Permit CITY OF TIGARD ELECTRICAL PERMIT
I. COMMUNITY DEVELOPMENT Permit #: ELC2013 -00239
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/29/2013
Parcel: 2S110AA01700
Jurisdiction: Tigard
Site address: 10890 SW CANTERBURY LN 29
Project: Maple Tree Apts. #29 Subdivision: CANTERBURY PLACE, AMENDED Lot: 6A
Project Description: (2) branch circuits to change out multiple exterior fluorescent ballasts
Contractor: BEAR ELECTRIC Owner: DECE III INVESTMENTS, LLC
PO BOX 389 PO BOX 5668
DONALD, OR 97020 PORTLAND, OR 97228
PHONE: 503 - 678 -1355 PHONE:
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 04/29/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/29/2013 $7.63
Type of Use: MF 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 ) I(JA J LL / 952-001-0090. You ` may obtain a copy of the rules or direct questions to OUNC by calling 503. 19
503.232.1987 or 1.800.332.2344.
Issued By: �✓ i. Permittee Signature: (),(J , /' • �C/G1 44 ad
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.
APR- 25- 2013(THU) 12:33 Bear Electric (FAX)5036781108 P.001 /002
RECEIVED
Electrical Permit Any FOR OFFICE USE ONLY
PR 2 5 2013 Kcdcrvcd
City of Tigard nmemv, M. Penult No.: do/ 3 .;,0a3
r 13125 SW Hall Blvd., Tigard, OR
0 A7223..
Phone; 503,718.2439 Fax: 5 o0FTIGARD Miiii= Otherl'ennil:
TIGARA inspect; °nl•ine: So3 . 639 , 41 7sBUILDINGDIVISION lif '° Co a s.„,„2,.„, Internet: www.tigard- or.gov : ! �J Supplemental Informatian
TYPE OF WORK PLAN REVIEW
❑ New construction El Addition/alteration /replacement Please check all Mai apply (submit 1, aelsof plans w /itellls checked below);
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition ❑ Other'
where the available fault current CI Marinas and boatyards.
CATEGORY. OF CONSTRUCTION • exceeds 10,000 amp% al 150 volts or Q Flouting buildings.
less to ground, ur exceeds 14,000 ❑ Comutelcial -use agricultural
❑ I - and 2- family dwelling Q Commercial /industrial ❑ Accessory building amps fur all tither instnllallotls. baiWings.
® Multi- family 0 Master builder 0 Other: ❑Plre 1.3 InalaIlaipot, cif 7$ 11V,4 or
JOB SITE INFORMATION AND LOCATION ❑ Emergency tysltlu. larger Separately derived system,
❑ Addition of new motor load of ❑ "A ", "E ", "I.2 ", "1.3",
100HP or more, oecup Cy.
Job no.: Job site address: 1 0890 SW Canterbury Lane 1-1 0 Recreational vehicle parka,
° Six nr mare residential units.
City/Stale/ZIP: Tigard, OR 97224 ❑ llenllh•care fiacilities. ❑ Supply voltage for more than
❑ I lazarduut Irxluliuus. 000 volts nominal.
Suite/bldg. /apt,no.: #29 1 Project name: Maple T.A 10890 Canterbury-RC , 0 Serviceorfeder6uoturpsormote.
.. FEE SCHEDULE -
Cross street/directions to job site: Dnwrrptrso i Qty. I ■._ I rain . I •
' New raidentild single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. 0. or less _ - ^ 161,14 .1
— - - -- - -- - • Ea. ndd'I 500 sq. 0. or portion 3192 1
p parcel n0.: ia -- `
Tux mu Limited energy, residential
°.DESCRIPTION OF WORK. • ., (with above s q. A . ) 75,00
l.itnfled energy, trlulli•family 75.00 2
Change out multiple exterior fluorescent ballasts. residential (with above so, n,) _ ,
Services or feeders Installatiou,alteration, and /or relocation
200 amps or less 100,10 2
® PROpERTy!OWNER :r.` - ... T IVAhiT' 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
Temporary services or feeder's installation. Alteration, and/or
City /State/ZIP: relocation
Phone: ( ) Fax: ( ) 20u atrtos or less 39.36 1
20I amps In 400 scups 1 25.08 2
Owner instillation; This installation is being made on property shut-1 own which is not
intended for sale, lease, rent, or exchange, according to OILS 447, 449, 670, and 701. 401 amps to 5 amps - 16g.54 2
Branch circuits -. new, alteratlon ertcnsion, per panel
Owner signature: Date: A. 1: cc for hranNt ettmtits with -
above service or lecher Ice,
0 APPLICANT):; ,, ` "" . CON iCT 'PERSON 7.4z 2
----- each bmnch circuit
Business name: Bear Electric, inc. B. Fee for brunch circuits without
. . - _ service or feeder fee, first 1 561 N 56-18 2
Con bud name: Vanessa Diosdado branch circuit
Each add'1 brunch circuit 1 7,42 7.42 2
Address: _ ur_feeeiernot inc luded )
City/State/ZIP: ach manulitclured or modular 67.84 2
y dwelling, service and /or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Vamp or irrigation circle 67.84 2
E -mail: Permits@Bearelectric.com
Sign or outline lighting 67.84
CONTRACTOR —
,.' Signal dreuit(s) or limiird•rnrrBY
Business name: Bear Electric, Inc. panel, allerution, or extension. . - ___ Pine 2 2
- Each Additional inspection over allowable In any nf the above
Address: PO Box 389 Additional inspection (I hr min) 66.25/ hr
' Investigation (1 hr min) 66.25/ hr
City/State/ZIP! Donald
Industrial plant (1 78,18 /hr
Phone: ( 503 ) 678 -1355 I Fax: ( 503 ) 678 -1108 lrls lealinos lbr which no fee is -- -. _ . 90.00/ hr
speei ti nte d (Y , h r ,r n n ) _
CCRLie.: 20919 l rledtricul -107c _ Supry L i:
4881s ^ :' " 1CY!RICALSPERMIT' _ = - .f.
-
Suprv, Electrician signature, required: Subt ): 63 -60 •
Tian review (25% of permit 1'ee): N/A
Print name: Stephen Shepherd Date: 4 -25 -13 State surcharge (12 %ol'permit fee): 7.63
X TOTAL. PERMIT FEE: 71.23
Authorized signaturc:r M4 This permit application expires if a permit is out obtained within IN
days after it has been accepted as complete.
Print name: Vanessa Diosdado Date: 4-25-13 • Number of inspections allowed per permit.
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