Permit t , CITY OF TIGARD ELECTRICAL PERMIT
'' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00082
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/04/2011
1t
Parcel: 2S102BB01400
Jurisdiction: Tigard
Site address: 9940 SW JOHNSON ST
Project: BOGDEN Subdivision: Lot: 0
Project Description: (2) branch circuits.
Contractor: BEAR ELECTRIC Owner: BOGDEN, ROBERT W AND
PO BOX 389 BARBARA J
DONALD, OR 97020 9940 SW JOHNSON STREET
TIGARD, OR 97223
PHONE: 503 - 678 -1355 PHONE:
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
2 oil Branch Circuits wo /Purchase 02/04/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/04/2011 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are het forth in OAR
952 - 001 -0010 through OAR •52- 001 -0090. You may obtain a copy of the rule= �uestions to OUNC by calling 503.2 1987 or 1.800.332.2344.
I
Issued By • _ _ — - •ermittee Signature:
'—
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
•
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FEB 03 201 1(THU) 13: Bear Electric (FRX)5036 ?81108 P. 001 /002
Electrical Permit Application FOR OFFICE USE O1\LI
Ili 7 City of Tigard ;) �' " i �� • L _
1312$ SW I-Ilt11 Blvd., Tigant. OR 97223 . 3 2011 ,
Phone: 503,639.4171 Fax: 503 598.1960 ,
TIGARD inspection Lino: .5133.639.4175 i - . 11 ,... . RI See rage 2lbr
Internet: w'v+w.tiµard-v.gnv 1 r i � I Ii_a � Not I ledi %Ir,hodt IMO Supplemental larermatton
i. t ' ''':. , et '7,RA rt +' ,,,: ,,„ .. Pr I OF 8ty1Jtt} ', .. 1 .4n Mt , ;; k* `.'h i , `' ',.. r`PisA"1!16 ' egI 1!Viuu " .: , `" , wi
El New construction ® Addition/alteration/replacement
utru k all Ihdl apply (submltZt+ t,i nl plum 33 chtcl �d lxhn, I:
❑ sto,iee or leader 400 amps Or More ❑ Dufldingot cc dins: stories.
❑ Demolition ❑ Other. tsbert the available fault current ❑ Marinas and heal) sink.
't :C M „w ! ';4o „ � ko"v. 14 : 1 nr '.'CAT. GC31iY,,O1`; "'CC*TrI tyre 1 ," M d l l T 44f4 ` 5:. I tweeds 10.000 ampym 150 volts or ❑ Ili mina buildings.
less to ground, or mends 14 ,11110 ❑ Gummetelal -use agricultural
tgl .I and 2 family dwelling El CummercIulrindustrial ❑ Accessory building amps for all other Installation:. buildings,
L] Multi - family ❑ blaster builder ❑ Other: ❑ fire pump, ❑ Insiullutlon of 75 RvA or
f, CI Emergency system. lamer swamiI) derived 10, stem,
�` +i” 1I A,„ "' m 0 13;SITMFQ,dt�'F'CW41'1i�7",10NUSD I0.S.4 TIN iff.l t ,41:"`.1 Addition of
._... ❑ ❑- I�'•, -1. °. ,. - - -
Job no.:
Job site aelelress:q - 'IQ .9•4\e".\ • nri s.1 C ` I' i c' tr more residential excupaney.
❑tls nr morenwI dentialunit.. ❑RCM:laial:Itelti¢le
City /Slate /Z1P :^�`^� el rJ 3 0 il.(0,wuntuellitite. ❑bnpply. „ ha ml 1 .
J min; a
��n
L1, * Lam/ iv sus it e.•tt o nf. 141111 volIN nomiltal
Suitc/bldg./apt. no.: 1 Project .n•m e: 60mps or re.
0 St.-nice or f'ectifer 0 a more.
- ONNINNOMAIMMOZEXSCOMMUMSTM;IVRFAPONS
Crotos street/directions to job :liie: b.r...44 4M I I)Ih. Ire. J - Intel
New residential sinula or multi - family dwelling unit
Includes nttuchad minute.
Subdivision: I Lot no.: 1,1100 so. ft. or IOU 168.54 4
lit. add'I 500 331, It. or poraaq 33.92 1
r , «,,,r
�^ Limited snotty, residentiul 71,00 '
iL\ map/parcel p:lru, no. LI
MvprkM.MV. ve .�'iZIP•l.'„l,(yP1 ; w vM:�. 11 awK'"`'' ''w' ",Yiw.6.:::�t"M„ �wil{t ah,we el 0.)
"i 5!," .. , �1�1� . - r rrr•�arr rr, mww- - .
Limited energy. multi -ra oily 75.00 2
k 5 k cl Cr \Vs. - above ��� O ff- r. \ C\ reskiendal ;Milt abovcl. 0.1
1 l� Services Ur feeders installation, !therm lion. it nillor rcloculiun
Ob. - . • _ 200 amps or Ie s — 100.70 2
i i n v l :till °{ . , . . g1, u. sass ,: . �,. vwM ,:; v *' to NtOs .4Ht':gr I 201 amps to 5183 amps 03.36
Name' •I01 amps lo 6011 amps 200.54 2
6U 1 amps to 1,000 atnps 3; 2
Address: Over 1,000 umps or volts :152.26 2
City/State/Z11): Temporary services or feeders installation, alteration, and /or
relocation thon
Phon ( ) Fits; ( ) 200 am or less 59.36 r 11
201 amps to 400 amps 125,0i 2
Owner installation: '1 installation is being made on property that I Own which iii nut 401 antpv to 599 amps 16x 2
intended for sale, lease, rent, or cxch:ulge. according to ORS 447, 449, 670, and 701. -
Branch clrcul d — new, Mention, or extension. per tot net
Owner signature: - Date: A. roe for brunch circuits with --
" a,ua� r..:" "* so>-c sct•vic eur rimier roc, 7.42 � +�- . , �; L�l t,:. 8 ✓n7+ "I t«�`' 1. b.42
� ." ........ ..a "•• „sass each hunch circuit `
Business name: IS. Pct for branch circuits truhoaa
ACrs ice or tecdtr rte, Ono 1 56.1 tf r 5'ta•ILl 2
Contact name: -
_ tampon circuit
- - Each DWI branch circuit 1 '1,4, 1, 4,12. 2
Address: Miscellaneous (service or feeder nor included)
t;'itch ntunufaclured or 'nodular
City /Stnte/ZIP: dwelling, tarries and /or feeder 67. 84 2
Phone: ( ) I Fa :: i ) Reconnect only 67.54 2
Pump or irrigation circle 67.8+1 2
E-mail: Sian or outline I belting (i7.84 2
" "' .,re ! . .. iaa Ol I > iiiti11L , M rum 1 e : ': Signal circuit(e) or llndlcd- energy
13uslncsti mime; panel, alteration. orcxtcmi n, Ptute 2 2
"aft P. IL ,• Each additional) i eetion over allowpblt In any or the ahovc
Address: p_in f � Ig AddhluOtl hmpeislun(1 hrn, 66.25 hr
.,, .....__._. _.. ('� W., sass, ..,.,., _ ,.,.., . -- ^ -Ip . �tj1ailan•(I•hrminh_.
C.ily /5lutc /7IP: ( �, 1 �� `�' lndu$4,1.1 pta01 it Iv min) 78.181 hr
Phone: (303.1 p \ 5,' I Fax: ( 3) "i+' 1✓ f('.4 u (\ Inspections Ibr which no Ira is 90.00/ hr
s ;licitly listed WI Iir min?
M
CC,B Lie.: 20ct Electrical Lie,: (4 —I 0 'aprv. Lis..: Q ` liginl aratt !i; W' Cam' ( � t
Subtotal: iii loll('
Suprv. Electrician signature, required: . - Pion review ( «59:, U fox):
Print name: Jtl� >• • • r . 1 *' , '1lIW Date. 2—R-11 state surehneue (12% of permit fee): ,
1 TOTAL. PERMIT FEE: "'�1r
Authorized signature: l: lltls permit imp' lean an esplre■ if a permit Is not obtained willlIn 1110
Prim name: Date: * (Ian after It bits been accepted ux 'de,
I\'nmtwrnrin..pn -liras allowed per permit_
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