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Permit x - CITY OF TIGARD ELECTRICAL PERMIT • -' COMMUNITY DEVELOPMENT Permit #: ELC2009-00226 TIGARD! 13125 SW Hall Blvd., Tigard OR 97223 503 639.4171 Date Issued: 05/20/2009 Parcel: 1S 133DA04200 Jurisdiction: Tigard Site address: 12550.SW GLACIER LILY CIR Subdivision: --� Lot: 0 Project: Project Description: (3) branch circuits for reconnect heatpump, install service outlet and change out breaker. Owner: FEES HALE, DIANE F Quantity Description Date Amount 12550 SW GLACIER LILY CIRCLE 3 crt Branch Circuits 05/20/2009 $60 15 TIGARD, OR 97223 wo /Purchase Service or PHONE. Feeder 1 ea 12% State Surcharge - 05/20/2009 $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 9 01 -0 00 You may obtain a copy of the rules or direct questions to OUNC by calling 503 246 66999 orr 800 332 2344 Issued By: e/— Permittee Signature: OA/ 4/ /G/ L , 9 --- 7 7 0 ^/ 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'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. uk„,_„r, v 4,....r n , Electrical Permit Application r o R OFFICE_ USE ONLY -° ,� ry N i - _ . _ City ofT; and MAY 1 3 2009 p:„,„ EG6',� De 'J � I7aLe.'4 . � �✓ /3 a - _...i te. No.- • 13125 SW Hail Blvd, Titrttd, OR 97223 n Ptmt Revi - Permit � , ,, ..1.-1 RE 7 ,; Phone: 503,639.4171 Fax: 503.598.1 OF TIGARD p alUgr . Other Permit: Inspection Line: 503.639.4175 B UILDING DIVISI011 aRsady"p — t'� T1G A'itD r• � y � � H see Paget for hU i www.I and -0r.gov Nalified'Method: / / Supplemental Info modem TYPE OF W OR K PLAN REVIEW _ - ❑ New construction El Addition/alteration/replacement Pt r1 cic all that apply twbmitX sets of pLm wilwees checked wow): ❑ Demolition Q a 0 Service or feeder440 amps or mote ❑ Building over three xteries. whore die available fault current Q Marinas and boatyards. C4TECORY OF CONSTRUCTION exceeds 10,000 amps III ISO vas or 0 floating buildings. less to ground. or easels 14.000 ❑ Cearrancrciat -asst agriculrwat to 1- and 2-family dwelling ❑ Commercial /industrial 0 Accessory building amps for as other installations. buildings, [o Multi- family © Master builder [] Other; O Fife pump. O installation of 75 KvA or ' JOB S 4NFORAIA11ON AND LOCATION . - - Ertietgcncy system, larger separately derived system. QAddilioDOfMtvamlar (� "A ". "E °1.2 "1.3 ". Job not: Job site addr ss: r 5 \ . ` mow or mote- oaupancy. (]Six or more residrraial units. 0 Reetcatiarai vrhiele parks. ay/Slate/ZIP: - 7 t \ ((� ° ci � i.2 ❑ Heath-rare facilities. 0 Supply voltage for mote Ono f in Hazardous locations. 600 wits nominal. Suitdbldgfapt.no.: I Project name: l7 Service or (croder600 amps. ormore. FEE SCHEDULE Cross s1r fdirrxtions to job sit= Description I Orr- r I Total _I - New residential single- or muItl-fatnilydwelling unit. Include attached garage. Subdivision: I Lot no.: 1,000 sq. It or less 145.15 4 Tart map/parcel no.: Es. addi 500 sq. IL or portion 33.40 l Limited energy, residential 75.90 2 ,,* r., .. :eA0 ;OF. WDAK , (with above so. It.} (� Limited energy, multi- family C C C A C , Is .) \I - )Z - V `a, \\ "C'\l,C, 0 residential (with above sq. n.) _ 75.00 2 Services or feeders tnstatlatla al_1_eratlntt, and/or relocation AIM. YiQ C O. ; l _ ,' Cy„ � 200 amps or less 80.30 . 2 ' • D PROPERTY- OWNER :J,. ''' C) TENANT 201 amps to 400 amps 106.85 2 Name 69.✓t= ? , / : I-E / 4/� -eC i t 4— 441 amps to 600 amps 160.60 2 f ! / 60 1 amps to J 000 amps 140 -60 2 E _ _ Over 1,000 amps or volts 454.65 2 City/StatctZ1P: Temporary services or feeders lamina alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less _ 66.85 1 Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 _ 2 Branch circulti -uew alteralion or exten , , ds n, par pane' Owner signature_ _ - Dat A. Fee for branch circuits with t3 AP.PILJCAN Q P.1?.:R 'CONTACT $ON above service or feeder fat, cacti branch circuit 6.65 2 Business name: B. Pee for h Lich cjrCUIis - fee without service or fond Contact name: ar fast branch circuit , 46.8$ 4�r$S 2 Address: Each add'I branch circuit 1 l - 6.65 1 2 - - - - - - Miscellaneous (service or feeder not included) _ City /State/ZIP: Each manufactured or modular 2 dwelling, service and/or fouler Phone: ( ) ] Fax: : ( ) Recomtcct only 66.85 2 E -mail: • • Pump or irrigation circle 53.40 2 .. ,,' , . , (CONTRACTOR ' _ Sign or outline lighting 53.40 2 i Business names Bear Electric, Inc. Si circuits) or limited- energy panel, altsation, or Addnxs: PO Box 389 extension. Describe: Page 2 2 City/State/ZIP: Donald, OR 97020 Each additional inspection over allowable is on of the above Phone. (5031678 -1355 I Fax (503) 678 -1108 Pi inspection I 62.50 Investigation per hour (I hr mitt) 62.50 CCB Lie.: 20919 Electrical Lie.: 24 -107C Su: . Lie.: • C 1, Industrial plant perhour 73.75 Electrician signature, required: ELECTRICAL PERMIT PEES Su prv. $ �j Subtotal: , ( Date: Plan review (2556 orpermit fx): Print name: ; �.t�� a. A 1. �A<„ a, 1[l.! lb. State s rcharge (12% of 14.--(2-2---') permit fee): Authorized signature: TOTAL PERMIT FEE: 1 a �� - Date: This permit application expires If a permit h n obtained „iihla°18O Print name: Date: atter It has Bern accepted as to . - • Number or inspoetiogs allowed per permit. Lauitdaselo arELGik alearp ear CS23 06 444.46 1 M t I OS COM WES