Permit CITY OF TIGARD ELECTRICAL PERMIT
`1 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00127
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2011
Parcel: 25111 CB01706
Jurisdiction: Tigard
Site address: 10305 SW HOODVIEW DR
Project: CIROTSKI Subdivision: HOOD VIEW Lot: 5
Project Description: (2) branch circuits for NC and service outlet.
Contractor: BEAR ELECTRIC Owner: CIROTSKI, LAWRENCE L AND LAURA L
PO BOX 389 10305 SW HOODVIEW DR
DONALD, OR 97020 TIGARD, OR 97224
PHONE: 503 - 678 -1355 PHONE:
FAX: 503 -678 -1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 03/08/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/08/2011 $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 set forth in OAR
952- 001 -0010 through 0 • • 952 - 001 -0090. You •• - • • • . copy of the rules or direct questions to OUNC by calling 503.7 987 or 1.800.332.2344.
411111110 / A
Issued By: L� _ , - Permittee Signature: ( r' n'7
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.
MAR- 07- 2011 (MON) 16:24 Bear Electric (FRX)5036181108 P. 001 /002
Electrical Permit Application FOR OFFICE USE ()Nis
City ofTi a nd I`
n,urst.: N. 1� 1
1312! tier Hull [3ivd,'I'igunl. OR 97223 1'km Keview (Mu Wrnvic
Phone: 503.63').4t7I Fax: 503,598.1960 smells
TIGA1tD lnapee(ion Line: 503.639.4175 Dl Itan*hd1y: See rage: for
inland: tww.tijani- ur,gnv Na IltctINcrhnd: IRMI $ npplrmrnnl (nrornWtion
ti' ,:'. , r j + tr t 1 8 . ' w > x r t' r M r r tS ,"r r
,�, ^ " r -; -," . .;fir +)^Mw� •l "+ A ik�".�1 T + �,- �F'�1VtlFt rr ,.�'s m a `' ".I � p ? ` xnxc or Ilcde7.inl1 �'W� -A , i'.R�� w :: � -, ,.. w ,
CI Ncw c onslructinn ELAddition/allcr'.ltion / rcplac metlt i'Ic till utut apply (submit1,sets ot'pluns n nom.checked helmet;
nanra more C Building over three stories. ,
in Demolition ❑ Other: where the available fault current ❑ !Marinas and Mvryanis.
.„v "'a, " r',,�, A„t .'TECOltSVO*,e6 t1Q " : 1; exceeds 10.000 amps at 15(1 volts or ❑ flouting Poildinlw
4" ° ++ ^+�r"r".{g14 less to ground, or occwds 14!1410 p Ctrmmemlul -use agricultural
i.1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other Inswllutlons buildings.
❑ Multi -family ❑ Master builder (] Other. El I,Irc pump. D instnllutlon oI'75 KVA or
❑ Emergency system, l uracr mutnrhlaJ of scpnraovl. derived 'system,
i 'r 4 �1 i B n lNiroRm rev is , O O SSiV
� rl.!r1 nwv ' , � � , :. �, � �� � , � t ,JY ::. [a .1JJh i an anew l' C "A ^, - I', ^, "I -2'. "I.3^
} 1011111' or awe. uecup;au�-
Job no.: Job site atkirrss :\ `�' tY Dr, 0Rix ormolt'residentiulunits, p Recreational vehicle leeks.
City /State /Z1 P' 1 n .1.1c C C —12'11.,. ❑ l lwlthr;arc l able; ❑ Supply voltage for mine than
11 mss+" 1 in I!martini's'motion& AIM %nice nominal •
Suite/bldgJapt, nu,: Project name: c 0 titrvlea or fender 600 maps or rwwi.
■
- -- EISCi:tEAi7;iESiett+'e ta
Cross street/directions to job site: nr.rri I i4r% -1 1 . I lnr 1 .
New residential single- or multi - family dwelling unit.
includes attached ;pine.
Subdivision: Lot no.: 1,000 sq. 0. or leas 101.54 4
map/parcel _
Ea. udd'I 50(I sq. it. or portion 33,92 1
Limited energy, resldennal 75,00 2
^,..." MW.WV. O WO 4 14. w ztt p Ll (with [demom1.11,)
-
. Ina yy����jy ��yy��yy Mr 1 � I ��
'. �. '��, , Mt , ikf1JWUT ' ���... � N M W . ntited energy, multi• limlly 75 2
I` IL . t r
■ r i. , • , rcridcnt (with nhnve ay. 0 -)
Sorvk4x or feeticr,t hisulliation, alteration, pndior relocation
CA k u ( ` * )- n a +♦� o c )� 20(1 amps or less 100.711
1 " +'" +p 9 1 9F v Si r ' lh, 8 w t 01e ' 0 ',, 201 amps to 400 amps 133.56 2
401 mugs to 600 amps 20r1. �4
•
Name:
601 anips l0 1.000 amps 301.11.1 - IM 2
Address: Over 1,000 amps or volts 552.26 1 ,'.
Temporary services or reeders Instnilntion, 'Mention, and /or
City /Suits /ZIP: reloca
Phone: ( ) Fax: ( ) :nn turps or loon 5996 1
201 amps to , Inn amps 125.08 2
Owner installation: This installation is being made on property that l own which is not
intended litr sale, lease, runt, or exchange. according to ORS 447.4:19, 670. and 701. 40 amps to 599 amps 168 2
Brun Cis e1rCbi - mow, at tention, ur cx tcaslon, per pa ncl
Owner signature: - Date: A. Fre Or bnmeh eiwulta wills
��,,yy I„r abort ry c ur I'lsdcr 11:c. ru4�r.? + +'VVI 4 '' 1 r 1.. W., �pW O i L ' . ,'l .p p , ! r, ChCh brlscbclhclrc euil 7.42 ''
BusinC9a name; 1:1. Fee ror branch citcoits withoof
service or feeder [cc, first \ 56.18 r s , 4 `A
Contact name: branch circuit tr 5i.H
— -- Belt 4dd'1 brunch circuit 7.42 •1. -4 2 2
Address: _ Miscellaneous (service or feeder not included)
Clt /Slut! /71P' 1 latch manufactured is rn 67.tW
> dwelling. service nndlnr feeder _
Phone: only 07.64 2
i hone :( ) Fax : :( )
Pump or Iregin on circle 67.84 2
E-mail: 8 () R _
Sign or outline lighting 67,84
A
r; ":+ +�'" +"t " F' M y, " O t e +,� � , ?' tit nal clrcul[ s nrllndl.drner y
^ a nd 0horutios.orcxrcasion. Pum2 2
Business name: o V¢Q��� I i 9 �1\ Eacb additional inspection over aliuwn in env of the ribose
Address: Q r ae x `SCI Additional inspection (1 hr whit 66,251 he J
�( ("")�� -^"� , lrivcisiiguiiuii( I IirniTn) .-- 'L-----' ._ 6G 'l � rld ,.- ._._ . ..... ........._. _ --
Cit /State /ZIP: JCalC1 \ c 1 Q . `-'l 1 C:'.0--C.
il 78,18/1w
Phone' 1 I Pax: (� hwiseenoes for which no fee is
"' ' , * P � �--'�! � �+' —L — � � ` w eciltcr11v listed 'A lir mitt 90.00) Iv
CCB Lie.: I S Electrical. Lie.: Li Suprv, Lie I a S M „ ; + '^ACT�EGIMI;:T ER3tl"1111 t:gl « zo i” ..
Subtotal: 1R 4 it
Suprv. Electrician signature. required: � ` sip Plan review l:S'sb of Itttit rail:
Print natne. 1 $ K , Date: —1-1 r State surcharge(12%rofpermit fee): il w
1'l _1 -� \ t tt _ ., _ ��� I TOTAL PERMIT FEE: —7 1 2?.,
Authorized Signature: This penult application expires If a permit Ix on( nbt *lord rvlthln 1140
dnyn oiler i1 bas hecu accepted as complete.
Print name: I Date:
" Neuter ot'inspections nik »yell ru;r permit,
I lli„adSotrni.,i ltuII I I•Ikxndekro 110c 07■111 /1,1 4111416151'i I 1 /I1511.(O.1'R"lill