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Permit Support Document CITY OF TIGARD ELECTRICAL PERMIT . . COMMUNITY DEVELOPMENT II �ao 11 Permit#: ELC2017 00445 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 11111 Date Issued: 06/14/2017 1Pi g Parcel: 2S 110DD07600 Jurisdiction: Tigard Site address: 10445 SW GREENLEAF TER Project: OLSEN Subdivision: SUMMERFIELD NO.5 Lot: 240 Project Description: RECONNECT AC/HP 6/20/17,REPRINTED to add(1)additional branch circuit. SERVICE OUTLET GAS/OIL FURN RECONNECT Contractor: BEAR ELECTRIC Owner: OLSEN, DAVID L PO BOX 389 10445 SW GREENLEAF TER DONALD, OR 97020 TIGARD, OR 97224 PHONE: 503-678-1355 PHONE: FAX: 503-678-1108 FEES Quantity Description Date Amount 3 crt Branch Circuits wo/Purchase 06/14/2017 $71.02 Specifics: Service or Feeder 1 ea 12%State Surcharge- 06/14/2017 $8.52 Type of Use: SF Electrical Class of Work: ALT 7 Electrical Permit 06/20/2017 $7.42 Type of Const: 1 12%State Surcharge- 06/20/2017 $0.89 Occupancy Grp: Electrical Total $87.85 Required Items and Reports(Conditions) I 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. ATTENTIO • e -••n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 rough OAR 95 •01-.:°c Y.- may obtain a copy of the rules or direct questions to OUNC by calling 5 . 32.1987 or 1.800.32.2344. /��y, Issued B Permittee Signatur Q �( 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. Electrical Permit Ap licat�ion FOR OFFICE USE ONLY City of Tigard RECEA/ED Received Date/BY' ( / A , i Permit k: g"Ledei,_d6 q4 Ili a 13125 SW Hall Blvd.,Tigard.OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.598.1N N 1 9 2,017 Date/By: Related Permit P: T I G A R D Inspection Line: 503.639.4175 Ready Datelliy: a loris I H See Page 2 for InlerneL' www.tigard-or.gov NotifiedlMethod: /7 Supplemental Information r. F TID GAR , 0 -tt. : New construction ®Addition/alteration/replacement 4 Please check all that apply(submit 2 sets of plans whims checked): IC 0 Service or feeder 400 amps or more 0 Building over three stories 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. 4:t01'00#, QF 19.50'R1UCrI0 _, x ,, h exceeds 10,000 amps at 150 volts or 0 Floating buildings. ® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural snips for all other installations buildings. 0 Multi-family 0 Master builder 0 Other: 0 Fire pomp.R ❑Installation of 150 KVA or JOB':SrT>& tt►t4�r;"tt 4pNp.. ,'tiQ ... ..: ,x' _. � g0 Emergency systemlarger separately derived Job#: Job site address: 10445 SW Greenleaf St. El Addition of new motor load 01 system. IOOFIP or more. ❑"A' "1:""1-�" "I-i" City/State/ZIP:Tigard OR 97224 ❑Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Harardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal Cross street/directions to job site: . , s +. Baan r:..„.�... a. ,.. ,,a ' Description 1 Qix I Each I Total •1 New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. 1,000 st. ft.or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.lt.or portion 33.92 1 .,.ryn=I i,, m ; .,7.0M :..... i ?i;t t s,s a„ :°i a »' < ` ,._ ,-. . = Limited energy,residential add additional circuit to existing permit-ELC20I7-00445 (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 residential(with above sq.ft.) 4. Renewable Energy 0 See Page 2 "' ©"P' 'A: ''t: '4; "`` ' t `'' `M">r " i:1 Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 t �fi Branch circuits-c new,alteration,or extension,per panel A.Pee for branch circuits trirh Business name:BEAR ELECTRIC above service or feeder fee. 7.42 2 each branch circuit Contact name:SARAH OSTERHOUDT 13.Fee for branch circuits without Address:PO BOX 389 service or feeder fee,first 56.18 2 branch circuit City/State/ZIP:DONALD OR 97020 Each add'I branch circuit I 7.42 7.42 2 Miscellaneous(service or feeder not included) Phone:(503)678-3411 I Fax::(503)678-1108 Each manufactured or modular Email permits@bcarelectrtc.com dwelling,service and/or feeder 67.84 2 . Reconnect only 67.84 2 lt'F iCjf -".'r.'' z " '„--t -; •s%*:g .-,% Pump or irrigation circle 67.84 Business name: BEAR ELECTRIC Sign or outline lighting 67.84 2 Address: PO BOX 389 Signal circuits))or limited-energy Sec Page 2 2 panel,alteration,or extension. City/State/Z1P:DONALD OR 97020 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 6625/hr Phone:(503)678-3411 I Fax:(503)678-1108 Investigation(I hr min) 90.00/hr Email:PERMITSc BEARELECTRIC.COM Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90.001 hr CCB Lie.: 20919 Electrical Lic.: 24-107C uprv.Lie.: specifically'listed(Vr hr min) 4r, Irl xI aL ►ITA s ,..,:,..44,.,-. Suprv.Electrician signature.required: ---. Subtotal: 7.42 Print name: �`.. _-')ate: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): .89 Authorized si natu c: TOTAL.PERMIT FEE: 8.31 / /" f" ' this permit apiscater t has bing permit is plete. within I80 Print name: Date: 6/16/2017 days after it has been accepted as complete. Number of inspections allowed per pemtit. IU3uilding\l'ennits1ELC_PennitApp_ELE.ERE dor Rev 06/17/2015 440-4615T(11/05/CONI/WEB 5T4lt/0i/COMM'ED City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 10445 SW GREENLEAF TER, TIGARD, OR, 97224 Record Type: Record ID: Residential - Electrical ELC2017-00445 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor