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Permit CITY OF TIGARD ELECTRICAL PERMIT I - • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00721 T (GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2012 Parcel: 2S 1038810300 Jurisdiction: Tigard Site address: 12140 SW KATHERINE ST Project: Rabau, Wolf Subdivision: YE -OLDE WINDMILL Lot: 23 Project Description: (3) branch circuits for AC, service outlet, breaker change out Contractor: BEAR ELECTRIC Owner: RABAU, MARLA S & PO BOX 389 WOLF, KEITH S DONALD, OR 97020 12140 SW KATHERINE ST TIGARD, OR 97223 PHONE: 503 - 678 -1355 PHONE: FAX: 503 - 678 -1108 FEES Quantity Description Date Amount 3 crt Branch Circuits wo /Purchase 12/18/2012 $71.02 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/18/2012 $8.52 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $79.54 Required Items and Reports (Conditions) 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 952 -00 0090. You ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344, ,� I Issued By: �f l.0 �1 Permittee Signature: DN ► 1 1 1 LI C,4'" (lad 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- 17- 2012(MON) 09:46 Bear E1eREC IV I (FRX)5036781108 P 002/002 Electrical Permit Application [ MM FOR OFFICE USE ONLY DEC 17 2 0 eecivcd City of Tigard D2103 : /a-I/ /13- c- Permit No. � .0/ a - 00 . 2 3 I 13125 SW Hall Blvd., Tigard, OR 97223 C Ir Revtew s rhonc: 503.718.2439 Fax: 503.598.1960 CITY � TIG • terry; Other Permit: T1 Q A RD Inspection Line: 503 BUiLDtNG DEVI V' "IteaJ lurii. ®see Page 2for Internet: www,tigard- or.gov • •t ted/Mc111mi: _ / 4iJ Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction XAddition /alteration /replacement Please cheek all Mai apply (submit 2 sets of plans w /items checked below): 0 Service or feeder 400 amps or mare CI 1Snilding over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards, CATEGORY OF CONSTRUCTION e xceeds 10,000 amps a1 150 volts or O Floating buildings. -- less to ground- or exceeds 14,000 O Commercial -use agricultural 1- and 2- family dwelling ❑ Commercial /industrial 0 Accessory building amps for all oilier installations. buildings. Multi•fitmily © Master builder ❑ Other: 0 Fire pump, 0 Installation of 75 KVAor JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger aepttraiely derived system. ❑ Addition of new motor load of C1 "A ", "0 ", -1 -r, -1 -3", C 100111'ormore. occupancy, Job no.; Job site address: 1, r, .it L : I 1 0 Six or more residential units, 0 Recreational vehicle parks. City /State /ZIP: 1 ` O I-leallh•cale facilities. 17 Supply voltage for mote than 0.� ��� Q I WM11oas I0ea00113, 600 volts nominal. Suite /bldg.apt_ no -: Prdjcct name: O Service or feeder 600 amps or more, FEE. SCHEDULE Cross street/directions to job Site: Pourlptw„ I Qty. I Mee._1 Total 1 • New residential single- ur multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. It. or less 168,54 a Tax map/parcel no.: - _ 1:.%1. asd'l 500 sq. fl, or portion 33.92 1 Limited energy. residential 75.00 2 DESCRIPTION OF WORK (with above sq. 0.) r -I- /� Limited energy, multi - family 2 ( ` 5 -e�r 1 Ce., 0o-\" \R-k-) ?recA -)-6( residential (with above sq, ft) 75,00 % J �1s v Services or feeders installation. alteration, a nd/or relocation — • a • � i e II 200 amps or less 100,70 2 ._ •:1,.; ;.' t • PI.R'ry OWNER 0 TENANT ' - : . 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: - .. -- _ -_._ 601 amps to 1.000 amps 301,04 2 Address: Over 1,000 amps or volts 552.26 2 City /Site /ZIP; _ • 'Temporary services or feeders l ostallation. alteration. and/or relocation Phone: ( ) 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 intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701. 401 amps to 599 am 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 AI'YI IG1V'Y I `:0 •CONTA4"T.PERSON each branch circuit 7.42 2 Business name: 13. Tea for branch ciicuits without service or feeder fee, first 1 Q Contact name: branch circuit 56.18 2 �.] Each add brunch circuit '. 7.42 0.2A 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.64 2 dwelling. service 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 ,. �: . CONTRpf�TOR ? - .... . -_. : S 3 rel l aherai Ott, or limited-energy d Business mane: 0 ( ( '-/ y--y C - . p• extension. PaEE2 2 r r ti✓ ` , , Each additional inspection over allowable in any of the above Address (� V� 3 Additional inspection (1 hr min) 66.25/ hr — Ci /Statc/ZIP: v � , � ,i G4 I I 01' , 7 investigation (I hr nun) 66.25/ hr ^ lndustnal plant (I hr min) 78.18/ lir Phone:) 7� Fax; (545)Q7 I inspections for which no fee is 90,00/ hr ` "s-'•.a- l specifically listed 04 hr rain) CCB Lie .ZO /Q Electrical Lic.: .- /47G Su rv. Liu. Ag 8 i . ELFCrRICAL PERM15' FEES subtotal: "I t. QZ Suprv. Electrician signature, required - .• Plan review (25% of permit fee)~.., -rte Print mime: A r . r & /I e Dille: (� "t �/ 7 State surcharge (12 % fee): 0,5 --fr(_ C/ TOTAL, PERMIT FEE : n7 Authorized signature: ` permit application expires if a permit is not obtained within 80 Print name: Date: • days after It has been accepted as complete- ' Number of inspections allowed per permit. I:lD uitding \Verm its \III.C- Permit App Ana 07/01/10 4104615111 1/05/COM/W0D