Permit q CITY OF TIGARD ELECTRICAL PERMIT
111 = COMMUNITY DEVELOPMENT Pe rmit #: ELC2012 -00242
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2012
Parcel: 2S111 CA05200
Jurisdiction: Tigard
Site address: 9500 SW LAKESIDE DR
Project: Massaro Subdivision: SUMMERFIELD NO.12 Lot: 672
Project Description: (1) 200 amp panel change
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Contractor: BENTLEY ELECTRIC INC - Owner: MASSARO, JOE
41330 SW EDNA LANE 9500 SW LAKESIDE DR
GASTON, OR 97119 TIGARD, OR 97224
PHONE: 503 - 789 -4229 PHONE: 503 - 739 -2025
FAX: 503 - 985 -9595
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/26/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 04/26/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
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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 0 952 -00 -009 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. D/� _ /
Issued By: L ! � l � — Permittee Signature: r ��Z / e� -7eN
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 603.639.4176 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.
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Apr 23 12 08:48p Bentley Electric, Inc. 5039859500 p.1
Electrical Permit Application RECEIVED FOR OFFICE l SI:: ON1.1
City of Tigard , Received
III APR 2 4 2012 Dam,, y 2 s 6, ' Penny N.6 - D0.2 ya..,
0 V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.7182439 Fax: 503.598.l96 D Other Penult:
Ti G A R D Inspection Line: 503.639.4175 C I TX OF TI GARD Date Ready/6y: to nr� SI See page 2 for
Internet: ww•w.tigard or.gov BUILDING DIVISIO Nodf1Od 4 ( I Supplemental lnforma
TYPE OF WORK PLAN REVIEW
Please all that apply (submit 2 sets of plans Winans checked below):
❑ New construction ® Additionlalteration /replacerrlent
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition 0 Other:
where the available fault currat ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
®I - Slid 2 -famil less to ground, orexeoeds 34,000 ❑ Commercial -use agricultural
} dwell' ing ❑ Commercial/industrial ❑ Accessory building
F i re for all other installation Installation o
❑ Multi - family ❑ Master builder
❑ Other ❑ Fire pump ❑Installation of 75 K VA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ 'A " - E ^`1 2', "l -
Job no.: Job site address: 9500 SW Lakeside Drive 100liP ormore. occupancy.
0 Si.c or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazirdous locations 600 volts nominal.
Suite/bldg.iaptno.: s Project name: Massaro ❑Service or feeder 600 ampsortnorc.
Cross streetldirections to job site: FEE SCHEDULE
Descript:en 1 Qh• I Pee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. IL or less 168 I 4
Tax map /parcel no.: Fa add'I 500 sq. A. or portion 33.92 1
Limited energy, residential 75.00
DESCRIPTION OF WORK (with above sq. ft)
150A Panel Change Limited energy, multi - family
residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 1 100.70 100.7 2
PA PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
Name: Joe Massaro 401 amps to 600 a hps 200.34 2
601 amps to 1.000 amps 301.04 2
Address: 9500 SW Lakeside Drive Over 1,000 amps or volts 55226
2
City/Statc /ZIP: Tigard OR 97224 Temporary services or feeders installation, alteration, and/or
I relocation
Phone: (503)739 - 2025 Fax: ( ) 200 amps or less i 59.36 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08
intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Branch circuits - new, alteration, or extension, � er panel
Date: A. Fee for branch circuits with
® APPLIC_ANT I. ❑ CONTACT PERSON above service or feeder fec, 7 42
each branch circuit
Business name: Bentley Electric B. Fee for branch circuits without
service or feeder fec, first
Contact name: Jay Bentley branch circuit 56.18 2
Address: 41330 SW Edna Lane Each add'I branch circuit 42 2
Miscellaneous (service or feeder not included)
C its /State:71P: Gaston, OR 97119 Each manufactured or modular
dwelling, service and/or feeder 67.14 2
Phone: (503) 789 -4229 I Fax: : (503) 985 -9595 Reconnect only 67.84 2
E -mail: jay@bentleyelectHeinc.com Pump or irrigation circle 67.84 2
CONTRACTOR _
Sign or outline lighting 1
J 67.84 2
Signal circuit(s) or limited -energy 1
Business name: Bentley Electric panel, alteration. or extension. p 2 2
Each additional inspection over allowable in any of the above
Address: 41330 SW Edna Lane
Additional insprstion (! hr mini 66.251 hr
City/State/ZIP: Gaston, OR 97119
Investigation (1 hr min) 66.5/ hr
Phone: (503) 7894229 [ Fax: (503) 985 - 9595 -
industrial plant (1 hr min) 78.181 hr
VCCB Lie.: 44467 7/13 I Electrical Lie. )� Suprv. Lie.: 3635S I : 2 -20c 7 I I O�) Inspections for which no fee is -
11
hr
specifically listed (!4 hr min) 90.00' 014
Suprv. Electrician signature, requited:
ELECTRICAL PERMIT FEES
Print name: James Powell 1 Date: 4-23-12 Subtotal: 100.70
Plan review (25% of permit fee):
Authorized signature: State surcharge (12% of permit fee): pig pig IA 0 e Y
Print name: Jay Bentley I Date: 4 -23 -12 - TOTAL PERMIT FEE: )( //,2 7 eY
/ 42r 7a
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