Permit r , CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00148
Date Issued: 03/05/2013
,11GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 1S135CD03200
Jurisdiction: Tigard
Site address: 9630 SW LEWIS LN
Project: Steward Subdivision: RUTH Lot: PTS 3-4
Project Description: (3) branch circuits for heat pump and service outlet
Contractor: BEAR ELECTRIC • Owner: STEWARD, SAMUEL A & LINDA K
PO BOX 389 9630 SW LEWIS LN
DONALD, OR 97020 TIGARD, OR 97223
PHONE: 503 - 678 -1355
PHONE: 503 - 807 -9590
FAX: 503 -678 -1108
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 03/05/2013 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/05/2013 $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 OAR 952- 001 -''90. Yo, may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4', / Permittee Signature: OAT /7-644 ie9
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.
MAR- 01- 2013(FRI) 14:18 Bear Electric (FAX)5036781108 P.002/002
Electrical Permit Applicatio FOR OFFICE USE ONLY
City of Tigard j WCL � Receiv `:I e , 0 ,
1
...v, Dov 3 /3 r Fennel No.:E�
w 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
t: '• Phone: 503.718.2439 Fax: 503.598.1MA R 4 2013 b ie/b ; Other Pernttl:/YerA9 / 3 - 0#
T I G A RD ww Inspection Line: 503.639.4175 Date IteadylBy: Fa See Page; for
Internet: w.tigard- or.gov CITY OF TIQARD Notified/Method: NM Supplemental Information
�
TYPE 0 B TIMING fIV1s1ON PLAN REVIEW
❑ New construction Addition/alteration/replaccmcnt Please check all that apply (submit 2 sets of plans ,/items checked below):
❑ Demolition ❑Other: 0wherr Service
teravalablefaultc�ment ❑ Ma r i n a g over otreestories
0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 0 Commercial - use agricultural
I- and 2- family dwelling 0 Commercial /industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi - family 0 Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND. LOCATION CI Emergency system. larger separately derived system,
• O Addition of new motor load of ❑ "A ", "Ii ", 9.2 ",14",
Job no.: Job site address: c +'' 100F0�or more. Recrc anty,
'1� 51n1
S ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP 770\0..6 � r O Healthcare facilities. 1:3 Supply voltage for tunic than
/ �"12Z3 I] Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: I Project name: - e II+IS ❑ Service or feeder 600 amps or mare.
411 �11 ��� Rs �, 'FE SCHEDULE • . •
Cross street/directions to job site: (� Baer!. flan . . Fes. Taw •
New residential single- or multi - family dwelling un1L
Includes attached garag
Subdivision: Lot no. 1,000 sq, O. or less 168.54 4
Ea. add'I 500 sq. R. or portion 33.92
Tax map /parccl no.:
Limited energy, residential
75.00
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
r residential (with above sq. IL) t _
�. • M ■f . \ i1 �a ( ■ - Services or feeders Installation alteration and/or relocation
Alt:k 200 amps or less t 00,70 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
Temporary services or feeders installation, alteration, and /or
City/State/ZIP: i relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
11 201 amps 10 400 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 branch circuits with
- D i1PPLICANT . . _': = : D CONTACT P , : 742 2
c service or ec ec
each bnmth circuit
Business name: B. Fre for branch circuits without
5 1� service or feeder fee, lust 56.18 �', X S 2
Contact name: 3 1 � i blanch circuit
Each add'! branch c ircuit
Address: w., , Mfaceilsoroos (service or feeder not included)
�� k�K� { Q , Lech manulucttired urmodular
City /State/ZlP: V &�, d,,cili service and/or feeder 67,114 2
Phone: ( ) Fax: : ( ) (/ ' v i/ only 67,84 2
E 11 Lt Pump or irrigation circle 67.84 2
_ CONTRACTOR . _
Igonrout lee lighting 67114 2
• - •- - - ; _ S igma] circuit(a) or limited-;ltergy
Business name:
.... Z - pp,,//ss _panel, alteration, or extension. Pape 2 2
t / "^.v " l V 51C � / '�+ } .. tads additional inspection over allowable In any of the above
Address: 0 Y. APR Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: �l‘t d C) P TIN a Investigation (I hrrnin) 6615/ hr
/ y 15 LJ Industrial plant (1 hr min) 78,18 / hr
Phone: ( ) , a 4 Fait: (:)C)5) , v La , inspections for which no fee is - '
e _specifically Iistcdp hr min) 90.00 / hr
CCB Lic.: a. • Electrical Lic.: Z - 6 , Suprv. Lie.: lib ', ELECTIt1CAL'' :pERMrr EFS' .s::s: ' i :':
Suprv. Electrician signature, required: • - ..
Subtotal: �
" — IF ►_1 Plan review (25% of permit fee):
—
Print name: ' State surcharge (12% of permit fee): ........140 . 0
1 i .t► _AII tll_ ti
Authorized signature: __ ,...•■-- _ / TOTAL PERMIT NEC: �/�'
-- / ix 11 This permit application expired ifs permit is not obis • • within 180
• days after it has been accepted a completes ✓
Print name: C i os , Date: � .. 1 1 ~1� • Numler orinapeclions allowed per permit. 9
1 tt3iIilJinu \omitetEL.C- r'mmitApp.da 07/01 / /10 440.46151'11 iNS /C(imiwkm r aisK