Permit rt CITY OF TIGARD ELECTRICAL PERMIT
t; COMMUNITY DEVELOPMENT Permit #: ELC2013 -00287
1 3125 SW Hall Blvd., Tigard OR 97223 5 03.718.2439 Date Issued: 05/22/2013
TIGARD Parcel: 25111 DC01600
Jurisdiction: Tigard
Site address: 15960 SW ALDERBROOK CIR
Project: Bare LLC Subdivision: SUMMERFIELD NO.8 Lot: A
Project Description: Reconnect only
Contractor: CANBY ELECTRIC INC Owner: BARE LLC
790 S IVY ST 22275 SW SCHOLLS - SHERWOOD RD
CANBY, OR 97013 SHERWOOD, OR 97140
PHONE: 503 - 266 -7878
PHONE: 503 - 349 -4326
FAX: 503 - 266 -5543
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/22/2013 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 05/22/2013 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 05/22/2013 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 re. ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR - -0' -0090 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: /l / Permutes Signature: eAt
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 603.639.4176 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.
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lectrical Permit Annlicitt
t"EIVED .
. • Citv of T igard p
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. - 7 ... 13125 SW 1.1all B!' (I . I igard.
1 : ' .ric. 5 03.71 8 2439 f:Ctx • SO.;14. : 9
III (.IL Pk(62 2013 1_,-:,. ..,,,.,, I' .•!
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IriSpectiOn I,.inci 503 639..1175 Date Ready/By . : , .;.1, 1 G,.. @ See Page:1 for
1 1G A 1,1.0 ' .
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:IhtomcV W WW tifTard•ul.ETOY or; OF TIGARD No, ifiedNeth„d
_ _. -- -- SupplerfiCntal InfOrTnntiOn • .
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IITRIRJ 0411YY1NP:gq----
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Please check 811 z p it ;:., ::■::::,:f ::81:. w chec.ked belovik
D construction .1., Additionitilterni ion/replacement
ID Serviet or rettilci Alio li , .ii •, . ic ,••,-.• 71 it.,4: ,,,,,:l three ItTlies. • • . •
0 Demolition 0 0111er. whelc The avallahic ii::::: ,;1:,:: :1::::or:, T:T:d1 .. .
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.. . c,ceecls :0.000 :::::ps 8: I ',.: ,:•!•,• D ! 'Name boadnigs .
CATEGORY OE CONSTRUCTION . . ..
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" . -- less 10 ground, ,1 cxeced: I.1,11(1( 0 T;o1:fleicial .12Tioultoral : :' ' • .
Y 1 - and 2'-famiiV dwelling 0 Com me,rcialrindostrial 0 Accessory building ' amp all other miitaliatiomi luitliittigs. . .
0• Multi-family 0 tvloster huilcict D Other: CI Fire pump. 7 ;;I•a:niation at 75 KVA or
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F .-- . . 0 Emergency SyStem Fii poi lop' otely der; val sysern.
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‘ 10B SITE INORMATION AND LOCATION • . . 0 Additi orliew inetoi toad of
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1 001IP or or ni..cilpime■.
Job 60:! • . I Inh site ad .,4 dtc.gt' )5 S .
, ..L. • ilgeec„,_ . t , .0 Six or min t rOSIO 0
I :lei*,
,.- Itai,:ational valeic parks • . .:
City/State/ZIP.
' r ' T, I_ 69, , 0 Health-car e 111e I Ii(;
0 Hazarc10118 loc811oos E 5, ,8118a c ter more thrill
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Xi() vAti< 7111111111M ,
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Suite/bldg/apt. no.. U ; Project nme 661.;:. — • DSC/Viet or (cede' 600 amp iii ow,: .• . ..
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FEE SCHEDULE -
. . Cross street/8i
sections to job i0. o
New residential single- or main-family dwelling mut. • :'
Includes attached garage. ..
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t ,00o ;41 ti or lirs !O.54 . . • 4
SubdiVision:: " Lot no.' 1 ,.—________... ...._____
, .--- --------- Ea. aderi 500 so ft. or M11111111 , 11 92 ! • . . 1
Tax map/parcel Po.: , ., 1
' Liin lied cnerey. rcsiderad.
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- !!.:,I{:',.. .,..t:'.. ... ' DESCIIII&1071 Woilk _ . • ____I . -: (witil =PVC 5:i4 fi.) . J— ' : — . .
... 4 .„.,.._ ___....... 1 1.,,,iitc..d cnergv. midu-iimo, . 2 .. •
.. —... ' . • • '. ! P441 X Gket.. ace-r)Ld_h4a_s. .
residential (with ahoy:. '41 1 .... _.._ . _ 1 •-
7 Fage2 • . ,
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. • . :- Services or feeders installation. alteration, ancl/or reloiatiOn
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',':YVi.f• , OWNER i 200 amps or Ic
. ITTEl‘ft . • . .. : / , oo.0 i itA 70 . •
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1 20 2,
1 amps I? 400 amps , ' - .
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401 amps to 600 amps • ■ 200 34 I • ' 2 • • ..
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Addres: - • . 601 amps to 1.000 unto,. • • • ; •
. ; 301 04
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..„, .. — Ovei 1,000 amps or volts : 552.26 • : .: 2 • • ,
City/State/ZIP --.....
_ 1 - Ternporgry services or feedcrs instailatioit. alteration, and/or .. . .
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Pone ( • • ) . l'a.\ ( 1 ksclucation
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, .... 1 200 amps or Ici,S : 59 36 I , 1 . '.
Owner installation: this instikilalion is being made on property that I own which is not h"
to 1 1 - . - .
intended for•salc. leme, rent. or eNcItane,c. according to OR s 447. 449. 670 and 701. 201 amps 400 amps I2S Ok 2
401 amps To :599 amps 16.8 , •,4 .
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.,.„.. Date: __. _ Branch circuits _ new,.alteraliort, Iir extetiSiOn, Rel panel • . . •
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AkPLItANT . .1 —M D CON'CACT•• PERSON A Vet for hr c:rcsw, with i I .. ' ' ' r 7 • .
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1 _, ., ut sc ,u, w rci:iCier tee i : 7:12 i 7 412_ 2 •
' • . • 13.USiti name' cad, bmnoh ■:treliiL 1 . I ' . • ' .
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Contact nAme:
) - sevict: or recdcr 11%
SO 18 ! . 2
-------- ---1 branch circuit
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Address: : q or±l_S _ r-.1) add I bih Lt-calt
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City/St.ite/ZIP! Cg, .64.. 0 0 f ,.. z
MiSCCIIMICOUS (scryiceor no Lit .,..._. •
. . Each Alnufactured Or modnIa7 . •
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.:••• PilOrM:(563 rta- (': - _ 7 , Zfe,..t h 55Y,.. d p wcIlIng, servicC alicif0r !MIL!: ' ____ . ..
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E-niail: On 1 I 4..1 k., 4 Z ( '. (L).""-A------ Pump or irrigation click • • 67 8:1 2,.
CONTRACT( ' .. - Sinn or outline lighting - ' 67 g4 1 . . • 2 .. • '
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Signal circuit(s) orhmavd.orwris ,
• !BuineSS'Ilames (44 ,,, a c f-i ; (.___ , r c,.._s____ _ _Enei alteration„or esicnYAnn. ' . . j Page 2 I
Address: .7 c / e Ey 4 S_j- Each additional intirctiOil over Allowable in any of the above
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- I t 66 7i/ hr
, ■ Additona1 mspcction I iii Wu.% i
City/State/ZIP: Lyi 0 l€, _ii — 7 C i 3 „_________.........._•. - .
; Irwesie,asion (1 11, 610.2ii hr
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Conc: ( 9,3) - ? .... o e ,_ u 7 7 . :F; 5 ) •#,_ 5'13 , 1 .ri,,UStrial pMiil (I hr in.::: : 71i 18! lw
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Suprv. Electrit'i:: • ir.mtitii ro,,II:i, od• 1 l Li ( , sidaolal. , 103 1'2_
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oa :iuIr III, ,. • • , , ,!.1 as onidittlit• V
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