Permit - ;, CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00220
T1GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/27/2011
Parcel: 2S104AA02800
Jurisdiction: Tigard
Site address: 12235 SW 126TH AVE
Project: Jackson Subdivision: BELLWOOD Lot: 38
Project Description: (3) branch circuits for heat pump, service outlet and furnace.
Contractor: BEAR ELECTRIC Owner: JACKSON, EUGENE L
PO BOX 389 12235 SW 126TH AVE
DONALD, OR 97020 TIGARD, OR 97223
PHONE: 503 - 678 -1355
PHONE: 503 - 997 -5480
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 04/27/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/27/2011 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports (Conditions)
This permit is issue 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 ir - ccordance wi - pproved •lans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A ENTION: Oregon I. r•uir- y to follow the rules adopted by the Oregon Utility Notrfi - • 'Center. Those rules are set forth in OAR
952 -001 0010 through OAR 952-0B 0090. Yo rrey obtain a cop of the rules or direct questions to OUNC • • r 1987 or 1.800. • .2344.
I / r .� %. � idZr .
Issue. y: ``� PermitteeSign• r !
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' / /f FV �{ 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.
APR- 27- 2011(WED) 10:47 Bear Electric (FAX)5036781108 P.001 /002
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Electrical Permit Application, � FOR OFFICE USE ONLY
IN City of TIgard f Permit No.: ESC- aQ / /"Oj�2.Q
13125 SW Hall Blvd., Tigard, OR 97223 $�� G , •� ,
• Phone 503.639.4171 Fax: 503.596.1960 S% � \ ' r . ` -- Other Permit
TIGARD Inspection Lille: 503.639.4175 Q, i tarts: See rage 2for
Internet www.tlgatd -orgov 0 Supplemental Information
i
❑ New construction 'ddition/alteration/replacemIkt' 9 Please check all that apply (submit2 een ofplana wfkema checked below):
❑ Demolition ❑ Other ❑ Service or feeder 400 amp; or mom 12
Building aver thtee stories.
where the available f current ❑ Marinas and boatyards.
002M r,. �: ° " °'� r n "'�mn a t ! x .,. , de 150voltaor D Floating buildings
.
ling ❑ Commercial / industria) lea to groun or exeends 14,000 ❑ C ilding elal -use a(picultural
94- and 2- family dwe
} CI amps for all gtherinatdlatlona. buildings.
❑ Multi 11 ❑ Master builder ❑ Other: ❑ Pite pump, i ❑ M041400n of 75 KVA or
0 Emergency system. Larger separately derived system.
_._....._ .. e i;r ' ''I,a:ttitl ''1itd,iirIS4,.a. ,l4.ita al0:n "`u C Addition of new motor load of 0"A- , "E", "l.2", "I.r,
Job no.: I Job site address: I 2,35- S i 4) I 2cre-- 4 d d 100H1• or more, occupancy.
`` l� '1 Q Sin or mom residential units. ❑ Recreational vehicle parks.
City/Stale/LIP j C� .1 ❑ Has r does Taconic*, ❑ Supply voltage for more than
a ' �( ! / �` (J Herardoue locations• 600 volts nominal.
Suite/bldg/apt.no.: a Project name: 41 ❑ Service orfeider600 amps ormore.
AVilititiNetailligaililitiStattitlitillegialkeiSitatail
Cross sttcet/directions to job site: ,
_ � L!�ev� 1 pre. I n,e "i -- 1 •'
New residential single- or multi - family dwelling unit.
Includes Attached garage. _
Subdivision: Lot no.: 1,000 sq. ft. or teas 168.54 4
Tax map /parcel no
Ca. add'I 500 aq. ft. or portion 33.92 1
Limited en residential
!' is Ly t7 1.. s qAr s l r , m �� 75.00 2
".,..,::. a+ .,at.,i i, it,.t,•utvi r : „na1:4.r1” s iMIti I44.ld!tArM eti1a. ,:''� �, ;l 4.,. F,,, ,1'' w lh ab t ft.1 _ - - --
Ig!� i Limited energy multi- tinnily 75.00 2
4 � residagdal (with above sq. ft)
Services or feeders installation, alteration, and /or relocation _
200 amps or Ices 100.70 2
:tt' 1,7 ra rr r "n c 717:17,777,7777::".',;
1:;,1, k"2 rwt'�n� "t 3'J a ,;�n � r, ,. ::','V, , ", '; ,,, .;}t "I']li tutor ,vti 201atrtpa toADi)amps 133.56 2
Name:
401 snips 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/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 temps or leas 59.36 1
Owner installation: This installation is being made on property that 2 own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Rraneh circuits - new or ex tension, per panel
Owner signature: I Date: A. Fee for blanch circuits with
1R ' Il 7, R� 7,7 aMP t t 17:7 ,+, nn m. r r r r it t r rr r w 1, Irtr 1 + �m k a 1 above aervIcp or root,. fee,
1
1 , R . ,..; : A: v o,f1 + !, t,.. l,A r,A. a ;,,Ant..,t11,..�.,!,g)+r,l../ :+, t._ctf.: de" i...A.LUZI /11 :11L I, each branch circuit 7.42 2
Business name: - B. Fee for branch circuits without
service or feeder fee. first I 56.18 5sv leg 2
Contact name: branch circuit
Each add'i branch circuit 9— 7,42 .Sy 2
Address: Miscellaneous (service or feeder not Incladed)
City /State/z1P' Each Manufactured or modular 67.84 2
dwelling, ervideand /or feeder
Phone: ( ) Fax :: ( ) - Reconnect only, 67.84 2
E or irrigation circle 67.84 2
c rat yr rc,,l e t ,n> I s f rHnvr , t n „! w }, Sign or outline lighting 67.84 2
,i` 1 ��::., . ;,Ili j 11 I.+w C l:11,3,:i1i1 : !:. i°,M . �� qr /Mf EX atlia 1 ;LTr ', t;;, },v'S"',ru''u'WI t'. , 2 , ,. � *, , Si ei.uito or thrilled- energy
Business name r-` snot alt ration orextenoian. Pa:o2 2
� n !" 6I �� ,e I r .7 (� Euielt additional inspectiun over utllownble in any of the above
Address: eo �J''•'r J Q 4 Additional inspection (1 hr min) 66.25 / hr
lP: — l� O l Investigation (li hr min) 66.25/ hr
City /StatelZ
to - _1 n )
7 -- Industrial lant'ol 78.18/ hr
Phone: (5r5) 628-- /3 55- Fax: (67 7 •- 'l D8 inspections rut which no fee is 90.00/ hr s Ciilcali listed h hr min
p q lIM IX:1 � r- IV' 71r,"!"-171
cCB Lic.: ! f Electrical Lic.: Sappy. L .: ���,r R f 1 G�..vr t �sN DIRT r,s I af; "� " Tr't$Prliyf?sw
Sum. Electrician signs lure, required: Subtotal: '? / . O
a . Plan review (25% of fee):
Print name: e: State surcharge (12% of permit fee): L.
w
Authorized sigttatutt i TOTAL PER/ LIT P1 E: 7q, 6
This permit application expires If permit Is not obtained within 180
days aver It has been accepted as complete.
Print name: Date: • Number of inspections allowed per plonk
1: 1I )undineennttsTLIGlvmnItApp.dna 07101 /t0 440461ST(11 /g5/COM/WP.B