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Permit II �n CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 00719 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/23/2011 Parcel: 1 S135CA00303 Jurisdiction: Tigard Site address: 9605 SW NORTH DAKOTA ST Project: GILLINGHAM Subdivision: MEADOW VIEW Lot: 8 Project Description: Panel replacement and (2) branch circuits for A/C and furnace. • Contractor: BEAR ELECTRIC Owner: GILLINGHAM, TERRY L AND PO BOX 389 SHARON A DONALD, OR 97020 9605 SW NORTH DAKOTA TIGARD, OR 97223 PHONE: 503 - 678 -1355 PHONE: FAX: 503 - 678 -1108 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 12/23/2011 $100.70 Specifics: amps or less 2 crt Branch Circuits w /Purchase 12/23/2011 $14.84 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 12/23/2011 $13.86 Electrical Type of Const: Occupancy Grp: ' • Total $129.40 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 -0090. You ray obtai - • • • • - ct questions to OUNC by calling 503.232 1987 or 1.800.332.2344. s , Issued By: _ / /�� _ � �' _ i Permittee Signature: _ At-� �' .rl. 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. DEC 23 - 2011(FRI) 15:26 Bear Electric (FAX)5036781108 P.001 /002 El ectrical Permit Applica R Ur'r'10E USE ONLY Reserve ui-/ i City of Tigard j �� P No.: . nare/u : i 1I __ E.,,,.{,_ I I — -� ( Iii m 13125 SW Hall Blvd., Tigard, O rim Revie Phone: 503,718.2439 Fax: 50 '1960 1� Odicr Permit: t 'LQ DatelB . I� �.0 -, I I� .' c.) j T1CARD Inspection Line: 503.639.4175 1, i) Si See Parc2for Internet: www,tigard- or,gov Supplemental Information ': w„-r,',-::,- .,+.,.,41. r,. _::_ ..'_;5iat:=:•-2 : . .. i � ",.,' :V = _:..: ;', » ,ti;;i.:_'a' i i g .:ti;ir ., `r: ; :'ati:�s�t -� 15c.':::..s 1�:,,r31 'EOF wOR)( Q. :.: .:.: �._ , RLVItiW4s. ;;.:1r, sl,r A ❑ New construction Addition/alteril�io r"eRla`6e eat Neute cluck all that apply (submit 1 sets of plans w checked below); Demolition 0 Other: ��`l'l' ©Service or feeder 400 amps or more CI Budding aver throe rtonos. IJ `as a where the available fault current 0 Marinas and boatyards. M; • a ,� # 9- 1 ' C aF. 0:WS#1410�1� � R � t � .;,_:V.:. " '.'' exceeds 10,000 amps at 150 volts or ❑ Planting buildings. '''d C less to ground, m exceeds 14,000 1:I Cosmauclal -use agricultural tig.1 and 2- family dwelling ❑ Commcrcial/indusirial Q Accessory building amps far dl other installations buildings. ❑Multi- family El Master builder ❑Other. 0 Firs pump. 0 1 Installation of 7S KVA or ,, y a Emetgenc�y syat esn. larger separately derived system, it f i g.i;1,;JOB .S $ OR1VIll C1 '._ 0 ..• i 2 Addldon of motor load of 0"A". "E", "1.2 ", "I -3 ". Job no.: Job site address: `''►t 106HP or mom. occupancy. s y t � 1 (] Six or more residential unit Recreational vehicle parks. City /Statc/ZIP: t `--lr'•\. v 0 Health-care facilities. 0 Supply voltage for more than l i 0 lluzardous locations. 600 volts nominal. Suite/bldgJapt. no.: Project name: 05ervl or (midst 600 amps or more, ,01:4lifiE74.00000.110ZETSCHEDWIERRililltiniE5110 Cross street/directions to job site: De rr♦ tea I ply, I 5, I Taw I • Ncry residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. it. or less 168,54 4 Tax map /parcel no.: En. add'I 500 sq, n, or portion 33.92 1 e.c,,.r ^± , pr�n a•. •, v�,n. =c v.� apses.• �:irru{m� Limited energy. residential 75.00 2 ' i itt l K �r�ylT , , 'gip , - (with shove sq. R.) R' . + + •"'•� ti QAlm r,:� '+1.. "e :.. .:i.Er"�'F � Limited energy, mulli•family y res id e ntial (with a bov e a q. I).) 75.00 • Oil t, \ \C, ors r r. • V lea 1. Services ar feeders inatallatlon and/or relocation ■ . 200 amps or less 1 100.70 2 : , "i;i:s iil:INITCOl'$ ig4i, ' ' ....1_:_ g ,2..0 , CJ tw S , l'+ %G .?: .,,, 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200,34 2 Name: 601 amps to 1,000 amps 301,04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeder; installation, alteration, and /or relocation _ - Phone: ( ) Fax: ( ) 200 amps ur Iess 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps l0 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 neaps l0 599 tines 168.54 2 Branch circuits- new, alteration, or ertenstorl, per panel Owner signature: - A. Fee fur brunch circuits with h ��i� - - an a��• ' •' � ' , - - ,. , ?I' - "� anal 1e- �" - -CQ ., Sdt!►�.rY above service or feeder fee 7.42 1 4. 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee. first 56,18 2 Contact name: _ branch circuit Each WWI branch circuit 7,42 2 Address: Miscellaneous (seryice or feede not in cluded ) Cit /Suh[e/ZIi': Each manufactured or modular 67.84 2 y dwell tau, service and/or feeder Phone: ( ) i Fax: • ( ) Reconnect only 67.84 2 Y Pump or irrigation circle 67.84 2 E -mail: _ E - * y / /( /'��yr�r t+a Sign or outline lighting 67.84 2 x1 ' r '�S. M.a i! .. -r '4r9�� , - :4�.ONIP t, tAre®i . Y fta,. � , AI�I _. i. • ^ - Signal circuit(s) or limilut- etierKy Business name: Gic, [�,e(� `t 1�` • �'v. , panel. alteration, or extension. NM 2 � — Each additional inspection over allowable In any or the above Address: Pr 0- " • Additional inspection (1 hr min) 66.25/ hr City/State/ZIP: �Jr` i ib 'r % ii Industrial (1 hr min) 66.251 hr >+ ]ndhuaial Ohara (1 hr min) 78.181 hr Phone: ( • — Fox: N hlspeulions lhr whico fcc Is `�-� X11► �� •" a h n specificN�listed1ihrmitt) 90.00/ hr CCB Lie.: ele 1ill Electrical Lie._ 4 h` I Suprv. Lic.: ,, Al i egaic 'liP.LI Ii1Vl;1 11 SIk. :.. 1 Suprv. E;loctricia, =;mature, required: Subtotal: 1 k , 5 � Air „ es...,- a..- • -- _ Plan review (25% of permit fee): Print name: 4 V6s4 9 5. Date: . - 1 State surcharge (12% or permit fee): ,OD r�Y .f TOTAL PERMIT FEE: t • L 1C ~ ) Authorized signature: Thla permit appfcatluo expire. if • permit L sot obtained within IVO Print none Date: days after Ulm been accepted as complete. Number of inspections allowed per permit I:\ PuildiOTROOliltO ll.C- PaniatApp.aoc e-7 /0hl1 o 4404615T(1I /O51COMM1VFA •