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Permit CITY OF TIGARD ELECTRICAL PERMIT 11111 , COMMUNITY DEVELOPMENT Permit #: ELC2009-00141 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 639 4171 Date Issued: 04(01/2009 Parcel: 2S 103DD02600 Jurisdiction: Tigard Site address: 10900 SW GARDEN PARK PL B Subdivision: Lot: 0 Project: DeMarc Project Description: Install (3) branch circuits Heat pump, service receptacle, reconnect electric furnace. Owner: FEES DEMAREE, THOMAS E & JUDITH A Quantity Description Date Amount REVOCABLE LIVING TRUST, BY DEMAREE, 3 crt Branch Circuits 04/01/2009 $60 15 THOAMS E & JUDITH TR, PO BOX 23944 wo /Purchase Service or PHONE Feeder 1 ea 12% State Surcharge - 04/01/2009 $7 22 Contractor: Electrical BEAR ELECTRIC PO BOX 389 DONALD, OR 97020 PHONE 503 - 678 -1355 FAX 503 - 678 -1108 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $67 37 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain n acopy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800 332 2344 p Issued By: — Permittee Signature: l ( OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N Date: LICENSE NO. Call 503.639 4175 by 7:00 a m. for an inspection that business day. This permit card shall be kept In a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. .:. RECEVE . . rotz clrFlcc lisixa it Electr Per mit A plication - , MAR 312009 r • • 9 pett,+is Nu.:' E _ell. . O 4 ■ City of Tigard Dalrre . • ' l L2 _ 4i 1 111 - r 13125 5W Hall 1i1vd -, Ti�ud 97n Mao wr is° cm,. Permn = Phone: 5034639A171 Far: 50359$d TIGARD nmleta ' , steYaSo!Tor lnspeetion l.irlc :.5p3.639A175 BUILDING DIVISION p D a l e ca4/ thod: Sapptr 2 for Y:fGniiT]' ( : www,trgard.or0 V TYPE OF !NOM , PLAN NOM PLAN REVIEW . ri Place check all that apply (submit X sus of plans wtitems checked bebW }' New construction Additi /alterttiuolt Addition/alteration/replacement Q Service er feeder 400 amps or mote 0 %itding over three stories, ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards- _ e:txeds loAao otapsal ISO volls (? }'lmtiegbultdiu�. '' • 4.W - - - - L1C}N Iss to ground, or exceeds 14,000 Q Cnmau,ciat•ure agricultural ig 1 - and 2- family dwelling ❑ Commercial /industrial Q Accessary building amps for all other installations, buildings. Q Fire pump. Cl Installation of 75 KVA or it4a ster builder ❑ Diller Larger separately derived system. p l,�ttlti- rart Cl ©Eme Emergency JOB Siir4' INFORMATIOPI AND I4I.Q ❑ Adeitioo of war motor toad of ❑ " Rey- I.2' , "I.3 ". q03 ` ∎L 11 _ si. or m ole. 1 ',chick Jab n0.: i Job site addr l t r a • O SIR w o r more. r ememral un11s. !7 gee"' �`�' �� () Supply voltage for more than 13 Health faeilitid- 600 SuPP wits Ram nut Cily/Stall�ZlP: 1 C i ~ - _ 0 Hazardous locations. o ❑ Savi`'e or feeder 600 amps or mane. Suite/bldg./apt. n0 : r� Project name: FEE SCHEDULE Cross street/directions to job site New residential single- or mold - family dwelling Ludt includes attached garotte. l al no 1,000 sq_ R. or less M�� Subdivision: Fa. addl 1:10 sq. ft. or portion 33A0 Ell Limited energy. residential 1111 75.00 � � Tax map/pu[ticl no.: . a �bN with above ttw° himited etcmt;Y. multi- fancily 75,00 � � i it 4P`a. � , * r . %.. iesitkd 6 1 w h above _ n. •- art ;k 1 OA V - r . „ -- . 'S J \ C a. • • , 200 am - or lees 80.30 �fl C-..,.. � e v � � „`+ 201 amps to 400 amps MI IMO - [� 1'RO�IrRTY' own* N` 401 amps to 600 amps 111M 160.60 — Name 601 amps to 1,080 amps 111.1 240.60 WI Over 1,000 amps or volts 454.68 ill Address: Temporary services or feeder's installation, alrerallea, Radler City/State/ZIP: /5tatrJZl P: relocation or less Phone ( ) I Fax ( ) 200 Z 66_ fl amps dt5 201 amps to 400 amps 100.30 Owner Installation: This installation is being made on property that I own which is not 201 594 amps 133.75 intended for sale, feast, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alienator. or estensiotaper panel - Owner signature: Date A. Foe for branch circuits with ❑ CONTACT rERSON above stxvicc or fcedcs fee, 665 2 t} ppi r lGAPlx each branch circuit B. Fee for branch circuits i Business name wlrheur tcrvice ar feeder fee, 46.$5lD' a Contact names first branch circuit ��7 Each add'I branch circuit 6,6$ ►MO Address: manufactured or modular • 90,90 Ma City/State/ZIP: dwellin: ravine and/or leader' II ��� Phone: ( ) Fax:: ( Reconnect only 53.40 Q Pump or irrigation circle E-mail: C Sian or outline lighting MI 53.40 111.111 CONTRACTO Signal circuit(s) or limited - Business name: Dear Electric, int. energy panel. alteration, of 2 extension. dscribe: Page 2 Address: PO Bo: 389 Each additional los crtion over allowable is on of the above City/State/ZIP: Donald, OR 97020 Per i •. - don MI 62 IMMO Phtmm (503) 673-1355 Fax: (S03) 678 - 1108 Investigation per hour (1 hr min) IIII 62.50 L11. Itudustrial Plant . � hour 73.75 IMMEll CCB Lie.: 20919 Electrical Lie.: 24-107C Suprv. Lie.: �ij ELECTRICAL PERMIT FEES Subtotal: � { ,. Supitr. Electrician signature, required: `� Man review (25% of permit fat): IIIMIIIIIM Print name: • 101101 — - A `i % • ' ��tk Date: ”' • .. . - TOTAL PERMIT FEE: (pi r Author n signature: _ ills permi application repieta if a permit it not abtat within 110 Date: days after It has been arrepled it complete. Print name --- — • Humber ofilopeetiane Allowed per permit. atw61 Srt11 M eOJ,IWEn [rBu+1dF8'ram3rF�.Gf4Tmir�WP�c OS Z7 06