Permit CITY OF TIGARD ELECTRICAL PERMIT
is • COMMUNITY DEVELOPMENT Permit#: ELC2013 -00387
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/10/2013
Parcel: 1 S135DA00300
Jurisdiction: Tigard
Site address: 11150 SW HALL BLVD
Project: Bergman Subdivision: METZGER ACRE TRACTS Lot: 12
Project Description: Install 200 amp service for future building
Contractor: FRAHLER ELECTRIC COMPANY Owner: BERGMANN FAMILY TRUST
11860 SW GREENBURG RD BY BERGMANN, KENNETH L & DONNA J
TIGARD, OR 97223 TR
10726 SW 63RD PL
PORTLAND, OR 97219
PHONE: 503 - 639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/10/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 07/10/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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: law regg9uiirree�s� you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 thro OAR 952- 01 -00 — . Yo may obtain a copy of the rules or direct questions to OUNC by calling 503 .• .1987 or 1.800.332. 344.
Issued By: Permittee Signature: _ - ' ,�j�V� '
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' , j Date:
�.1i r_ ire—.
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.
07- 08 -'13 16:05 FROM- FrahI r ° -,,, • _ 5036394673 T -300 P0002/0003 F -996
Electrical Permit Application il y
VE1 ' - - . - . FOR UFFI E USE •ONLl
City of Tigard D raa/0 ° YD ��
�
J UL Permit No.: �/ 3 oa 38 A
w• 13125 SW Hall Blvd., Tigard, OR 07223 8 20 1 3 Plan Review
' F ,' ' \ Phone: 503.718.2439 Fax: 503.598.19 e DatcB : Other Permit:
_l I ' t 0 Inspection Line; 503.639.4175 TV OF TIGARD Date Ready /Br JOf el See Page 2 for
Internet: www tigard or gov BJ D Notified/Method: Supplemental Information
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✓ r y ; ✓r r� ? `✓ �.,� " r { e g[ rs . y{� lv 1 y 1. jyS,r • f : T ( ( r i n yY � n /,,e r, ,, 1 , r ,,
/' �,. "/,, r .r„ i i . „ >,✓q,; , H! N,a I � � p : r �rErr'7 ; ,a . i ✓ ',1, ., P6 t ? fq .4 ' ' A' $•••∎1 4 i/ r � . 1470•• `�11�q 1 '�. 2 I tr t rr X1 l r 4' � . ,, •
Phase shack all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ® Addition/alteration /replacement
E Service or feeder 400 amps or more Q Building over three stories,
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards.
i , ", + !' p /^" ; f i ' / _, (0/ , t ,' � , r J ryry`ul J,/,,r / ,, p , � q ,, ° e.�, ' { p Art:, I J :< sat ISO volts or g g,
Lt f 4 yy% r. l_nrrris'� 141 :4:.' Z',Ji }; C1+.`dudPX41nr,tdi., 1) g .i r�iiA J <ar i exceeds 10,000 amps ❑F loatin buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
Ca I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
rn iv" + „n ry I rr I , a r a/ uu e ci 6 • r , a - • ✓ E,ner enc S Stem, larger p y ' ✓ , / , 1 �, � a ' � 7 I d2 8 Y Y a<ga separately derived system.
/I i „ „,1/ ,r ,,;; : + "l 'awl , l I (r ', ■ 4 f (' ' ' q , LI , k , ;!�,�� ' ❑ Addition of new motor load of ❑' A "E '1.2 1 3
rl eHk 5 r r aY.2.'
Job no.: 70778 I Job site address: 11150 SW HALL BOULEVARD 100HPor more. occupancy.
• El Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP; TIGARD, OR 97223 ❑ Health -care facilities. ['Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.; I Project name; BERGMAN RENTAL HOME ❑ Service o (feeder 600 amps or more. r1 ]4 ,
i:, 'i y ho er /.• ?Ye ;toi ;.v. '-1 l ,r: 5Ir.7L� ,,, u J.; /rI /, ii/,„ /
Cross street/directions to job site; omrnerien Qty. Fee. Toni
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no,: 1,000 sq. ft. or less 168.54 4
Tax map /parcel n0 Ea. add'! 500 sq. ft. or portion 33.92 I
,� �, � Limited energy. residential
,il1r.r l q�yy l / 4 r" , C 1 7/-'r ‘ , ' " ' ' r:' ".1. ' . i . .
Nit <ldN"rga �.l ',- ' ,, "r ,I -,' . t a . : P % . 'i, ±. d
' f� iur •7;r , � if : 4:' �4 v 7 ty� (wiWt above s q, fl.) 75. 2
Limited energy, multi - family 75.00 2
200 AMP SERVICE FQR FUTURE BUILDING ressiiiddenttia�l ((with above R.) 5 �r �, ,
Services or feeders installation, alteration, and/or relocation
f "¢ �[' I S 4 1,'' i � ( jr p ` - 1W YJr " ] , y"a 7, r ' .f , .4"t, f.{��y� r . - . r�] ✓ a e' o a� [pS Or less I 100.70 100.70 2
', / / %. ;4 ,.�A1, Il .; % /�•'''• QI • - � • 2, ,.. I / , J r .l ,' i ' „„y' t L l:.tw q r ' i 200
, r
201 am ps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( )
relocation
200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
40l amps to 599 amps 168,54 2
Owner signature: Date: Branch circuits- new, alteration, or extension, er panel .
r '
N l , r• f F'r S L +rr v r r7 ✓1 4;', .. r N r `4 r 9 '*I S
I 'V 'e, ,r �� +r fC / !f " +�.r x f 7+' f f �y , ,' s ' T��7�7 't p � � �� A. Fee for branch circuits with afrir �F,, il'. . 4 ; � h '. '' ,r• • 4 M., 1' 4%7 ,0,'1', kn.e ,.. r ru ^ a ,1 ':1.+d6U �J1J i ' h'•' � l ' '''. ' ' 'e'V'' above service or feeder fee, •
Business name: each branch circuit 7.42 2
B. Fee for branch circuits without
Contact name: service or feeder fee, first 56.18 2
branch circuit
Address; Each add'] branch circuit 7.42 2
City /Slate/ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: dwelling„ service and/or fbeder 67.84 12
( ) Fax: ( ) Reconnect only 67.84 1 2 -
E -mail
" % %� �, "' /� h1'�°�� ynY7 %� �,T" di ` ti's / ' - '. ° °'; v ". +'d✓ o 7,0"5,?,. y r Pump or irrigation circle 67.84 2
, ', 4 7N r y,r,3(l /tili . /d'ti�Hl a. r �': ..@)'1' ''�.. :?l A; r . ; "
.e .G x 1..h� , Sign or outline lighting 67.84 2
Business name: JRA, INC. dba FRAHLER ELECTRIC COMPANY Signal circuits) or limited - energy See
panel, alteration, or extension, Page 2 2
Address; 11860 SW GREENBURG ROAD Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr ,_.1__
City /State /ZIP: TIGARD, OR 97223 Investigation (I hr min) 66.25/ hr
Phone: (503) 639 -4627 Fax; (503) 639 -4673 Industrial plant (I hr min) 78.18/ hr
Inspections for which no fee is 80.00 / hr
CCB Lie.; C861 Electrical Lie,; 197172 Suprv, 1.ic.: 5110S • specifically listed (h hr min)
Y• ' 7.40 r6 a �J .Ninon
%%' " I A / l <1 / 0 S' � 0;ty6
Suprv. Electrician signature, required :
Subtotal: 100.70
Print name: ADAM E'I'HERINGTON Date: 07/08/13 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 12.08 /
Authorized signature; TOTAL PERMIT FEE: 112.78 11 /
This permit application expires if a permit is not obtained within 180 ���www
Print name:
Pate: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1 :1Building\Pnrmit•AELC,Per0IilApp ELR ERE.doc Rev 05 /21/2013 440.441ST(i1/OS /COWWEB