Permit CITY OF TIGARD ELECTRICAL PERMIT
c COMMUNITY DEVELOPMENT Permit#: ELC2013-00584
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2013
Parcel: 1 S136CB00227
Jurisdiction: Tigard
Site address: 8110 SW THORN ST
Project: Ring Subdivision: SHANNONDOW Lot: 26
Project Description: install mini split heat pump
Contractor: BEAR ELECTRIC Owner: RING, GREGORY PALMER&VICTORIA
PO BOX 389 23210 SW CASCADE PL
DONALD, OR 97020 SHERWOOD,OR 97140
PHONE: 503-678-1355 PHONE: 503-625-3240
FAX: 503-678-1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 10/02/2013 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/02/2013 $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 a ance 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. ATT TION: Oregon\law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0 10 throu h OAR 952-0 -00 0. Y may obtain a copy of the rules or direct questions to OUNC by caitiff-7727987 or 1.800.332.23.4.
Issue By: (g /� (�/!'�'t Nom-_• _ Permittee Signat. _ !�.. / /
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' 11W, _ ,� 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.
OCT-01-2013(TUE) 07: 42 Bear Electric (FAX)5036781108 P. 001/002
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City of Tigard • . "c""" /� / /3
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I 1 r Supplemental Information
( TYPE OF WORK 1 - PLAN REVIEW •
0 Ness con-.trultion JJitiunlahcrat��1 1t•• /ci Y-- - P1Cavil+a'�I.alllllalaphl.'I'nI,mn 2.en.0r1.,phnu n.•nl•.hcrL:dlxll•..I --
I ❑ I)C 111n1111nr1 0 ^(v1 1'I git4G I:0190.� ❑S..s k'nl 11.'.Ic,.71111 amts\.v 111.1+1 y nlllllllx . 1 1111
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-�,� .,heir the as:ulahle milli elmem ❑Manila,311.1 I>'+ayahl,
CATEGORY OF CONSTRUCTION �� es:ctd,nt,olul axgn at 150.,1l>.. Q F11141m1•i,iiiI IIn fs
Q'/ •and 7-hi iii Iv dwelling ❑('nmml rciahinduslrial ❑Acccsa,rl building In%ln etnulwl,Al eseeed>141110 ❑fnnnn.rcrabn.e aintenInnal
CIr'� :Maps t.a all mho uwlallanM■ Inuldmr,
Moil i-I{tmily ❑MaSler him Oder 0 Oilier: ❑I II.'InnMp ❑illmanhawn ul 7$1:VA Ai :
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JOB SITE INFORMATION AND LOCATION nlclreney o-)sl r+n lalgel Ie lvrn111■deuled•c.11m
� ❑A 4diruhl ul new Mlnr.a 10a.1 ll
oh an.: 1 Iuh site addressg 1 1 O V Y / 01f L 111011P AP Inuit' 0 oA ec npa1 ncr
11.01 name resideulial unns ❑Rarinvu•'0 l••"e"Ii'1 I 1I a
rks Cilr/Slate/ Ill. � ❑I alh-talc Ialtw Snarly rolilK lip none 16
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❑I iannlm.s hxallall> OM vnit>iuun,nai
Suitc/hiJp./apt, no.: Project name: ❑Servxc Ill ler11er 610 amps tar inure
(;rn3s slrccVdire�tions In joh site: -
FEE SCHEDULE
r tl.v.iptbo I QI]• 1 r». 1 Told I
^New residential single-or multi-family dwelling unit.
Includes attached garage.
SuhdiviSion: 1.01 no.: 1.000 sq ft.of less 1 O 54 t d
Tax map/part i n0.: ^ E.6,add'I 500 xi,1).w portion 3391 I
Limited energy.residential 75.00 2
DESCRIPTION OF WORK Ilvilh above s9.ft)
Limed energy.multi-family
..71- . . 2 r x nyidenlial(with 0bove sq.fl.) 75.00 2
Services or feeders installation alters lion,and/or relocation lPr r Qty t
_ 200 amps or less 10070 2
0 PROPERTY OWNER I [0 TENArY • 201 amps to 400 amps 13336 2
Nome: 401 amps to 600 amps 200 34 2
601 amps to 1,000 amps 301.04 2
AddreSS: Over 1,000 amps or volts 552.26 2 ,!„/
City/$laic/llP: Temporary servicesor feeders installation.alteration,and/or
-
_ relocation
-
Phone:( ) __tax:( ) 200 amps or less 59.76 t
Owner installation:This installation is being made on property that 1 own which is not 201 amps l0 400 amps 1 5.08 2-
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,Fria ael
Date: A.Fee for branch cireuils with
0 APPLICANT I 0 CONTACT PERSON above service or feeder fee,
each branch cileuit 7.42 2
-Business numc: B.Fee for branch circuits wiehow
' ) service ar feeder lee.first
V 56.IB �J� 5 y Contact name: QC/ B fie�° branch circuit
Address; DONALD,o oq �" Each add'I branch circuit l 7.42_)!"t L 2
- >�Y1a Miscellaneuas(service or feeder not included) _
City/$late/21P: Each manufactured or modular 67.84 2
dwelling,service and/or feeder
!'hone:( ) Fax: :( ) Reconnect only 67.84 2_
E.-mail:j pryY� *ai 31 1 it • .. . - Pump or irrigation ion circle _ 67.84 2
` �-s a� CONTRACTOR Sign or outline lighting G7,Sq 2
Signal circuilts)or limited-energy
Business name: r ( .-ln Q-, 1 (v panel,alteration,or extension. Pic 2 2
�o x ,--{t ►► �r �1.• Each additional ins•eedon over allowable In an of the above
Address: Additional inspection 1 hr min
sP ( ) 66.251 hr
City/State/Z]Y: . 9102-C Investigation(I hr min) - 66.25!hr
J-��41 s� Industrial plant(1 hi min) 78.181 hr
!hone,(5:13 1 ,,�--)a. Fax:l LQ' .� az
�(� ' ! Inspections for which no fee is
CCB Lie.: specifically listed(55 hr min) 90.001 hr
Electrical Lic.: Suprv.1_ic.:XSaS ELECTRICAL PERMIT.FEE,S !}�
a ► -ion p
Suprv. Electrician signature,required: _ Subtotal: �Q✓f
Plan review(25%of permit fee): •--'
Print nantex ' 2�L r
" y r L� ate: j, b pi, Slatesurcharge(12%ofperrnitfee):
Authorised Signature: / TOTAL PERMIT FEE: � l
r'Ylr� This permit application expire%if a permit is not obteiaed.rithin tau l,, /J
Print ttani Date I J days after it has been accepted us complete. ✓wr
1-�D1 r/�_ • Numbcl orinspceliou"allowed per permit. tl
I:letuil.tl•Iatl'erll.a/\LLc-rermilApp nee Alfa It to 4.411--515i I 1 irasicorawFn