Permit CITY OF TIGARD ELECTRICAL PERMIT
'r -'ll = COMMUNITY DEVELOPMENT Permit #: ELC2012 -00359
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012
T1GAFiD Parcel: 2S110AD08200
• Jurisdiction: Tigard
Site address: 14809 SW 106TH AVE
Project: Phillips Subdivision: LANG HILL NO.2 Lot: 74
Project Description: (3) branch circuits NC service outlet - Gas furnace
Contractor: BEAR ELECTRIC Owner: PHILLIPS, JAMES & ANNE
PO BOX 389 14809 SW 106TH AVE
DONALD, OR 97020 TIGARD, OR 97224
•
PHONE: 503 - 678 -1355
PHONE: 503 - 244 -3420
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 06/11/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/11/2012 $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- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 2 32 2 .1987orr1 C 8000.33 1 2..23 `'
Issued By: dikej4 Permittee Signature: 4P // l ! DI.
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.
JUN- 07- 2012(THU) 08:25 Bear Electric (FAX)5036781108 P.002/003 S{
Electrical Perm Appli catio CEIVE D FOR OFFICE USE ONLY II
City of Tigard Received , In.- s,( Permit N a _ 0055' P
IN , r 13125 SW 1•Ia11 Slvd., Tigard. Ok 97223 I U N 0 7 20 12 Plan Rev ��
• Phone; 503.718,2439 Fax: 503.598.1960' Date/Br. Orkin PermliP' /-2
TIGARD Inspection Line: 503.639 OF+�TI(3AR� Pate RI See Page 2 for
Internet: www.tigard- or,Bov p�� CITY NmiliediMahod; • SspplemenalInformation
TYPE OF Wt 9Rl'e O NO DIVISION PLAN REVIEW •
•
-
New construction l Addition/alteration/replacement all that apply (submit sets of plans whims checked below);
❑ Service or feeder 400 amps or more ❑ Building over three stories.
Q Demolition ❑ Other
where the available fault curse Q Marinas and boatyards. •
• . .. CATEGORY OF CONSTRUCTION . ezceeds 10.000 amps at 150 volts or O Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -tier agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps Coral' other installations. buildings.
Z1 Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of75KVAor
JOB $1TE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
... 0 Addition of new motor load of Q - A ", - 4 ", - 1.2 ", - 1.3 ",
Job no.: I Job site address: 14809 SW 106th Ave 100HP amore. occupancy.
❑ Six or more residential units. 0 Recreational vehicle parks.
City /Stale/ZIP: Tigard, OR 97224 O Healiheare facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suile/bldgJapt. no.: I Project name: OH in Service or feeder 600 amps or more.
job site: s®
Cross street/directions to
. Description ....... I Qtr. I Fee. ranti 1 • ,
New resldentlal single- or mold -family dwelling unit
Include attached garage
Subdivision: Lot no.: 1. u6 ft. or less 168.54 4
En. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
- ' . 4': • ..,'-'.::-... ''''-. DESCRIPTION OF WORK. • `: ! .! :::; ; -. . - (with above sy. tt)
Limited energy, multi- famil 75.00 2
AC - Service outlet - Gas Furnace residcntia with above 5. n.)___ _
Service or feeder. instaiation and/or relocation
200 amps or less 100,70 2
IRIFPR01ER . ❑'TENANT -:, • _, 201 amps to 400 amps 133.56 2
F . .. • .. .
401 amps to 600 amps 200.34 2
Name: James and Anne Phillips 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
. Temporary services or feeders Installation, alteration, and/or
City/Stme/7,IP: relocation
Phone: ( ) F ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125,08 2
Owner installation: This installation is bein made on property that ] own which is not • 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch curer its - sea, alteration, or =tension, r panel
Owner signature: Date: A. Fee for branch circuits with
_ >- ' above sery or
. � _ .:� -,. -. -- , Q.A�PLCAlV7'_..., - . ..: .:: .:::.: ..: ::.' •-- . I].�ONTALT- �FRSON. - -'• -,= ea brunch ice dreuil feed fee, 7.42 2
Business name: Bear Electric, Inc. ' B. Fee for branch circuits without
service or feeder fey. first 1 56.18 56 2
Contact mime: Stella Fowler branch circuit
Each add'I branch circuit 2 7.42 14.84 2
Address: PO BOX 389 Mlaedtaueou jservice or feeder not included) _
City/State/ZIP: Donald, OR 97020 Each manufactured or modular d 67.84 2
wcllin ; service and/or feeder
Phone: ( 503) 678 -1355 I Fax:: ( 503) 678 -1108 Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
permits @bearelectric.COm sign or outlineli lighting Br. Bh � B 67.84 2
__ .- .. .. :.: g� •.' :i ' , ':CONTRACTOR. '2:2;1 = r : a'! , . - _ .i= .... _ . .. Signal circuit(s)orlimited-energy
panel. alteration. or extension. _ Page 2 2
I3usin name: Bear Electric, Inc. Each additional inspection over allowable in any of the above
Address: PO BOX 389 Additional inspection (I to min) 66.25 /hr
City/St terZIP: Donald, OR 97020 mrestigadcn(111tlnin) 66.25/ hr
Industrial plant (t hr min) 78.18/1u
Phone: ( 503) 678 -1355 I Fux: ( 503) 678 -1108 Inspections for which no fcc is 90.00 / fv
specifically listed ('h hr min)
C4 Lie.: 20919 sle .tricul Lie.: 4 -107C . tv. Lie.: 4881 S . r . --W.LI EitiCAJ PE1tMI EES ' ._;; .
Suprv. Electrician signature, required: -.\ ,'. ` ., Subtotal: 71 .02 ` • Plan review (25% of permit fee):
Print name: Stephen Shepherd ` , I Date: 06 -07 -12 Stale surcharge (12% of permit (cc): 8.53
Authorized signature: _ TOTAL PERMIT FEE: 79.54-Sr
This permit ppptientioo spires if ■ permit is not obtained within 1a0
Print name: I Date: • days after it has been accepted as complete.
Number of inapemions allowed peeperrml.
I• WIIilA4IuWalnil elE,LC- PermilApp.due 07101 /t0 410.46151(11I05/COMA4LD