Permit , CITY OF TIGARD ELECTRICAL PERMIT
L =' COMMUNITY DEVELOPMENT Permit #: ELC2011 00394
TlGARU 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011
Parcel: 2S103BC00600
Jurisdiction: Tigard
Site address: 12605 SW 121ST AVE
Project: Subdivision: Lot:
Project Description: (1) 200 amp service
Contractor: BEAR ELECTRIC Owner: STEVENS, JAMES H AND LYNN N
PO BOX 389 12605 SW 121ST
DONALD, OR 97020 TIGARD, OR 97223
PHONE: 503 - 678 -1355 PHONE:
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/15/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 07/15/2011 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 - ,95 -6 -00.1. 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: 7 Permittee Signature: ON / / Lf( 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.
JUL -14 -2011(THU) 09:114 Bear Electric (FAX)5036781108 P001/0O
Electrical Permit Application RECEIVED - ,0,,,„,,..-.... us., ,,N...,,
. City of Tigard
41 13125 SW Hall Blvd.. Tigard OR 97221
Phone: 503_718.2439 Pax: ' 503.598.19(i()
14 1 .11' JUL 14 2011 Emmen! ,,,,,WMIl Penult No.: 4-z ,. ,
lifialli Wm ' ilcnnil;
inspection Line: 501639.4175 crty OF 'TIGARD D'ilel41,10.'illY: Jnit 1:1 See Pagel' Mr
TI CARD
Internet: www.tiraucl-or.gov RI 1 1 NG niVISIO . iNa liodim.hod: 'num. Su elemental Inlartriudon
,. '" . :(bl'.''''''''i'i`'''''.''''' , "'"P.7-". 34* • . t•In N'"4■.., ii:A0,481'r,arf,'"4,,A,,el, 4.,,-. i,,,,,t 4 m ,4 / 1 , • ': ., , „0 0.44,‘„,,, 44,7 fr,:',.;, • 4' , I ' - , ..: - , L;14,i11
0 Ncw construction 3 Addition/alteration/replacement please noeuk nil nun apply (suhrol i 7 seis ofplans se/items checlos.1 he(m):
CI Service or feeder 40(1 amps or more 0 Building over three stories.
0 Demolition El Other: bbhere the available fault current E3 Marinas and boat)anis.
''.1:;;•111:::ii""z1V,:z^41.1-. ? -y , ,■ oil'' T "."'. cc , ccvd1 19 1A11/1 4 1$1) vuhs °I. Dl win bulklIn
less to laounu, or malteds 14.000 0 Corrmicn:ial-oso agricultural
EL 1- and 2-Family dwelling 9 Commercial/industrial 0 Accessory building romps Our all other Installations. buildings,
in Multi-family 0 Master builder 0 Other: 0 Plre pump. 0 Inkallailen or 75 KVA or
. ; 4.^-----.. ,,, . 0 Emergency system. larger separate!) derived tiYstem.
.';;' ''`' 4, '" OltilarigiMpVAVipigarille0,04C,110 6' I' ' O'i '." t"`. . '',..:" MI Addition of nes., mmor Itind of 0"A". "1 " l-r,
Job no.: rzirsre address: V ,..)\,,.., \2\St ANie
- . - , 100111 or more
0 :its or ropes tcsdential units. oucupano.
a ItccreatIonal vehicle parks.
CityiSlitteZIP7 4 09 , Ck-.Vallal.111 0 I Ittalth.ccre fsellIties. 0 Supply voltage for mon: thun
Ciliatardous lomtions. 61111 volts won't nul.
Suite/bIdgiapt. no.: 1 Project name: 0 Soviet:or ftebils 100 limps or more.
egE1,5112,1ZD'Ent
CM:tt; $trttthiirections to job site:. arum son t u. i4 I Itttli
...--,-+.
New residential single- or m ulti dwelling unit.
Includes atteellal garngc.
.
Subdivision: 1 Lot no.: 1,)D0 set ft or less 1 ,6854
Ea. *14'1500 sq. ft, or portion 31,92
Tax map/parcel no.: Limited energ residential
"15.nt) 2
Limited energy. multi-tinnily
75.UU -1
residential with above s it)
_Services or feeders instollutionoiltoration ondior relocation
2110 tontot W ICIS 10(00 \c, 4 2
1 1 ,, , ,. !:. ,, , , A.N Aer,+;0. El !''' -1 „ , i i' , P'' ".. 'Ir. ' .. , 4' I t '' 201 UM Iv 400 14110 133.:56 2
• .10l um lo 6u0 amps 200.34 2
Name: .--C 7" 6fi i inno, tu t.000 amps 301.04 2
Address: .5 4t/Ve- 0,., 1.00U amp % or Suit 552.26 2
Temporary services or feeders Installation, alteration, tin dior
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 5936 1
201 amps to 4(0 =pa 125.011 2
Owner instillation: This installation Is being roads on property that I own which Is not
intended for sale, lease, rent, or exchange, according io ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54
Branch circuits - new. allenollon, or extension, or Ertel
Owner signature: Date: A. Fee for brunch circuits wail
" 1:. ...:4:41 ,,,,,. ;:ela L770 "•+.:■".,C.1„',, 4' , l i n , ;, ,:,,,. .„ A 4,,, : ci : t r ,i f i rla rcc 7.42 2
Business mime: B. Pee for branch circuits without
service or feeder fce, first
56.111 2
Contact name: hninch circuit
Each add'i Smelt circuit 7.42 2
Addrecs: miscellaneous service or reader not included
Each manufactured or modular
City/State/ZIP: liwellisti. and/or feeder 67.84 11111
Phone: ( ) 1 F. , ( ) Reconnect only 67,84
Pump or irrigation uirete 67.84 2
E-tuall:
Sign Of outline lighting 67.84 2
signal cimuito liniii
Business luirne: panel. alteration, or cittentiOn, Paso 2 2
Each additional inspection over talloi o
sa hie in we of the tanom
Address: • Q -.9.,,c, Additional Inspection (1 hr min) 66.211 hr
Investigation Cl hr min) 66,25/ lir
City/State/ZIP: Illb 41 . C. e • 1111 — )C23 _ Industrial plain Cl hr nun) 78,13/11r
Phone: L .5 0 i -17,-1. Fax: I a 111 :, ,-- (2) 1, lremections for whltat no feu la 90.00/ hr
. a eci5collv listed in hr mitt)
t CCB Lie,: 6,1 • EIMMEINIIM Suprv. Lie.: = .,,, . 1 Ow ft
' 'fit StiblOtO I:
Suprv. Electrician signature, required. -
Plan revieW (25% of permit fee I:
Print nante:.\_epta I" I I ci Date: i — i 1- stnic surcharge 02% or permit fee):
■
Authorized sigtuttlIte: This permit oppneation expires Kit permit is not ohm toed within lItO
dun after it lin, been accepted as complete.
Print name: I Date: * Nanner 0 r tits rititA it)I15 allowed per permit.
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