Permit •
CITY OF TIGARD ELECTRICAL PERMIT
o_. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00120
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 03/12/2009
Parcel: 2S102BCO3400
Jurisdiction: Tigard
Site address: 13010 SW WATKINS AVE
Subdivision: Lot: 0
Project: Groat
Project Description: Install (4) branch circuits.
Owner: FEES
GROAT, RANDALL S & CAROLYN J Quantity Description Date Amount
13010 SW WATKINS 4 crt Branch Circuits 03/12/2009 $66.80
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/12/2009 $8.02
Electrical
Contractor:
BEAR ELECTRIC
PO BOX 389 •
DONALD, OR 97020
PHONE: 503 - 678 -1355
FAX: 503- 678 -1108
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $74.82
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 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503 246.6699 or 1 800.332.2344
� y,'(I e ,
Issued By: -L (\ )y 1 v $ ' 4o�J�.t A Permittee Signature: 0 O -/ .0 1l1, O
OWNER INSTALLATION ONLY " 111 111FFF"'
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 an Inspection that business day.
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.
03/114?009 WED 12:26 FAX 5036781108 Bear Electrlc,Inc. R001/002
I. •
sgrs �9\ RECEIVED .
Electrical Permit Application FOR OFFICE ISE ONLY
City of Tigard MAR 1 1 2009 Dale • s • " _ Permit No.. v` 1 '�fj \�)
• 13125 SW Hall Blvd . Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax 503 598 G9� OF TIGARD DatcBy
Other Permit.
-
T I C, A RD Inspection Line 503 639 4175 BUILDING DNISIO Date Ready By Jvro•en cy El See Page 2 for
Intemcl www,tlgard- or•gov N o tified. Method. I_ �1 / Supplemental Information
TYPE OF WORK, . • . ..11 RE1 kk,• ,
❑ New construction dition /alteration /replacemen[ Please check all that apply (submit 2 sets of plans w'itcms checked below).
❑ Service e or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards .
CATEGORY - OI?, .CONSTR()Cl'lON exceeds 10.000 amps at 150 rolls or 0 Floating buildings
• less to ground or exceeds 14.000 ❑ Commeretel•use agricultural
- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other Installations. buildings
❑ Multi- family ❑ Master builder ❑ Other Ohre pump 0 Installation of 75 KVA or '
• JOB SITE INFORMATION AND LOCATION O Emergency system larger separately derived system.
. • - . • ❑ Addition of new motor load of "A". "E "I-3".
Job no - Job site address: \'O \Q r �I.C ec IWHP or more occupation.
> Recr eational vehicle
\ n Six or mor< residential units ❑ parks
City /State/ZIP Q r On �� ❑ Health-care facilities 0 Supply voltage for more than
1 O Hazardous locations 600 volts nominal
Suite/bldgJapt no.: Project name: ❑ Service or feeder 600 amps or more.
FEE :SCHEDULE • i •
Cross street /directions to job site Omenpiion I otv. I Fee. I Tina! I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft. or less 145.15 4
Ea. add') 500 sq. ft. or portion 33 40 1 .
Tax map /parcel no.:
Limited energy, residential 7500 2
fi,C ::
„ ':'•., 1DESC�tIPTiQ]!It0)�.WORK ... i ... ... (with above sq R.)
tt .240/2- � O Limited en(,multi -fa multi-family .
75.00 2
12,J- ti a residential ial (with above sq R.
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER •I ❑ TENANT 201 amps to 400 amps _ 106.85 2
Name 401 amps to 600 amps 160 60 2
601 ainps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454 65 2
City /State/ZIP: Temporar services or feeders installation, alteration, and/or
relocation
Phone ( ) Fax: ( ) 200 amps or less 66 85 I 1
Owner installation: This installation is being made on properly I y that I own which is not 201 amps to 400 amps 1 100 30 1 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 401 amps to 599 amps 133.75 2
Owner signature' Date: Branch circuits - new, alteration, or extension, er panel
A Fee for branch circuits with
fl' AP P1iJC'A;N`r , - • C ;CUNT �r QERSON above service feeder fee
ce or ee,
�:: ' r4 bv 6 65 2
each branch circuit •
Business name: B Fee for branch circuits •
Contact name: without service or feeder fee, 46.85 6- 2 ■
first branch circuit ,
Address. Each addl branch circuit 7 6.65 15 .9 C 2 .
Miscellaneous (service or feeder not included) •
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone ( ) I Fax. : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
C � \e ��� ) �� , energy panel, alteration, or
Address: � C^-) x 3�
extension Describe. Page 2 2
City /State/ZIP , • ` ` � V ' V Each additional inspection over allowable in am of the above
Per inspection 62.50 '
Phone ( fax: )
5Q� �� _ ,�� (5C • A\ .' 1l CA Investigation per (rout (1 hr min) • — 62.50
CCB Lie.: 2C)G (-1 Electrical Lie.: - Q IF� • Lk.' LI Ci% \ S Industrial plant per hour 73.75 ,
wit ELECTRICAL PERMIT FEES • / �� u
{{
Supry Electrician signature, required: A f )� . Subtotal. 6b '
1 Plan review (25% of permit fee) _ _
Print namc ^ �hI ..
Date 1 \�(r} — - - --
1 4l�� Stale swchargc (12% of permit fee)' "Z
Authorized signature: - TOTAL PERMIT FEE' / u •$Z
Thic permit application expires if a permit is not obtained within 180
PI inl name. D IC: days after It has been accepted as complete.
- - — ' Number of itupaunns allowed per permit.
I Iiw t•;,,m.a I t.t'.re Aa ii• :' db 411) 161 PH 0. l'UM , A FN
0 ( 2 Oto Z .. -- - - - - --