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Permit CITY OF TIGARD ELECTRICAL PERMIT - COMMUNITY DEVELOPMENT Permit #: ELC2012 -00697 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/12/2012 Parcel: 2 S 101 AD00400 Jurisdiction: Tigard Site address: 6655 SW HAMPTON ST 210 Project: Hampton Oaks Subdivision: WEST PORTLAND HEIGHTS Lot: 14 -31, P Project Description: (1) branch circuit to reconnect rooftop unit. Contractor: BEAR ELECTRIC Owner: HAMPTON OAKS LLC PO BOX 389 6665 SW HAMPTON DONALD, OR 97020 2ND FLOOR TIGARD, OR 97223 PHONE: 503 -678 -1355 PHONE FAX: 503 -678 -1108 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 12/12/2012 $56 18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/12/2012 $6.74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 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 2 -00 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503 22322.198 or 1.800 332.2344 / Issued By: oze Permittee Signature: 2 4 A / e / C 9 77O&/ 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. DEC- 11- 2012(TUE) 13:51 Bear ElREC ' (FR)()5036781108 P. 002/002 Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Received �► g DEC 1 201 Date e . 42 /_ .;sue,• 'ennitNn. C=GCeZe /o? Y/ ,, y 13125 SW Hall Blvd.,'I'igard, OR 972 Plan Review fi ' • Phone: 503.718439 Fax: 503,598,1960 CITY OF TIG • Date![iv: Other Permit: u TIGARD Inspection Line: 503639.4175 DateReadyBy rw'd t;3 Set Page 2 for Internet: www.ligord- or.gov BUILDING MS •'• ; oldied/Method- �6 C7 I Supplemental Information TYPE OF WORK PLAN REVIEW New construction Addition /alteration /replacement Please check all that apply (submit g sets of plans w/rtenis checked blow). ['Service or feeder 400 amps or more 0 Building over three stones. ❑ Demolition ❑ titer: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps of 151) volts or CI Floating buildings. less 10 ground, or exceeds 14.000 0 Commercial -use agricultural 1- and 2- family dwelling 0 Commercial /industrial [] Accessory building amps for all other Ir151itllalrpm buildings. (] Multi- family El Master builder 0 Other: 0 Fire pump. 0 Installation 'if 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of 0 "A ", "E ", "1_2 ", "1.3 Job no.: Job site address: J ,�,. e� �� l Six nr or more occupancy. _ %o Tl fire i 0 $rn more residential units. CI Recreational vehicle parks. Ci Ty/St ate/Z I P:Vo (-k l ������ 02 C1-77_0- 1 ❑ Hcandcare facilities. 0 Supply voltage for more ,hum V .22! ���� 0 Hazardous locatations. 600 volts nominal. 4 suite/bldg./Apt, no.: a / O Project name: i/4 7:9p7' d 0 Els or feeder 600 amps or more. _ FEE SCHEDULE Cross street/directions to job site: description J Qty. I r**. 1 mud j - New residential single- or malts- family dwelling unit. Includes attached garage. Subdivision: I I.ot no.: 1,000 sq, n. or less 168.54 4 '['ax map/parcel no.: F--a. add'1500 sq, ft or portion 33.92 1 Limited energy, residential 75,00 2 DESCRIPTION' OF =WORK = (with above N. R.) Vie cz1r1 _ _ ` .r� U l 1 Limited en tial mu with aabfvove sly et 75.00 2 C �J J C k 1 J l n ^ retiden 7 - ti ergs. (be skit) �+ Services or feeders lnstallation and/or relocation 200 amps or less 100.70 2 . ©:. _PROPERTY OWNER 1 - ' . Q „TENANT . 201 amps to 400 amps 133.5e. 2 401 amps to 600 amps 200.34 2 Name: G01 amps '0 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: ( ) Fax: ( ) 200 amps or less 59,36 I 201 amps to 400 umps 125.08 2 Owner installation: This installation is being made on property that 1 own which is not 1 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps i68.54 2 Branch circuits — new, alteration, or extension, r panel Owner Signature: Date: A. Fee for branch circuits with CONTACT PERSON above service or feeder fee, 7 42 2 .f.., - _ �] APP4ICANT, _0 each branch circuit Business name: B. Fee for branch circuits without �/ service or feeder fee, first 1 56.18 spy lS 2 brunch name: bch circuit ` Each uid9 branch circuit 7 42 2 Address: Mincenaoeoassserviee or feeder not included) C ity /Stale /ZIP: Each manufactured or modular 67.84 2 Dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E - mail: Pump or imgution circle 67,84 2 Sign or outline lighting 67.84 2 _ "_ T. _. � , . , CONTRACTOR; . - " — Signal eircuit(s) or limited -energy Business na►ne: C r J+r panel, alteration, or extension. , Page 2 2 ��, ` - '+� -� ` 1 G •• F„ach additional Inspection over allowable in any of the above Address:.�� • • Y Additional inspection (I hr min) 6625 / hr Cit /State/ZIP: Y Investigation (1 hr min) 66,25 / hr 6. Ilk a ■�- To In plant (I hr min) 78 181 hr h one: ( .. + s. . Fax: ` v- J speelions for which no fcc is I - yecifcally listed eh hr mm) 90.00/ hr CCI3 l.ic -:"L C Electrical Lic.: . ...I n c _ _.rv. Lic.:.4 s _ ; :r ?i,'e* PERMIT s = -:' -= _. Suprv. Electrician signature, require' : , • 1 �� Subtotal: ,1 r� t Plan review (25% of permit fe'• j� Print namc:8 ItL_ Jia ., 'U �` D ate: 7` 1 1 l J' State surcharge (12% of permit fee): C Authorized signature: TOTAL PERMIT FEE: 0 ?. 4 L This permit application expires if it permit is oat obtained within 180 Print name: _.r . Date: days after is has been actrpfed as complete. Number of'inapectinns allowed per 'twilit. I.1Hugel'uu l'mrnna4LLC- PcrmaAap.the' 074)1110 '140-461S1(1 1 /05 /COM/WER