Permit , � CITY OF TIGARD ELECTRICAL PERMIT
: . IS COMMUNITY DEVELOPMENT Permit #: ELC2011 -00521
'TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439
Date Issued: 09/22/2011
Parcel: 2S110BC10400
Jurisdiction: Tigard
Site address: 12031 SW CAFFALL LN
Project: JOHNSON Subdivision: BULL MOUNTAIN VIEW ESTATES Lot: 2
Project Description: (3) branch circuits.
Contractor: BEAR ELECTRIC Owner: JOHNSON, DEBBIE S
PO BOX 389 WARZENSRI, DANIEL T
DONALD, OR 97020 WARZENSKI, STEVEN
12031 SW CAFFALL LN
TIGARD, OR 97224
PHONE: 503 - 678 -1355 PHONE
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 09/22/2011 $71 02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/22/2011 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79 54
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -0010 through OA' •52- 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800 332 2344
■IIIIIP VIP i
Issued By: 1 "_c --- Permittee Signature: _ — _ _i ._..�‘,....
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
5EP 21 2011('JE0) 08:05 Bear Electric (FAX)5036781108 P 001/002
Electrical Permit Application FoR OFFICE USE ONLY
NI City of TiigaxYt �� nn y
``V' s ,.•
^k 13125 SW HaII Blvd., Tigard, OK 9722.3 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 . t �$�" Dete/B : Other Permit;
Inspection Line; 503,639.4175 ��, O ! Date Read /B El See P. 2 far
TIGARD Internet: www.tigard- or.gov � ( y (. 1 48)1Aed/Method: Supplemental Information
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,M.», 1 * , :, A t „ M" ' ' w ,r Okipx iiici + 1„ f , ;,-; W42 v. , ' 4- t t I^ i r :ii , � '1 „” A a h P t g „
❑ New construction Addition /altt:lation /replaee tt \,,,' - Please gam, check that
apply (submit m t a sets o ❑ building over �r!�t�QM p t� ,: ,N J��yy(�1 � q �YW, y
a x r'L - A ^. Y »". Yt 4 M ky av'"�f�,,' --»A _ ...- ..5._. �W AA I ' -�»�C ri», btZ Av +4A " ANMwYV IW'�f4'�2AM1 i _ 2�.� ,ygY�y�p � M x
aXNrM: . hit
n
checked below):
®' Y Y erthreestones.
❑ Demolition ❑ Other: c�� 4� " where the amiable fault current ❑ Marina and boatyards.
, ,p� ",.. . 4 R .
,A a• ro , � rl , -, -- GO _ ,. . _.. ... _ _.. ... t .,. , P ❑ Floating buildings,
w'�.dd�k'R�.S.,r'1 It M. - "' � ; . � �� Q CDI�ISZ OIV ( »'It. l , „ � , , . ; w- „ exceeds 10,000 amps 150 volts or F ,
. . .. - , ..
and 2-family dwelling leas s o o n all Of installations. 14,000 ❑Commercial -use agricultural
5.l-
y g ❑ Commercial/indtrstrial Q Accessory building amps for all oilier installauona. burldiags.
Multi - family 0 build er ❑ Other:
„x " "r 'il - -.. . ❑ Fire pump, ❑ Installation of75KVAor
K .. ft s q i ❑ lanaracncy system. larger separately derived system.
❑Addition ofnew motor load of El "A", "E ", "1-2 ", "1 -3 ",
Job no.: rJob site address: { .� 100Hr or mate, occupenry.
I W y -
�� `W��C '1 u_l ❑ Six armory residential units.
in Recreational vehicle parks.
City /State /ZIP: s ` lb t a ^L ❑ Health -care facilities 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suitc/bldg. /apt. no.: Project name; ❑ Service or feeder 600 amps or more,
t4 ^III. A Y , a l M+,', ' ;.; v :hi);t a ittSC wdll Y r IY th"' 1 04A. ", 9!«..ve 4 7v 4 yr A,
Cross street/directions to job site: beecrip too ( g j , 1 F...___1
New residential single- or multifamily dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft or l 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy. resldentlul 75,00 2
7 :: ,A. .
;:;; (with above sq. 11,) 11,) a.. x
k..' a "a i r 'J� "a1 CItIPI'AIO 1701��I�4 ." .i' i l
� � Limited enen . multi - family
75.00 2
Q - KD\k ‘ C-‘7 _� C r-hr ‘\ I residential (with above_ Q ft.)
'� ` y ` `' ` , S ervices or feeders installation, alteration, and/or re location —
At, , -1 e n lk ._ • 200 amps or less 100.70 2
1 s.1, :l ;. a t_-. x.rO,.P,::1 rI
w , 4'1' + , 1 'i 4 ",,,,,L .r: i -r S it,E>1T Mill'' AAA. t,k hu A(AI r,, 201 amps 10 400 amps __ 133.56 2
401 amps to 600 amps 200,34 2
Name: - -
601 amps 101,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Cily /Slott /ZIP' Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) _ 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 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
Branch circuits - new, alteration, orex tension, per panel
Owner signature; Date: A. Fee branch circuits with
41 • . - k" : , N t IN M , ab69c cc or feeder fee 7
b Yv1M041'4',. ' �•�I ° t J "" , :, „,r� r(Y�, ,.. ��� �.s,.� . .42
' r+�";v w
each branc cirottn
Business name: D. Fee for branch circuits without
service or feeder foe, first ‘ $6,18 5 , 2
Contact name: T branch circuit
Each add - 1 branch circuit - . 7,42 j I-- 2
Address: Miscellaneous (service or feeder not included) _ _ _
Each manufactured or modular
City /State /Z1P: 67,84 2
dwelling, service and/or feeder
Phone: ( ) Fax: ; ( ) Reconnect only 67.84 2
E Pump or irrigation circle 67.84 2
II a Sign or outline lighting 67.84 2
MM tf0t , 34 , : IYMw , r CONTU t” rVV' - is w r (' itw I' ',„.:m. , ,7' Signal circuit(s) or limited-energy
Business name: �- F \ {"� • \ . _. panel, alteration, or extension. Page 2 2
3 Each additional inspection over allowable in any of the above
Address: C) +� - �l
f 1 Additional inspection (1 hr min) 6625! hr
'�
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: �a J A all Investigation
Industrial plant (1 hr min) 78.18/ lir
Phone; (533 (.1.1� 4 Fax: (503) i1 ;` \Q • Inspection for which no fee is 90 to
CCB Lie.: tQ Electrical Lie.: i �- .413..11' listed 4 hr mini -
i � trMcwa�ui ra:va�aw A u ,
,,, - ..
I rat wr
Y ti
, Subtotal; 1' .0.52
Suprv. Electrician signature, required:
i Plan review (25% of permit fee):
Print name: 4 �j? t l Date: C - 2 1.-1 State surcharge (12% of permit fee)'
Authorized signature:
TOTAL PERMIT FEE: _252-•
i , 5
This permit application expires Ira permit Is not ubbilned within 1.1
days after it has been accepted as complete,
Print name: Date: • Nutubm of inspections allowed per permit.
I:touddiii Permita\ELC- PernhltApp,doc u7/UI /In 440- 46157(11 /05/COMfW6a