Permit CITY OF TIGARD ELECTRICAL PERMIT
_ • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00585
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 10/08/2012
Parcel: 2S102BC00903
Jurisdiction: Tigard
Site address: 12815 SW GRANT AVE
Project: Eng Subdivision: NORTH TIGARDVILLE ADDITION Lot: 29
Project Description: (2) branch circuits for NC and service outlet NC must maintain 5' side yard setback and approved rear yard
setback
Contractor: BEAR ELECTRIC Owner: ENG, CINDY
PO BOX 389 PO BOX 23086
DONALD, OR 97020 PORTLAND, OR 97231
PHONE 503 - 678 -1355 PHONE 503 - 307 -9911
FAX• 503 - 678 -1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 10/08/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/08/2012 $7.63
Type of Use: SF Electrical
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $71.23
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 52 -001- 090 You may obtain a copy of the rules or direct questions to OUNC by calling 503232 1987 or 1.800.332 2344
Issued By: 414 1 Permittee Signature: t 3 r i4rm' L-k� Q'
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.
OCT - 04 - 2012(THU) 12:32 Bear Electric (FAX)5036781108 P.002/002
Electrical Permit Applic2 RECEIVED FOR OFFICE USE ONLY
II City of Tigard Dec o/ �' Z for _ '
13125 SW Hall Blvd., Tigard, OR 97}!� Plan Review ,
- Phone: 503.718,2439 Fax: 503.S9g�(46(f O 4 2012 Date/13v: OdxrPermu c 00. 1 -
TIGARD Inspection Line: 503.639.4175 DateReady/By FEW 6J see rice 2fur
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Willed. Sappicauahllnfarmadao
TYPE 3inui9I6 DIVISION PLAN REVIEW
Please check all that apply (submit j seta of plans whims checked hetow)
0 New construction Addit len/alteration/replacement
❑ Demolition Cr ❑ Service or feeder 400 amps or more ❑ Building over three modes.
where the available lauli eurrent ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural
- and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings. Multi - family ❑ Master builder ❑Other: 0 Fire pump. 0 Installation of75 KvA or
JOB SITE INFORMATION AND LOCATION 0 Eminency system. larger separately derived system
O ArWition of new motor load of ❑ - A ", - E ", "I.2 ", "I -3 ".
Job no.: 1 Job site address:`*2, e71,,3 (*( 004 . 4 c G 0 S�a or
residential units occupancy.
0 Recreational vehicle parks
City /StatdZl I': r 0 Henhh•care facilities. 0 Supply voltage for more than
` QS :'` 1 0g, `/ - 2..7_-- - ❑ Hazardous locations 600 voles nominal
Suite/bldg./apt. no.: [Project name: Cl Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I re. 1 Twig I •_
New residential single- or mold- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
En. add'I 510 sq. It or portion 33.92 I
Tax map /parcel no.: Limited energy, residential 75.00 2
. - DESCRIPTION OF WORK•' (with above sq. ft.)
Limited energy. mutt -family 75.00 2
N C, ru \Cc. Q ).� residential (with above 9. ft.)
Services or feeders inatallation and/or relocation _
200 amps or Ica 100.70 2
0 PROPERTY. .. J 0 TENANT '-.. 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 feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 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 circuits - dew, alteration, or extension, per panel
Owner signature: Dale: A. Fce for branch circuits with
Q � _ _ - I above service or feeder fee,
7,42 2
0 CONTACI;,PEIiSON each branch circuit
Business name: B. Fee for branch circuits without ��y+
service or feeder fee, first 1 56.18 0 /{1 .10 2
Contact name: branch circuit
_ � �
Each add'l branch circuit V 7.42 - 1.4 - t+l .,
Address: Miscellaneous (service or feeder not included)
Ciry /State/LIP: Each manufactured or modular 67.84 2
dwelling, service and/or (ceder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
Signal eircuit(s) or limited-energy
r. Business name; ` „� , t �� panel. alteration. or extension , Page 2 2
�.�. Each additional inspection over allowable in any of the abov
Address: R Q r - yq ay. AAA Additional inspection (1 hr min) 66.25/ hr
City/Statc/ZIP: Dan `_ . , c — CD2 lovesligutlan (1 hr min) 66,25 / hr
k Industrial plant (1 hr min) 78.18/ hr _ _
Phone: ( Fax :e03 f l t /1 inspections for which no fcc is 90.00/ hr -
6 v cilically listed (4 hr min)
CCB Li c.: ICI Electrical Lic.4./07� Suprv. Lie.: 31(07 = = - - ELECTRICAL (Elrs - -.
Suprv. Electrician signature, required: Plan review (25 (25% of permit feeSubtotal): : �� -�('
Print name: Date: , S tale surcharge (12% of permit fee): - 1 . (0 ?
r `• J �� `r � TOTAL PERMIT FEE: 7.
Authorized signature: (- 7_�
This permit application expire if ■ perutit is nut untrained within 1tl17
Print name: , 8 - t RQ. n 9 cp. d Date: ' , • do after It l been ltd as complete
Munk' of it recbolls allowed Writ
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