Permit CITY OF TIGARD ELECTRICAL PERMIT
Permit #: ELC2013 -00451
°►�! COMMUNITY DEVELOPMEN
Date Issued: 07/30/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1 S135AA00804
Jurisdiction: Tigard
Site address: 10161 SW JEFFERSON ST
Project: Subdivision: METZGER, TOWN OF Lot: 5
Project Description: (2) branch circuits for furnace and NC.
•
Contractor: BEAR ELECTRIC Owner: LAI, DANH DUC
PO BOX 389 10161 SW JEFFERSON ST
DONALD, OR 97020 TIGARD, OR 97223
PHONE:
PHONE: 503 - 678 -1355
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/30/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/30/2013 $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 through 0A 52- 0 090. •u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: r# P - Permittee Signature: e' /V </ 1 C I -151--7-70/1/4)1
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.
JUL 29 2013(MON) 12: Bear Electric (FRX)5036781108 P.001 /002
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City of Tigard RE Itrcet+e,l 7/se) �� a e t ' �GG o2V43 QQ yJ /
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TIGARD u�N• u,•�,I. n. . 'N.,o `
Illlt'u nil w is Ilg;lyd -t11 gut -� OFTIGARD _.. Na1 1 Supplemd information
1 _ YPF r., . e I AI ,: 1 PLAN REVIEW
❑ No, co ,irnt.IIUl1 i` /1ddilinn,it Cant ton rep ar4me111 - - -- — 1' 4 br ilt.aL:dl ,hatapplylmuhtmi 3.rtsnl'plaln•• arm >,ItcrL ;,llrrhn
1 Demolition
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mei due: dN•\
❑ 12 Other:
• . .. whet; the m;uhthlc Iwh :.mem Q ma,",.l. a,ut 1144n.m.b
CATEGORY OF CONSTRUCTION - 111.1110 moos al 1 4I ruh> eu ❑ Ilnaun hu
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r, l ess In pn un.1. nt chee 14.81111 ❑ tlnlfu eral•me a n. ullmal
- and I;nttilr duelling ❑ Commercial /industrial ❑ Aeces� 1luildin8 amm lot all t +Ihrt nl.lallauorM l nsr
0 Mt111t 1a11111V ❑ Master builder ❑ Other' ❑ lam
Of
r•u ile I It a11atum in 75 KVA ni
JOB SITE INFORMATION AND LOCATION r�rl.pletp:ney aaalem Imp arpalata. dernCd >�srem
_ ❑ Adtliluun of new molar load ul ❑ "A" "1 , ' 1.;" - I 1
l oh nn.: Job site address: l0llh_1._S n y � �n I n01'11'lu utmr nCCnpa
5 - �
I �V C / ❑ l Ii ar nmrc Icsi : . ❑
l mob CI Siipph +116l,m,al t i par than
junks,
Cit �' /Stale /1,11 /1 0110 Of Suplily 11 }r fin mole >I ❑ Hazardous Ithalion> Km rule nnnwWl
Sill 10 /bldg. /a ftl. no.: Project name: ❑ Service or feeder 8110 amps al more
—
FEE SCHEDULE
Cross SI reel/di rect inns; in jab site:
bese riprt„ j Qn. T r... ► rc,.l I
New residential single- or multi- family dwelling unit.
Includes anaehed corset.
Subdivision: l,nl nn,: • 1,000 so. II. or less J 1 n8 54 4
Tax nlap /parcel no.: la. atI4 t 500 sq. Il. us portion 33,92 1
DESC OF WORK 75.00
2
---- Limited energy. roulli-lomily
75 C10 2
Services or feeder) installation alteration, and/or relocation
200 amps or leLs 100.70 2
0 PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 1 33.56 2
Name: amps to 600 amps 200.34 - • 2
_601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/11P: Temporary services or feeders Installation. alteration, and/or
relocation
Phone: ( ) I Fax: ( ) — 200 amps or less 59.56 1 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08
intended for sale_ lease, rent. or exchange, according to ORS 447. 449. 670, and 701. 1101 amps so 590 amps 168.54 2
Branch circuits— new alteration. or extension panel
Owner signature: Dole: A. Fce fur branch ctrcun with
p
1=1 APPLICANT 0 CONTACT PERSON above service or feeder fee.
branch circuit 7'42 2
Business name: B. Fee for branch circuits without 1�
service or feeder fee. firs) ��Q�
Coffin' name. BEAR E E INC branch circuit 56.18 I J �� 2
20985 BU V E R — Each odd'; branch circuit 1 7.42 4 18, 2
Address: DONALD, OR 07020 Miscellaneous (service or feeder not Included)
C;ty /State /LIP: Ges at eta Each manufactured or modular
dwelling feeder 67.04 2
Phone: ( ) F a : : ( ) Reconnect only 67.84 2
• E -mail �' iii., .. Pump or irrigation circle 67.84 2
*' t r I, Sign or outline lighting 67.84 2
CONDUCTOR Signal cilcuit(s) or limited energy
Business name: Gt a/ t i 1�(' ��� panel, alteration. or extension. f>ese Z 2
•+ Each additional inspection over allowable in any of the above
Address: •
�_ � , � Additional inspection (1 hr min) 66.251 hr
• City /State /71P: ��Itt Invesrigstion (1 hr min) 66.251 hr
1►.� Awe Industrial plant (I hr min) 78.18/ hr _
P one: 0'.7' ) ax: ' � r , b ipee1ians for which no fee is
specificall listed ('4 hr mun) 90.00 / hr
At CCB L1c I Electrical Lice, ' uprv. LIC w��
` � � ELCTRICAL PERMIT FEES
E i�
Suprv. Electrician sigrtalure. required.
/ 5u br ore t
i i Plan review (25% of permit fee):
<-... ~ i -�
ate: 3-
�C L �C� -CuL .>'-
Print name Zw° 1 ., te: � f
, _ State l
TOTAL PERMIT FEE: j Authorized signature. _
�M.... w ///777 _ This permit appdcaritro expires iI a permit is not oblalae within JRa
Print nifmCy a S i _ A r J S /y/1✓/� , // �] b.5 days icon it Allowed pi accepted as complete.
W ( I�t7lC: ! f% Number nl' insMerions allowed per pnunrt.
IlDN itdinV Wertude5CLC• Per ..ulApp.00r mmino 4411 4615THI10OICUavwkn