Permit CITY OF TIGARD ELECTRICAL PERMIT
' - g COMMUNITY DEVELOPMENT Permit #: ELC2013 -00360
TIGARD 13125 SW Flail Blvd., Tigard OR 97223 503 718.2439 Date Issued: 06/27/2013
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15951 SW 72ND AVE
Project: Miller Pain Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: (2) branch circuits to reconnect rooftop unit and replace service plugs.
Contractor: BEAR ELECTRIC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 389 ATTN: N PIVEN
DONALD, OR 97020 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 -678 -1355 PHONE:
FAX: 503 -678 -1108
FEES
Quantity Description Date Amount -
2 crt Branch Circuits wo /Purchase 06/27/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/27/2013 $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 OAR 95 - 001 -0090 You 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 — Permittee Signature: /Y/(l r1 /) «-7 /
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 503.639.4176 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.
JUN- 26- 2013(WED) 12:14 Bear M' :,— I ill° -' (FAX)5036781108 P. 001 /002
City of Tigard JUN ; Ittr.•ne.1 4 j . 7 /3 ! I - „n.r , ELC 3
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TIGARD !'""1".” I i i' `in b;4 •11?• CITYOFTIGARD 1 11..,. Ih.nh h . _ .. tea. - -- ti for
Illli 10�{ ,•a„ Ir�arlI pm 1l L , „I,U.•.1 :wt.l
-- - Supplrmrnld Informahen
_ DIVISION _
L _ TYPE OF WORK 1 — PLAN REVIEW
I: Ne i JlhUan r hea.cih.•,lsitih., pyl‘uh n ur 2 , n alpha >..nan..hr,l.•dl,,:h...I
I El �k lll�l,ln 0 t)t11a 1' 171:,, ice 01 Katie, .1110 :imp In num: ❑ Ilurkln,l• me, ohm,. Omr.•.
riff . _ „Ike.' ili a..u6,hk huh ern Cllr 0 M1.wnj, ]nil leuh,n.b.
� � OF CONSTRUCTION • • 1, 10.nnn maps ar t mn , wt... C,, �•�. •� 1 ❑ Homing hod.huFa
I:
Iless m ground nr r�ceed,. 14 11110 ❑ Cumor:rcul.i.e apu, ullnrhl
I - :uhl 24411111 i y dlsr llingIfl mrrcrllhnduslr ❑ ACCCs >nrs blow ,mu • r.0 a ll.ahn m.,allh,n,m :
I iv
Pi .lullt•t:lmily I burldurr. ,
■ aste buil CI Q t l ur O1 ne. l n n np Q 1.1 Ill 7s',VA m 1
JOB SITE INFORMATION AND LOCATION 0 iIlCp1 n.v..,ltm kalFelselu,mel,der,.cd . sHani
0 Aiklmmn of no% When r h ul
Joh nn.' Joh site addreNs: Jitil I I ] Ai \ tontIP,n nine nca,panl)
• --- A / 0 O 11220 .1 C t i a I - ln eiI;iiu l nnn+ 13 Rce ❑ Supu mna(ve rot i parka
C 'tll.' /Stale /Y.I la: I] Ilehh•earc kxniuc+ h voltage rot mail km
I la hxauuu• td10 , nits n
SIIIIcJbilig ;Ipl. iii).' Protel.'I name: 0 Service or ceder ton amps Of ,Mole
Cross street /4JIm ions to job site: FEE SCHEDULE
Dncr,p [ Qrr. I F... I Tui,i I
' New residential single- or multi - family dwelling emit.
_ y Includes attached garage.
Subdivisi Lot no 1,000 sit Ii. or less 1n8 54 4
Tax map /parcel no.:
Ea. add'I 500 sit R. or ponlnn 3392 1
Limited energy. residential 75 00 2
DESCRIPTION OF WORK (with above sq. I -
Limited energy. multi•lamil).
p l' I/ ,11 - residential 'with above sq. n )
�' "� Services or feeders installation, alteration, aod/ur relocat
200 amps or less 100.70 2
Cl PROPERTY OWNER I ❑ TENANT 201 snips to 400 amps 133.56 2
Name; 401 amps io 600 amps 200.34 2
•—• 601 amps to 1,000 amps 301,04 2
Address: Over 1,000 amps or voles 552 26 - 2
City/State/ZIP: Temporary services or feeders installatioa, alteration, and/o
relocation
Phone; ( ) Fax: ( ) 200 amps or less 59.36 _ 1
Owner installation: This installation is being made on property that I own which is nut _ IOI amps to 400 amps — I 25 08 2
intended for sale, lease, rcpt_ or exchange, according to ORS 447. 449. 670. and 701. 401 amps {0 599 amps 168 54 2
Branch circuits — new alteration or elleusion . er and
Owner signature: _ Date' A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder l'ee.
each branch circuit 7 42 2
Business name: p,l / j��y -(' r 1(/�� . B Fee for branch circuits without ^ ,�
—
Contact name: — LGaSY,dA_.L �r IV service or feeder fee, first I 56 l8 ,.�I�I 2
BEAR ELECTRIC, t '1^ branch circuit
Address: PO BOX 303 Each add'I branch circuit I 7 42 111
20005 BIITTEVII L f � Mlacellaoco service or feeder dot included) __ _
uuituaa u, VFr'„ c:.t Each manufactured o
City /State/ZJP: CB N 20918 r modular 67 R4 2
,,,,
- ( dwelling, service and/or feeder —
� b Phone: , , Fax: : ( ) Reconnect only 67 1141 2
E-mail:
— Pump or 1rngalion circle 67.84 2
CONTRACTOR Sign or our lino h811ting 67 tla 21
Q ,/) ,r � Signal circuil(s) or limited- energy
Business name: rx fjj ►vy- , panel. alteration of extensio i Ps gc 2 2
p 4 � i_ l.t Each additional inspection over allowable hi any of the above
Address: 'I b s ax s
v Addrtion;rl Inspection (i Ile min) 66.25! hr
City /State /ZIP: bon/) l/', J /� Q�]O
Investigation (1 hl min) 66 251 he
t fl'4avf v l t Industrial plant (1 hr min) 78.181 hr
Phone (, I •I } ax: r , / 1 (.) Inspections for which no fcc is
`-' 1 I C 1 l J lJ specifically listed (4 hr min) 90.001 hr
CCI3 Lic. � �j J Electr L ic.: J ]�
- -�"1. Suprv. Lie.; �' .. ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: -- I Subtota
�; plan review (25% of permit fee):
Print name: ,6 /
,64.e' �� Dte: ( � I s Stare surcharge (12% of permit fee): 2 /
Authorized signature: v l TOTAL PL•RMI FEE: 71 S /
Aalr►
- this permit application expires if a permit is not Obtained within 38n
Print Warner ,, ^ u
days after it has been accepted as complete.
�t- ej.�ho Date: rJ f ' N um bar of mspe[hoM nllnwed per permit.
11 Dmld;..elre.mw:t.C - Per mnApp doe u7,01nu 44 -4111 ssTl 11ISJCOMAdkit
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15951 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
2014-03-27 (null)
ELC2013-00360
PASS - No C of O
Violation Summary:
Inspector Contractor