Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00296
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/02/2011
k" U. Parcel: 2S103ACO3200
Jurisdiction: Tigard
Site address: 12495 SW 112TH AVE
Project: LESAGE Subdivision: MCMICHAEL HEIGHTS Lot: 6
Project Description: (3) branch circuits for A/C and lights.
Contractor: BEAR ELECTRIC Owner: LESAGE, PETER C AND ANN T
PO BOX 389 12495 SW 112TH
DONALD, OR 97020 TIGARD, OR 97223
PHONE: 503 - 678 -1355 PHONE.
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
•
3 crt Branch Circuits wo /Purchase 06/02/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/02/2011 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
Total $79.54
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans, This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OA 9 v. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: - - Permittee Signature: 4 /51--,/6G/ 7-7C
OWNER INSTALLATION ONLY •
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
JUN- 01- 201100EO) 16:33 Bear Electric (FRX)5036781108 P.001 /002
Electrical Permit Applicati4 r rOR OFFICE , USE ONLY -
City of Tigard Fermi' Nifl. :S1,61o70/7- 1/10.4,7 9
q 13125 SW 141111 Blvd- Tigard. OR 97223 1 U N Plan Kcsicw
R ' Phone: 501.718.2439 Fax: 503.598.1960 2 U `I I)molt r Other l�nn' '7 2 : ,,f - , '
TIGARD Inspection Line: 503.639.4175 Owe. Reodyiuy: see Page for
totamet; www.tignrdwr.gov CITY OF TIGARD NdllledtMcthad: Supplemental 'Information
ri ryL.l ;' 1 (� r1', I , At"` 4r, "'„'° 1.Y } k '',7-;', ' �+�J7� '‘.1.''. ... � 7 ' :t 7 7^ 4W Y 1 !1 Ai N „",j-'.”. KV �.Mr 1 A p : 0 ":;) 4,1, lh 4Y x }IM '�
4, t . r r `:.rt r. �� � a T�rk7'� 1 .$ e rgr it ri�n �,� to . M � r '� � , � +n r � " ✓, .
CI New construction lddition! illerutlOn /replacement please chuck all shut apply ;submit axlx ui Plant• wiilcmx cheekur4 nelwv :
❑ !:cr+'iec or feeder 400 emptier more ❑ Building over three alork5.
❑ Demolition d Other: where the available (hull current ❑ Marines and boatyards.
::!n t
1- artd dwelling El Commercial/industrial El Accessol�' building 1 t ^ p p� ' h less 1 to ground, e ampsut % 1 ❑ CI Cummcrolu l mse agricultural
a
less to u, tx vcceda a11U1t Cummerciu• use
lding ulrlps Ott all other InouOmtons. buildings.
❑Multi- family ❑ Master builder ❑Other: ❑ rite pump. ❑ Installation or75KVAor
.._ Emergency Ys. separately v� system. ;, u w y f' � !° ,' 4i�, t+ �, , „ p A r «Y ,w Cnx.r cn a 1em. larger urulcl ' d�rl 'd
•
l'-i't''''
'� t.!. . .�. 0. 41 a�ierr itWORMWY.. ,wlui Y.1.' , +It, : ;'- 'yI'e ❑ Add t,„ofmsemotorload 0 .,An.,lr...1.2•`w1.3o,
Job no.: I Job site llddress: ( G� \ �f''1 /� k /p Isis or or more. �x�u ajtion
1 1 - G � J V `� L r + 1 V G . ❑ ills. ar more reAldcminl units. ❑ !teenAlone! vehicle parks.
City /State ZlP: • (� ^� in I iudd,.xao t4elutics. ❑ Supply voltage for room ONO � \ �'\ % � C `+ . ! ❑ I hoodoos kxadons. ono sails nocnlnni.
Suite/bldg./apt.no.: Project :name: ❑ Service or feeder (00 amps ormore.
. _ 4. ai "il. B.+ {.Q A�:', i. . i .,'
Cross sIreet/directions to jab she: Ii. tu 1 ulh'. bee 1 I Will I
New residential single- or multi- family dwelling unit.
includesnttached garage.
Subdivision: Lot no.: 1.000 $t1. P. or less. 168.54 4
Tax map/parcel no.: Ea. add'1 500 $0. ft. or portion 33.92 1
!~Imbed mew, residential 75,00 2
t a 1 ■ , " , ^ a ., (with ithtwe sq. 01 -
` t.lm hod energy, mull- iltrnily 75.00 2
a WM. t. s & �! a G., . ; v 1 , s residential (with above aq. 0.) _-
Services or feeder slnatallntion. nitcrnt nnd rclu¢athin
A, 4, • 0 6, r `
♦ tom ` 1 'V. ` •'. C) to 4 _111. _ - r • 2 00 amps or less -- 1 00.70 2
rv r7 r ,, MI Ppp _. � s l e ',a C7.y 1; o " r /J21- A " * '' 14t ' " R5 ,. ;''''' "' 70lampsto•00=Ps 133,56 2
0!1 ...,,,t ,o. � f 11 t ry
Name •e-" ., " ���,• 40 41M1/1 10 600 amps 200.34 2
t � 60I amps to 1.000 tunas 301.04 2
Address: Over 1.000 amps or volts 552.26 2
Temporary services or feeders installation. alteration, undlor
City /State/211 >: reluamtion _
Phone: ( ) Fax: ( ) 2011 3flt or less 59.36 i
201 amps to 400 amps 125.08 2
O►vacr installation: This Atstallation is being made on property that I own which is not
401 setts to 599 amps
1
intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration. or extension, per panel `
Owner signature: __- Date: - A. Pro brunch circalat with
r "`` 2 l Mild, .21. a y, i... 0 �r j )1 y � , M t a ki.t;; i ' %' above service ur feeder fee
xww. � wJ a�+rww � t�r�t ' � �.t� n ..1:e, L 1. : { `'A. tr7dA� a. �} { a ,
each branch circuit . 7.42 2
Business name: it. Fee for branch ciroults wirhua, i
service or feeder tic, tine I 56.18 . 1 2
Contact name: brunch circuit
, Each udd'I branch circuit 1 ! 7.42 f L k ,
Address:
Miscellaneous (service ur feeder not lacluded)
w Mich manufactured or modular _ 1
City /State/ZIP: ti67.34 I
dwc}linit. aervfec andlnr feeder
Phone: ( ) j Fax:: (, ) Reconnect only 67.84 2
'Pump or irrigation circle 67.84 2
E Signor outline lighting 67.84 2
1} e , , M3 M^:ii7747r:11 ' +, a '�" A + r:. d ie 1 It r.. 'r rug it }1` .-« 11 • 1�lr., «. r. - 477. lu g' 1 + rlr,i
rerr ��
t.�« ilsiftL.lwa.. - �» tik circuit(a) or limited - energy
nel.alteration.orextenslan_ Paget 2
Business name: \pr�� jo ., . _. P
tech additional inspection Duct allowa in any of the utsOV
Address: S y I. y �� Add iliunul lnsputtlon (I hrmihi) 6625 /hr
-
_
"Zi --.T�._. �........ -.__ .. m,laveat' ionm.in _.....,66251.hr __. ,.....
Ci! /Stale /ZIP - ..�._. • _.. ( )- -T.__ _
} �' + .. - Industrial plant l l hr min) 78.181 hr
,Phone: (
`ax: l ns Y ionsforwhich no fee is
90,00i hr
a ( �^ �� R �� ` [ a c Iislad ('J, hr min)
4 Cl l Lie.: r.r �I y Electrical Lie.: L•"4M � S pry. Lie.: `151 ,,,m7...7 ;),A,1 ;Co,1LU m r;,_; IS,ei;E C iF .. ? �,1:, f
�� Subtotal
Supra'. Electrician signature, required- 1 / r. ,
Plan wive v25% of permit rev }:
Print name' . 3 , , ''' ( .41k A f , Date: 4 — — — State uurchargu (121/4or permit foe): ,
TOTAL PERMIT FEll:
Authorized signature: S. y
'fists lwrnrit npplkatlan rspires ifs pe rmit is flue ol,taloevl within ISO
duya diet It Lae been accepted as complete.
Print name: l Date: , • Number orireptcliomellnwed pee permit.
i 1lhrililte aveeinTI-C-namilApe aoe 117%511 4111- lf,151'I I1tt15101.1M1VK'fin