Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT COMMUNITY ELC2013 00477
T I G ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/13/2013
Parcel: 2S 102BC00106
Jurisdiction: Tigard
Site address: 10290 SW BROOKSIDE CT
Project: Dickman Subdivision: WALNUT ACRES Lot: 5
Project Description: (2)branch circuits for a/c and service outlet.
Contractor: BEAR ELECTRIC Owner: DICKMAN,ALFRED E&CLAUDIA H
PO BOX 389 10290 SW BROOKSIDE CT
DONALD,OR 97020 TIGARD, OR 97223
PHONE: 503-678-1355 PHONE: 971-409-4657
FAX: 503-678-1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 08/13/2013 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/13/2013 $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 accor 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. ATTEN N: Or on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-001 through OAR 5 •S 1-i0•• You may obtain a copy of the rules or direct questions to OUNC by calling 5 . 32.1987 or 1.800.332.2344.
i
Issued By: 41.0 Permittee Signature:
•
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.
RUG-09-201 3(FRI) 1 2: 25 Bear Electric (FAX)5036781108 P. 001/002
City of Tigard RECEIVED i Rrrrrwe.l
l� " Ill l 25 N%1 Hall Iihd 1 ep.n.l lilt 't,.:•• n.nc lt. 8 J 3 .. I,rmrl N.-- L�Ow�/��� .7.
�I
1'hurq 411:71 N 2.1:4 l a. �nl: caS I'h n I'Lnr R.irr,. `
r 2013 I----,, 1111krt'eimit Hgeaei5-00 37_2
TIGARD hive:too I Hie 511:(:'1.11': �UG l Date lic:rj•jl. • --_ '---a„--- •-
Intaui-i t.wwww l,l!anl-•x po% h B See ernal im
OTIGARD x.nlrN,t'\I:11aa1 j Suppkmenlal tolormanan
_ TYPE OF REVIEW
QN --_--- PLAN RF.V W
0 New construction 1ddiiinn.':t t.r.1111111 r.I):I1c111Cill fleas:clma all than apply Isah111r1 2 so.ill plans m non.i1ttl..111M1.•..1
❑Sri s.e m(cede,.ion amps to mare 011mIJmr inn Mire-mon.1 ❑ 1)e1011I inn Other:
.._-_ ..11.1•'•ln•a.adahk fault curlew ❑Manna.and lalanw:tbl.
CATEGORY Of CONSTRUCTION �- ore vl.total')amp.al I511 rull..1' ❑flnatmr InuWmLL •
h ✓ l- 4'"to ctmnal,ra r. ecds 14.1)1) ❑l•.ann•tal-ne nrual•and 2. durllin]: ❑Commercial/illlefn:l ❑ACCCS.nr� hui inU
,1111p>1...all oriia iii iallal inn, lnddmr■ •
❑Multi-111111U%. ❑Mactcr hitildcr
❑U1her. ❑1 ere pump
C lnt>lallabw,..l 7}AVAm '
CI Linn rem!,s∎stein lalae PeparaIell.citcii <1er1 I JOB SITE INFORMATION AND LOCATION
,,$�/ ❑Addllntn of new mm•x load ul Q'A""I' "1•` "I•i".
h1h nn.: Jolt si1C addr��:.:I�� l[d(1' /+n �- Intuit' mnrr nee.gtane
>. q ��L 1 J 16 ❑51.s i nmrr rcCiIit. al uu,ls ❑Airy,,,.„al.etot I part.
(its/$laic/%l l , ❑I Ieaaht ni e i aII II. ❑lint t1 l nllapr tot mnrc dnvn
$0ilc/h1d!,/:1 I. 110,; > ❑I In2aWnas 111(311011)1 tnn0 wilts OMWnaI
L P Project nillne: ^�1/1 (,r, M 6 ❑Service m Ieeder NM amps co mnrr
Cross slreeUdireetinns u)jolt site; FEE SCHEDULE
0mi-rialto° qiy, P . Tuts, •
New residential single-or multi-family dwelling uni4
Includes anacbed garage.
Subdivision: 1.nl nu,: 1,000sq ri or less loll 54 4
Tax Ini)plparcel no.: - Ea.add•1500 sq.ft.or poninn 33 92 MIME
-
Limited energy.residential 75 OD 2
DESCRIPTION OF WORK Iwith above sq.11.)
•
Limited energy,multi-Inmily
_ residential(with above scL Il.) 75 00 3
Services or feeders installation,alteration,nndlar relocation
200 amps or less 100.70 2
PROPERTY OWNER C1 TENANT
701 amps to 400 amps 133.56 2
Name: tC�, r"L �— 401 amps to 600 amps 200.34 2
- 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volrg 552.26 2
City/Sitlle/ZI P: Temporary services or feeder's installation,wlteralion,and/or
relocation
Phone:( ) I Fax:( ) 200 amps or less_
_ 59.06 1
201 amps Io 400 amps
2
Owner installation:This installation is being made on property that I own which is not
intended for sale, lease,rent_or exchange,according to ORS 447.449.670:and 701. 401 amps to 599 amps 168.54 2
Owner signature: Branch circuits-new,alteration,or extension,per panel
_Date: A.Fee far branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
- each branch circuit
Business name: A.Fee for branch circuits without
service or feeder fee,first • 1 56.18 2
Contact name: 1�a1/1P� . l BEAR ELECTRIC, INC,. _branch circuit
Address: 98s BuT 1 E9 RD N!? Each add'1 branch circuit i - 7.42 1� 2
• DONALD OR 97p2n , Miscellaneous(service or feeder not included)
City/Slute/21 P: C 0'20918 Each manufactured or modular
dwelling,service atolls feeder 6784 2
Phone:( ) Fax; :( ) Reconnect only 67.84 2
E-mail: 1 �, �r� 4r r■ l - Pump orirrignlioncircle 67,84 2
ONTRACTOR — Sign or outline lighting 67.84 2
Silptal circuit(s)or limned-energy -
Business name:' pr�� 1._ ` panel,alteration,or extension. Paget 2
itii)
Address: ) -�--- s Y Each additional Inspection over allowable in any of the above
Additional inspection(I hr min) 66,251 hr
City/Slate/ZIP: ^L� 1 N' r r._
Investigation(Iluosin) 66.251 hr
�- 1 - Industrial plant(1 hr min) 78.18►hr
Phonc.T2 Fa • 116
' I �=' i • • � Inspections for which no fee is
CCA Lic.: • L' specifically listed(h hr min) 90,001 hr
r M� ti 1p /Suprv.Lic.X it% ELECTRICAL PERMIT.FEES
Suprv.Electrician signature,required:`se �' ~' _. Subtotal: •
�.� .. Plan review(25%of permit Ice): _ -�,10�►
Print name 'ems • I Stare surcharge(12°ia of permit fee):
•Authorized sig»att erV r L TOTAL PERMIT FL'E:
h�.-._. This permit appl catiun eapirrs if a permit is not obtained witbi°180 3
Print name; 'Ua S a! 1/ l Date:Nei 1(5 Rays after It has been accepted as complete.
....JJJ ��s _ • Number of inspections allowrd per Benoit. ?(''
1:10ui1a..ry;V'ermuslrLC•7ennirAapdoe 07I0I110 4 a0-44l5TliJi0lC'Un,AVI!p • nom
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
10290 SW BROOKSIDE CT, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
2013-11-01 (null)
ELC2013-00477
PASS - No C of O
Violation Summary:
Inspector Contractor