Permit q CITY OF TIGARD ELECTRICAL PERMIT
111 g • COMMUNITY DEVELOPMENT Permit #: ELC2013 00238
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/29/2013
Parcel: 1 S 135DD03301
Jurisdiction: Tigard
Site address: 11945 SW PACIFIC HWY 121
Project: Archers Afield Subdivision: METZGER ACRE TRACTS Lot: 9
Project Description: (2) branch circuits for new A/C and condensate pump
Contractor: BEAR ELECTRIC Owner: COMMERCIAL ENTERPRISES LLC
PO BOX 389 8320 NW HWY 99
DONALD, OR 97020 VANCOUVER, WA 98665
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: COM 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 0 52 -001 -0 90. You m y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: "r Permittee Signature: ad I 80 / N / /O t
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.
RPR 25 - 2013(THU) 12: 32 Bear Electric (FAX)5036781108 P. 001 /002
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard APR 2 5 201 Re tv�
• 13125 SW lull Blvd., Tigard, OR 97223 flan Review ATEklierriti
Phone: 503.718 2439 Fax: 503 :59S, &TY OF TIGARD Dttiunw- abler Farrah: •
TEGARD Inspection Line: 303.639.4175 Daekeady /By: tans
Internet: www.tignrd -or goy BUILDING DIVISION Notified/Method
(p EERERPRII
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit l acts of alms whams ebeeked below):
C Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other _ where tie available huh current In marinas and boatyards,
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or Q floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial-use earicultural
1 J I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other instsituriuus. . ' buildings,
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
- ❑ Emergeney system. larger separately derived system -
JOB SITE INFORMATION AND LOCATION O Addirian ofnew maw load of CPA - E", "t.2 ", - 1 -7 ",
Job no.: Job site address: 11945 Pacific Hwy Iin ii mote. si Res occupancy. ❑ six a more residential onus ID Recreational /chick perks.
City/State/ZIP: 7i ard,OR97223 ❑ Ileanh-carelbcilities. 0 Supply vdlage MOM thn
Y 9
❑ Hazardous lo cations 600 volts nominal.
Suite/bldg. /apt. no.: 121 Project name: SHC 11945 Pacific -RC O Scivice or feeder 600 wisps or mote.
FEE SCHEDULE
Cross street/directions to job site: ' o..eryaw I (Its- I see. I Tatal I •
' New residential single- or multl- fimilly dwelling unit.
Includes attached garage. _
Subdivision: Lot no.: 1,000 sq. 0. or less 168.54 4
- Ea. odd S00 sq. ft. or portion 33.92 1
Tax mup/parcel no.: Limited energy, residential
1)ESCR3PTION OF WORK (with above sq. It.)
. 75.00 2
Limited energy, multi- family 75.00 2
New AC & Condensate pump tesidenlial (with above sq. It.) _ . _
Service or feeders Instatlation and/or reloeados
200 amps or less 100.70 2
- ❑ 'PROPERTY OWNER 1 0 TENANT 2 amps to 400 amps 13336 2
401 nmp>a 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 /StatefZlP: Temporary services or feeders inatallatloa, alteration., aad/ur
relocation
Phone: ( ) Fax: ( ) 200 amps or lees 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which at not 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54
Branch circuits -new alteration oratension.. r tel
Owner signature: _ • Date: A Fee for branch circuits with
' la APPLICANT , I 1 O'CONTACF PER8ON ' above service or fader sec 7A2 2
each branch circuit
Business name: Boar Electric, Inc 0 Fee far branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: Ciara Snothen branch circuit
- Basil add'I branch circuit 1 7.42 7.42 2
Address: Miscellaneous (service or feeder not included)
Cl IStHterllP: Gelb manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Yhonc: ( ) Pax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: permitsatyboarelectric.com Sign or outline l ig)tting 67.84 2
_
CONTRA
.^ :. , signal circuit(s) or limited - enegy t
Business name: Bear Electric, Inc. panel, alteration, orextension. Page 2 2
Each additional Inspection over allowable In any of the above
Address: PO Box 389 Additional inspection (1 hr min) , 66.25/ hr I
City/State/ZIP: Donald, OR 97020 lnvestiga6oa(1 hr min) 66.25/ hr
industrial plant (1 hr ru 78.14/ hr
Phone: ( 503) 678 -1355 Fax: ( 503) 678 -1108 inspections for which no lie is 90.00/ hr
Specifically listed (rh hr min)
CCB Lie.: 20919 Electrical Lie.: 24-107C I Sup Lie.: 48815 `` • 37[L"l 3110u, pritiArr FEES .. ..
Subtotal:
Suprv. Electrician signature required: _ - ,.
plan review (25.w of permit lee): nice
Print name: Steven Shepherd Date: 4 -25-13 State surcharge (12% or permit fee): 7.63
Authorized signature. TOTAL PERMIT FEE: 71.23
�4--� .1 7 ' h;. pecmtt apptkatfon expires if permit :not obtained wields Inn
Print name: Ciara Snothen Dune: 4 -25-13 days slier a low 4 per p .. complete.
N um b er u Allowed per permit.
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