Permit 111 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00694
T I G A RC) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/11/2012
Parcel: 2S113AB00500
Jurisdiction: TIGARD
Site address: 16083 SW UPPER BOONES FERRY RD 110
Project: United Advertising Publications Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: (2) branch circuits
Contractor: LEAR ELECTRIC CO INC Owner: G &S FC LLC
PO BOX 573 16083 SW UPPER BOONES FERRY RD,
GRESHAM, OR 97030 STE
TIGARD, OR 97224
PHONE: 503 - 255 -0733 PHONE:
FAX: 503 - 255 -0676
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 12/11/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/11/2012 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit ' ' bject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do - in accordance w • approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day ATTENTION: Oregon - - • -s you to follow the rules adopted by the Oregon - on Center. Those rules are set forth in OAR
95 - 001 - 0010th •ugh OAR 9 I • • • 0. You may obtain - copy of the rules or direct questions to OUNC by k,_.1987 or 1.800 . - 2.2344.
sued By: t -L i ''y Permittee Si. • ture: f�I� (0-e
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' i •'f �j Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
12/11/2012 09:59 5036616389 LEAR ELECTRIC PAGE 01/02
Electrical Permit Application RECEIV 1OR 0111 ICE I ..Si. C1 \L1 City of Tigard > f #ArA Penult No. zze , - i3 6,
Phone: S 03. 9 T F f ax d , 03.598.1 60 DEC 1 1 2 01 4 Plan Review
netalg : Other Permit:
I : a r, n Inspection Line: 503.639.417$ n.ir. RI gee rage a for
Internet: www.tigard-or.gov CITY OF T� • (I �y suPP t Information
TYPE OF WO' CI 1 1 D ON PLAN REVIEW
❑ New construction '] Addition/alteration/replacement Please check all that apply (submit 2 sets of plans 'interns decked below):
CI service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition El Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2 - family dwelling Commercial/industrial ❑Access building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
g amps for all other iastanatiena. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergo cy system. brger separately derived system.
❑Addition of new motor load of 0 "A ", 8" °1 "1
lob no (a 5 Job site address 1 (PQ�S3 So � vor►p S 100W or more. occupancy.
T ❑ Six or more residential units. ❑ Recreational vehicle parr
City /State /Z1P_ T l d te (,� - i `T I. f r r l a,/ ❑ ❑ Italth. ca facilities. ❑ Supply voltage for more than
y t ardour locations 600 volts nominal.
Suite/bldg./apt no.: r tI D P r o j e c t name: Un! k 1 5-v veY 41 t n 1 1442, ❑ Service or feeder 600 amps or more. -
Cross street/directions to job site: FEE SCHEDULE
Dseriptioa I oev. L !et I Toil 1 •
New residential single- or amid-family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 16834 4
Tax map/parcel no.: Ea. add'l 500 sq, ft. or portion 33.92 1
Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
'" Limited energy. multi- faamily
11-C CA) C / /5-c (A1 1 residential (with above sq. ft.) 75.00 2
Services or feeders installation atterannon, and/or relocation
200 mops or less 100.70 2
0 PROPERTY OWNER
❑ T ENA. T 201 amps to 400 amps 13156 2
Name: 401 amps to 600 amps - 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/ State/ZIP: Temporary Services or feeders installation, alteration, and/or
relocation
Phone: ( ) F ax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is bein made on 201 amps to 400 amps 125.08 2
g p r operty that 1 which is riot 401 amps to 599 amps 168.54 2
670
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: _ Date: A. Fee fbr branch circuits with
above ❑ APPLICANT ❑ CONTACT PERSON each branch o f cede fee, 7 .42 - 1 2
Business name: B. Fee for branch circuits without
service or feeder fee. first 1 L
Contact name: branch circuit 56.18 2
Address:
Each add'I branch circuit 7.42 ' 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67,84 � 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 1 2
E - mail: Pump or irrigation circle _ 67. 2
CONTRACTOR Sign or outline lighting 67,84 2
Signal circuit(s) or limited- energy
Business name: Lear Electric Co., Inc Panel, alteration, or extension. _ Page 2 2
Each additional inspection over allowable in any of the abov
Address: PO Box 573 Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Gresham, OR 97030 Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 255-0733 Fax: (503) 255-0676 Inspections / ( ) specifically forte �r fee is 90.00/ hr
CC$ Lic.: 5 -52 '0a27o Electrical Lic.: 26-411C Suprv, Lic.: 37865 '� • EI.ecnuCAL PERMIT FEES
Suprv. Electrician signature uir \ •. 7/6/./
f Subtotal :,
•-.- Plan review (25% of permit fee): 2,
Print name: David Mumf State surcharge (12% of 7 I%0
I E I ( permit fee):
or signature: �//���/ TOTAL PERMIT FEE:
Auth
� ' � /� �6�i This permit application expires if a permit is not obtain with 0 1 m name_ David Mumford Da ' ,� t + — f •� days after it has been accepted as complete. �
I • Number of inspections allowed per permit.
T: IBuilding \Pemiits1V- C- PumitApp.d c 07/01/10 440<er5T(i /OS/COM/tt/es