Permit CITY OF TIGARD ELECTRICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELC2012 -00646
T I G APED 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2012
Parcel: 2S111AD01100
Jurisdiction: Tigard
Site address: 14585 SW 87TH AVE
Project: Thompson Subdivision: PINEBROOK TERRACE Lot: 8
Project Description: (2) branch circuits for A/C, service outlet
Contractor: BEAR ELECTRIC Owner: THOMPSON, HEATHER R
PO BOX 389 14585 SW 87TH AVE
DONALD, OR 97020 TIGARD, OR 97224
PHONE: 503 - 678 -1355 PHONE:
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/08/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/08/2012 $7.63
Type of Use: SF Electrical
Class of Work: ALT
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 O/ • 001 -090. You may obtain a opy of the rules or direct questions to OUNC by calling 503.232.1987 1.800.332.2344.
Issued By: AAA Permittee Signature:
Oki ?Pt/647)0d
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.
r,f �'
NOV- 08- 2012(THU) 13: Bear
RECEIVED (FAX)5036781108 P.001 /001
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard 0 8 2012 Received : L4 Permit No.: /
13125 SW Hall Blvd.. Tigard. OR 9722 Plan Review �� / _ ��V d
Phone: 503.718 2439 Fax: 503 -5913-19661 i OF TIGARD ontel8 . otlutr Permit:
TIGARI7 Inspection Line: 503.639.4175 BUILDING DIVISIO DaisRsadyr8y: SII See Page Zfor
Internet: www,tigard- or.gov Notified/Method: 111,1 Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration /replacement or feeder over duce souks.
D Service feeder 400 Nip of more ❑ Building over tr souks-
❑ Demolit ion ❑ titer: where the available fault current I] Marinas and boatyards.
CATEGORY OP CONSTRUCTION f exceeds 10,00D amps at 150 volts or 0 Floating building.
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
Multi - family ❑ Master builder 0 Other O Fira pump. ❑ Inatn111uion of75 KVwor
• JOB SITE. INFORMATION AND LOCATION
['Emergency Addition on o f system. larger separately derived omen'. omen'. ❑ Addio o new motor load of � «A ", "E ". "1". "1 -3 ",
Job no.: Job Site address: Q� (�� 11111 10014P or mare. occupancy. �` ►v� �1/�.► 1 0 Six or more residential mks. Recreational vehicle parka.
City/Stale/ZIP 7 2 1\ p Ha u fact ❑ Supply voltage for more than
t ` Hazanl°m klntials. 600 volts nominal.
Suite/bidg. /apL no.: Project name: 0 Service or feeder 600 amps or more.
FEE .SCIIEDUF:E . .
Cross street/directions to job site: ' 4 . LAS a a i. 1r _ rnr.erlpOou 1 9m. 1, F.. 1 Tara] 1 • ,
• New residential single- or multi -family dwelling unit.
Includes attached garage. _
Subdivision: I Lol no.: 1.000 sq. ft. or less 168.54 4
Cu. ndd•1500 sq, U. or portion 33.92 t
Tax map/parcel no.: Limited energy, residential
"•DII»;CRIPTION OF WORK (with shove 5. f it L 75.00 _ 2
r Limited energy, multi•fumily 75.00 2
residential (with above sq. ft.)
Services or feeders toatatladoa alteration, and/or relocation _
200 amps or less 100.70 2
PROPERT.Y:OWNER::.:._' - I : 0 TIf2VAlsi ... - '.. . 201 amps to 400 amps 133.56 2
401 limps to 600 amps 20034 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Ten services or feeders installation, alteration, and/or
City/State/ZIP:
Phone: ( ) I Fax: ( ) 200 amps or Less - • 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being tnadc on property that I 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 - new, alteration, or extension, per panel
Owner signature: -____ D ate: A. Fee for br anch circuits with
— . l feeder fee,
.'
- ° ve service or ee cc 7 •
:❑ :AP�LICALVT .:::.. --.. - . ❑ : CONTACT Ph�tS • 7,42
., - . _. - . . -. each branch circuit
Business nantc: B. Fee for branch circuits without
service or feeder fee. firma 56,18 &,.ig 2
Contact name: branch circuit
- - Each add'l branch circuit ( 7.42 • AV t 2
Address: Miscellaneous (service or feeder not inc luded) _
City/State/ZIP: I'' Each manufactured or modular 67.84 2
dwelling, service and /or feeder
Phone: ( ) I Fax: ; ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline li hag 67.84
' = CONTRACTOR.: --.
_ - -- - _ • = Signal circuits) or limiled-energy
•
Business name: e,„ p-c_ ` - ` C , ` � panel. Each additional inspection over allowable in any of the abov
Address: k.,) y� ) C Additional inspection (1 hr min) 66-25/ hr
City/State/ZIP: � `i 1ki O7 - n _Investigation (I hr min) 66.25/ hr
++ Industrial plant (I hr gun) 78, I8/ hr
!hone: -T15 T Fax: 6,7 g 1 $ e for which no fee is 90.00 / hr
�D V spcciliGdly listed ('/a hr min)
CCB Lic.: 7t4 1 Q Electrical Lic. • -10f rv- Lic -: 1.1. roc!" = .. - .I.EIiCI',Rlt".wl, pERN171 .FEE5_. fi •':•• _ : ',
Suprv. Electrician signature, required: Subtotal: �0 . (
— -g, le Plan review (25% of permit fee); , /4 '7. (or 1.
Print name. , Date: tt S i � . State surcharge (12°.0 of permit fee): (4i
J TOTAL PERMIT FEE: _i1
Authorized signature: This permit application aspires If a permit is not obtained within 180
days after it has been accepted as cumplete.
Print name: Date: • Number of inspections allowed per permit,
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