Permit CITY OF TIGARD ELECTRICAL PERMIT
° • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00407
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/18/2013
Parcel: 25111 CCO3300
Jurisdiction: Tigard
Site address: 10280 SW CENTURY OAK DR
Project: Feldman Subdivision: SUMMERFIELD Lot: 56
Project Description: (2) branch circuits for A. /C and service outlet.
Contractor: BEAR ELECTRIC Owner: FELDMAN, SHARON A
PO BOX 389 10280 SW CENTURY OAK DR
DONALD, OR 97020 TIGARD, OR 97224
PHONE: 503 - 678 -1355 PHONE: 503 - 746 -5225
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/18/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/18/2013 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set - forth in OAR
952-001-0010 Issued By. through OAR( 09 You ma,�T�� copy of the rules or direct Permittee Signature: calling
OA r 503.232.1987 /97 ' �ON /
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 603.639.4176 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
JUL- 17- 2013(WED) 12:52 Bear Electric (FRX)5036781108 P. 001 /002
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City of Tigard - nr „•d
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( WOR / V Supplemental (uformrtion
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TYPE OF K _
I p Ness COn11 — _ _ _ PLAN REVIEW
ruction �ldd11.:d1, i I /I ' fl 1'Ira.e am. all that apply lurh i ) 2 •.N of •—
r-�, p l plans tt ur111> tlhrltgl hell,. )
Ih ll,l,hl ll . a t >tha. tJILQI G DIVI$t1/'� /rs\I' U � "•.ie ,•r Iedder -Inn mils In mole Et tiulldmf m: i Alter •11111C,
- t-�t�. .1,,,, it.. it.. i :,..L0,1, laUh c1111011 ❑ Ktarul.h anJ IAlal.,lnl>
CATEGORY OF CONSTRUCTION muds. 10.0011 al Isn,nh „„ •
_ In FIOJ1mF huddrurs
'.. 7711,,1 :77.1;;;;. d ( - oI 111 nercial /industrial h'kkm41Mn1.L 14.11lln
❑ AtrICS�Itr, building
❑C
It
❑ Ivlltlll- I:111,11V mirk tin on flirt unlnllal'nnk luuhlnl
0 Master builder ❑ Other: r.
QI'nc tN lllgl ❑ In.lallaUno nl 7i}; vA m i
_� JOa SI TE- IN FORMATION AND LO ❑I.rnel Eertcyk.,lrm l
CATION CI nl;cr krpalalrh'drnt rd >■ilem
.10�, nn.. � CI Addition ut net. Mn,r W ul
Wit ❑ "A•• "t "I L ?„
Job site :ldtIrc55:`O ►v �` Io0I II' nln+t, • I. �l 1 Mcup:mrl
Cil v /tic :1tC /7.1 P; r /y /1 v d � �rl ^ a qtr or more residential unila ❑ ltecicahonat tchu tr park.
1 I J1 (/� 1 ❑ I Ieallh -care lacdilick 0 Supply w tin note dlan
Suitt: /bldg, /apt. no.: ❑ I lazmdnna Wallow; t,llr, nominal
` Pr o j ect name: Q SCtviec t u feeder 6041 amps or now
Cross sircet/dl Feet ions tojilh site: FEE SCHEDULE
_Deuwl wn 4A r e ,. Tor.l �L .
New residential tingl o r multi- family dwelling oau.
Includes attached garage.
Suhctivisimt: --�
Lot nu,: 1,000 sq fl, or less I ha 54 ,1
Tax map /parcel no.: La. add'I 504 sq. ul paninn 3J 91 I
DESCRIPTION OF WORK Limited energy, residential
�-
(with above sq f1.) 75 2
{� - ( � QQ Limited energy- multi - family - � --”
r pp �L/ I /� Jt residential I above sq. fl) 75.00 2
_
. Services or feeders installation, alteration and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ ENitN r 201 amps 115400 amps
133.56 2
Name: __— 401 snips 10600 amps 200 34
2
Address: 601 amps to 1,000 amps 301.04 2
~ -- Over 1,000 nips or volts 552.26 - - 2
City/Stoic/ZIP: -
- Temporary services or feeders installation. Alteration, and/or
Phone; ( ) ----- .� relocation
Fax: ( ) _ 200 amps or less 59.36 1
Owner installntion: This installation is being made on propeny Ihar } own which is not 201 amps to 400 amps — ,
1_500 2
intended for sale, lease_ rent_ or exchange, according to ORS 447. 449. 670. and 701, 401 amps 10 599 amps 168.54
2
Owner signature: Branch circuits- eew, alteration, or eategsiva L e panel
anel
Date: A Fee for branch circuits with
-
❑ APPLICANT NTCO ACr PERSON - above service or feeder fee,
Business name:
each branch circuit 7A 2
13. Fee for branch circuits without
Contact name: 'WAR ELEC'TF service or (ceder ter, first
_ branch circuit 56.18 2
Address: —vatl r igl - E u.t; RD N Each add'I branch Circuit I 7.42 1' l 2
DONALD. OR 97020 Miscellaneous (service or feeder nol included)
-
City /Stale /,Zl} 91A�- Each manufactured or modular A -
dwellin ,service and/or feeder 67, 84 2
Phone: ( Fax: : ( ) Reconnect only _
67.64 2
E m ail — Pump or irrigation circle 67,84 2
CONTRACTOR ftACTOR - Sign or outline lighting /'1.04 2
� r
{p � , � � ' Signal Circuit(S) or limited- energy — `-- - °' - --
Business name :
and alteration, or extension. Page 2 2
Address: E M` I . - Each additional inspection over Allowable in may of the abate
^� Additional inspection (I hr min) 66.251 hr
City /State /"L , mo d ,CR (��0 Investigation (1 hr min) 66.25/ hr
Phone: 0 1 l `1 _ Industrial plant (1 hr min) 7k -I/ hr
Fax: ( lll../7 Il
CCB LiC inspections for which no fee is
G a +G� Electrical Lie. L� . (p s chi IiSled h l C ES
in) �0 000/ S
Suprv. Lic.:)( s ELI'. ent1CAL PERMIT PE
, uprv, Electrician signature, required: fly .
7 Sn()IUmI:
Print name: x L Esba ,--, i I L Plan review (25% of permit fee): _ _
- �. Date: l I� State surcharge (12% el-Permit fee):
Authorized signature :� / /
TOTAL PERMIT FEE: 12,____.--t
_ _ Thi permit appticatioa eApirea If a perm it not obtained npettio 180
` I "'} 1� days after it has been accepted as complete
Print name: .. j72SdaCk)___ Dole: t
- Number of allowed perpem
l.lXiwldintu rmiri \FLC•Fc, mil App one 07/01 /1a
140 - 441 STI I uauCOMrwF.O