: 4
Project Description: (2) branch circuits to reconnect furnace and connect heat pump. •
Contractor: BOB'S ELECTRIC Owner: SHEARER, MICHAEL A & SHALA B
2700 NE BURTON ROAD STE A 14817 SW 109TH AVE
VANCOUVER, WA 98662 'TIGARD, OR 97224
PHONE: 360 - 254 -7200
PHONE: 503- 590 -4440
FAX: 360 - 254 -8219
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/20/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/20/2012 $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 95 1 -00 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800:332.2344.
Issued By: / i` ay-- Permittee Signature: eA/ .: /G /eff77O 47
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.
FROM <MON)NOV 19 2012 23: 08 /ST. 23: 04 /No. 8302828188 P 2
Electrical Permit Applicatio uri ,, t_ t ": O.l.l
Cl of Tigard � � I . � ,,)l( p /13 ` - Penn"' City igard DetrlB : Ii �0 ice. Zvi Etec2042 - "I . •
13125 SW Hall Blvd., Tigard, OR 97223 9 2012 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 O V 1 Date/e . Other Permii — j/5/
I . �, h Inspection Line: 503.639.4175 • Date Ready/By: M See Page 2 for
TC; Internet www.tigard- or.gov CITY oF TIGARD Notified/Method: Supplemental lnformadon
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❑ New construction ®Addition /alteration/replacement Please check all that apply (submit 1 sets of plans w /items checked below):
['Service or feeder 400 amps or mate ❑ Building over three stories.
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards.
='y -ji5i r� 2 Y " i a r '' exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
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._..: .. ;. -. _ . _i , , _ , _ ;..,,,.1....._ r m
to ground, or exceeds 14.000 ❑ Cotnereial -use agricultural
al- and 2- family dwelling ❑ Cotnmercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
. Y ryr- r _ � �s w v Emergency system larger separately derived system.
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' - '_'` . r .. :, _ ? :i.:..:In ._ ...� •
.. _ .r . :1 -._ .,� 5.4..;....: . ...._ ..:... ❑ Addition of new motor load of ❑ A ,. E ..� - 2 „ - 1 j .
loo�ormare. occupancy.
Job no.: 12 - 1237 Job site address: 14817 SW 109th Ave.
❑ Six or more residential units. ❑ Recreational vehicle perks
City/State/ZIP: Tigard, OR 97224 ❑ th facilities. ❑Supply voltage for more than
❑ Hazardous locations. 600 volts rominaL
Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or rmre }
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Cross street/directions to job site: nmlaa 4h• Pm is •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ta x ma /parcel no.: a ed � d'l 500 sq. ft. or portion 33.92 1
:- Ter energy, residential 67.84
arp, 7 1 x4 � ,.
ti_a t
_! t ,4 : .�� �: =. :r... 7r.!,:s W _ (with abovesq.ft.) 2
.;. L _.k .a , r .�- • - "" "'' Limited energy, mufti family 67.84 2
Furnace reconnect & heat pump connection residential (with above sq. ft)
Services or feeders Installation, alteration, and/or relocation
• 200 amps or less 100.70 2
" t ve; ,fir i{ z 1s- " { '\ T o' .1' V "il. 1 .`.��rrr - .,.• • -IVt
: - ' ii : .�a,..,,.f`. � -z . -, .' .'? < -1, {...,...� h rf .. —.,. a .,' . � 201 amps t o cm amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Mike & Shala Shearer 601 amps to 1,000 amps 301.04 2
Address: 14817 SW 109th Ave. Over 1,000 amps or volts 552.26 2
Temporary t services or feeders Installation, alteration, and/or
City/ State/ZIP: Tigard, OR 97224
Phone: ( 503) 590 -4440 I 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 I 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, alteration, or extension, per panel
Owner signature: Date: A. Fee for brands circuits with
Pf t r . i . .3. • x i 1 , i t f � rti above service or feeder fee. 7.42 2
= .. ` ._. Li�i w'r .. ,f.., ,iii. - . . , ., :. -i., 54- :19" . . ,s..- each brands circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56 -I B 56.18 2
Contact name: branch circuit
Each add'/ branch circuit 1 7.42 7.42 2
Address: Miscellaneous (service or feeder not Included)
Ci /State/ZI P: Each manufactured or modular
67.84 2
tY dwelling, service and/or fader -
Phone: ( ) I F : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
y _.n . _ ... :P. °_4 - �.y -,,a{� �.. .�.,+.. Y .ti r.�..� T 13: =1-�S �E ' 3i: �
3E .? max ._ - :- •1:: . :,i: =. ,o ;7, :_ , ..w• w e 61 _ ,-.4; a •..- _. :....: rte.._... _ — . _. ...
Signal circuits) or limited energy
Business name: r panel, alteration or extension. _ Page 2 2
Bob s Electric Each additional inspection over allowable in any of the above
Address: 2700 NE Burton Rd., Ste. A Additional inspection (1 hr min) 66.25/hr
Ci State/ZIP Investigation (1 Fir min) 66.25/hr
Vancouver. WA 98662 Industrial plant (I hr min) 78.18/hr
Phone: ( 360 ) 25 4 - 72 00 I Fax: ( 3 0) 25 -8219 Inspections for which no fee is 9000 /hr
0 — ifical listed 'f, hr min ` CCB Lic.: X Electrical Lic.: Suprv. Lic.: - " . ``.�.. '
53136 " I 1C p 432 - � �--= ���=<<''_ r .; � �i :M : : z�- �_�
Suprv. Electrician signature, requirede Plan review (25% of permit fee):
Print name: Kev B rose ll e Date: 11/15/12 State surcharge (12% of permit fee): 7.63
Authorized signature: TOTAL PERMIT FEE: 71. 23
Th,s permit application expires if • permit Is not obtained within 180
Print name: Date: days after It has been accepted as complete.
• Number of inspections allowed per permit
I:\ 6 uildingWermits\ELC•PermitApp.doe 10/01/09 440461 ST(I 1I0NCOM/WEB