Permit CITY OF TIGARD ELECTRICAL PERMIT
11111
° 111 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00235
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/05/2011
Parcel: 25111 DD00900
Jurisdiction: Tigard
Site address: 15830 SW 88TH AVE
Project: King Subdivision: STRATFORD Lot: 49
Project Description: (2) branch circuits for new heat pump and reconnect furnace.
Contractor: BEAR ELECTRIC Owner: KING, MELODIE L & JUSTIN S
PO BOX 389 15830 SW 88TH AVE
DONALD, OR 97020 TIGARD, OR 97224
PHONE: 503 - 341 -7720
HONE: 503 - 678 -1355
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 05/05/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/05/2011 $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. ATTENTIO • = - • • • law re uires you to follow the rules adopted by the Oregon Utility Notificatio enter. Those rules are set forth in OAR
952 - 001 -0010 t •ugh OAR 95 00 0 . ou may obtain a cop of the rules or direct questions to OUNC by calling ■3.232.1 or 1.800.332. 44.
Issued By: Permittee Signatur� /.i
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.
MAY- 03- 2011(TUE) 15:17 Bear Electric (FAX)5036781108 P.001 /002
Electrical Permit Application � � rt)1c (wrier 1.5E ONLY
City of Tigard �� �3i7 PcimU No. : Fi,C o?d /l - fra3
..- 13125 SW lion 1 4171 Tigard, OR 9� /� Plan Kevicty Neeoeff/ X
a "V d „IS. t]me!Ilvt OIhCt l'crrntt
Phone: 503.639,4k71 Pox: $OiSV .1960
T l G A u [7 inspection Line: 503.639.4175 Q ,� �w� tt<udyruy: Jtr EREEETRII
Internet: www.tigord- ur.gov G� \G del l Kd lfledtMcdiod:
9 New construction IR Addition/alterutioq meat mot thwk all that apply (submit 2 Nets orphan „Yllcros chcclusi beiow):
❑ Demolition ❑Ojber: ❑Sm ❑
iccorleader4011ampsormote ltulldingover three a1ertes.
where the available look current ['Marinas and boatyards.
u , . . ' e jrt,a n tl. o d' st-. R Gam{ l exceeds 10,000 amps of 150 volts or 1:1 floating bulldlnp.
i
less to ground, or cremes 14.0110 ❑ Commercial-use agricultural
12.1- and 2- fancily dwelling ❑ Commerehot/industrinl ❑ Accessory building amps thrall other Installations. buildings,
9 Multi -family ❑ Master builder ❑ Other 0 fire pump. ❑ lntutllatlon of 75 KVA or
y - ❑ Ulnaliency system, larger separately derived system.
.. Y , ' ' � its l#01000011 , M4 , ❑ Addition ar nov motor load or [1"A", ' $1-2", - 1.3",
Job no.' Job site Address• ?+ C . !male ar m occupancy.
(3 lV� p1 P .e ❑ 5{x or man nrlJendal oohs. ❑ Itcowls.,NI vehSel : ramie
City/State/ZIP: -TT
1Z1P' ", ^ ❑health -are f cator 's. ['Supply voltage for more than
1 \ �1 + 600 volts nominal.
/ � , ❑ Idtvit f ac iloas
Suite/bldg./apt. no.: Project name: �O ❑ S or feed's G00 amps or rains.
RierailennaligignESSCIMantiMONNINSIN
Cross sttecl/direCtionx to job site: nemeApttee I 11etc I e«. i 'limit 1 •
Now residential single. or multi - family dwelling unit.
Includes winched gunge.
Subdivision' i Lot no.: 1,000 sq. C. or leas 168.54 4
En. add`I 500 sq. It. or portion 33.92 1
Tax map/parcel no.: I Ite4 energy, residential 0
's ,CI ...... ... (with nbnve't4'IV 75.0 2
v Llinhed enetgy+,multathntlly
ti
75.00 2
� \\ rt ,r\e_s 1`, ��j+ `� �r^ .k ( 1.y - re's .. c k '+ Q )l\-, residential (with mimeo nq.III' > / Set' vice% or k lnstnllptloydierat ion, and/or rclnctition�
�--r�^� S�kQ? j 'c'c ., 0 amps orlcss 100.70 2
l l v It tv lt—t ` 1s ` ` 7 m I � 4 e 20
'', :U I amps to 400 amps 133.56 2
Nam e: 401 amps to 600 amps 200.34 2
60 (atnps to 1,000 amps 301.04 -2
Address: Over 1,000 amps or volts 552.26 2
Tomtpnraly services or feeders Installation, a1torutlun, antler
City /Stott /ZIP: relotvtion
Phone: ( ) l Fox: ( ) 200 antfa or less s9„16 1
2111 amr+s to 4n0 mutts I I 125.08 1 2
Owner installation: This installation is being made on property that 1 own which is not 401 amp in 599 amps I68 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Brunch circuits new. ulierutjoi, or extension, per panel
Owner. signature: , Date: A. Fee lbr branch circuits with
r u+ «.,,,,» ,,su..... L^717,' y , '"." "• . above service or fixder &'c, 2 '
C' ., =I .... + .... r�' i � a u a; v* 1 7.42
" cash branch circuit "
Business name: B. Pee for branch circuits without
service or feeler fee, first \ 5618 , 2
Contact name: brunch circuit
Each add"! branch *mill I r 7,42 �1._ 2
-
Address: Mistellancoun a4.91 orfecder not Included
ch City /State /ZIP: dw 67.84
Phone: ( ) i Fax :: ( ) Reconnect only 6714 2
Pump or Irrigation circle 67.84 2
a-mutl Si or out/ lighting 6784 2
+ _•., inc c b l
m r n
. .:''''''''"•": w,M" :i ,tli * i'="''''''':':": ," a w w iia °`' Signal cireull(v) or lintiled enct8y
Backless name: Q-CX\ r ‘ lzft -1r-( n [ tf V panel, alteration. n cstetlsk n. Page 2 2
1 t� .a ++......) t tom• Each additinnui inspection over uiluwa in any of the above
Addm.4: � e Additional inspection (l br min) ftti.251 hr
.._City /Sltltc/7,ITs:- - - - -� ._ - _ _.. . 0)-2-C . �
. -_ __ Investigation (1 hr min) 6G 251 hr
� �_ — ( industrial piton (1.hr ntinl
Phone; (5J ( fl it L F ) I 78.16 / hr
Fax: ( � ( `1 In.spcctions for which no feu k 90 001 hr
v, cetnealiv listed ('A hr Mu
CCB Lic.: ‘ Electrical L.ie. : - �I Suprv. Llc.: . a� y. ''t0, �,r • 3, — 7t7' "' '� " : ,,a�
Subtotal: •!
Suprv.1.Lectricttut signature. c r Plan review (25% of permit fee):
Print ntutte ` i �6 p+sk_ % I Date: - ` State surcharge (12"x6 of permit fee): • „„.
TOTAL PE'RMI'T FEE: \
Authorized signature. `` 'f ill penult application expires no permit is not obtained within 180
Print nettle:
I faille: dun uner it Intl been x
accepteducomplete.
- Number of inspcctlans allowed per permit.
I taerl;b ti uil.m!14: Ihi.a4AP+. 0710IHt 410- lfih