Permit n CITY OF TIGARD ELECTRICAL PERMIT
II COMMUNITY DEVELOPMENT Permit#: ELC2013-00696
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/21/2013
Parcel: 1S134CB11200
Jurisdiction: Tigard
Site address: 12301 SW MILLVIEW CT
Project: Connolly Subdivision: MILL VIEW Lot: 12
Project Description: (2)branch circuits for new a/c&to reconnect furnace
Contractor: BEAR ELECTRIC Owner: CONNOLLY,JEFFERY T/HELEN
PO BOX 389 12301 SW MILLVIEW CT
DONALD,OR 97020 TIGARD,OR 97223
PHONE: 503-678-1355 PHONE:
FAX: 503-678-1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 11/21/2013 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/21/2013 $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 issu •'- t 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 a rdance with a••roved plans. This permit will expire if work is not started within 180 days e, or if work is suspended for more the 180
days. ATT TION: Oregon law - •re yo to follow the rules adopted by the Oregon Uti1ty otification -Ca er. Those rules are set forth in OAR
952-001- 10 through OAR 952-001 1190. Yo' may obtain a copy of the rules or direct questions to OUNC by calling 2.198 r 1.800.332.23 .
Issu d By: [X'/Z Permittee
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
l c
SIGNATURE OF SUPR.ELEC' , Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
Thls 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.
NOV-18-2013(MON) 10: 35 Bear �� ,� 0 (FAX)5036781108 P. 001/002
�ti • •
City of Tigard ��V\-t
GQ+ I �''1 It 0// COL, Ktool E e
I:I:�.,, I ion 111,•1, I,}.a1.1 I III L i3-QO ��• mot;.•,.
t 3 . Phalle `Il:71 R 2.1:4 1.;0, III i ..•I\ 1"1•I' ���.1.!'n'22: 11ilw'r I'i r
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TIGARD 1'` civ, . 4, II i.01•Iir;kl. In
futcnl.l 01%•. I IMan1-en ear 10 4..Noiik.11 N1:IIw•.I �` $upptrmeol•t Informstlon
TYPE OF WORK •' IIt
—` 1
PLAN REVIEW •
New construction Atldlll•1111:Ihiralhill/rCplal'l'Il1Cnl __-^---— I'h•av ih:ci all!list apply lsahmd 2 vN 01 plan..•,Iym.ihecl:d Ix•dn•I
0.:,\we o,feeder alln mar.IN nun: 0 hoddoic...e•dor:.larrrs
! 01)CI)11111111111 Qt)IIlc1 ___ _� .Ih,c Ile ar:ulahli lash iunem DAtanna,,wllw.ua,u•Is
CATEGORY OF CONSTRUCTION .�•ieid.11118111 amps al 1311 vnli•IN 0 Fhla'.ns•hmlhnr•
less to powml..n e?eehls 1.1.1111) 0 Comm:,;ol,K••puiuh ,al
I•and 2-lilnily tiwellinl2 ❑("rnnnlcrcial/inthtstrial ❑Accessory huildilie amps 1•4 Allntlrrr m.talLlloo. hw,ldnrps
_0 Mul_li4:1111 v 0 WSW, huildcr ❑ Other: 01.111:pimp ❑Inua0.,l•..u'i 7:k VA n,
JOB SITE INFORMATION AND LOCATION ❑Itlnil fiuev•••lrm Lori•itmmil.'dcl,r�d symm
0 Addition nl IMr.1110101 Iliad Id 1]"A""1 • , "I
Inh nn.: lnh site atldrl Ss. 1 (> /► f1 1. r t D j�-Cf tool IP n,mots. R c reatio�
l 11V V `V 1 ul l..bv 1�J ❑ti•.or runic residential non■ ❑Recreational vehicle paps
City/Si:tic/ZI I�: T gc1..'-ii.. /O7 .3 01lealtlme Inellities 0 Solpll•nhapr Im mmc Ilan 1 l O / ❑I Iaraldnus dxauuns son sodSuite/h1d ,/apt.110.: I Praji c1 name: ❑Se1'viee or feeder on amps or more
•• •••" FEE SCHEDULE
(,I111ti s;rccl/llirt•0lDl1s 111 job site: Wier' y 'Road -
New residential single-or multi family dwelling unit.
Includes attached garage.
Subdivision: Lot nn,; • 1,000 sq ft.or less tag St [4 ,
�- -- Ea add'I 500 sq.ft.on poninn 33 92 I
Tae-111:11/parcel Ito" Limited energy,ttsidential
7500 2
DESCRIPTION OF WORK (with above sq.0)
A t - ,� Limited mealy,(with above am'iy 75.00 2
�aY'S�1 r� residential(with above .0.1 _
`^�'- +� — _Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2
Name; 401 amps l0 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or v'0115 557 26 2
City/State/ZIP: Temporary services or feeders installation,alteration.it
relocation _
Phone:( ) Fax:( ) 200 amps or less 59.36 201 snips to 400 amps _ 125.08
I 21
Owner installation:This installation is being made on property Mut 1 own which is not 401 amps,0599 amps I68.54 2
intended for sale. lease_rent,or exchange_according to ORS 447.449,670,and 701.
Branch circuits-new,alteration,or eitens(nts,per panel
Owner signature: Date: A.fee for branch circuits with
0 APPLICANT 0 CQIa TACr PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: t B.Fee for branch circuits w•lrhour
R ELEC PRl rC• INC. -- service or feeder fee,first I 56 18 �� 2
Contact narnC: I PO BOX 398 branch circuit
20905-EtlTT81/IL•Le RD 14E Each add',branch circuit { 1; 7,42 "---1 42 2
Address: DONALD,OR 07020 Miscellaneous(service or feeder not included)
- Cg4.2on±o
Each manufactured or modular
City/Stale/ZIP: dwellin service:tad/or seeder 67 84 2
g
Phone:( ) Fax: :( ) Reconnect only 67.84 2
p algarel.0411"°-11 C-117.71.7 rump or irrigation circle 67 84 2
E m-' -* `S Sign Or outline lighting 67.84 2
CONTRACTOR —
Signal cirewl(s)or limited-energy—
f-ea-_r-IsQ 1 panel,alteration,or extension. Pape 2 2
Business ntlmC: l�.�l 1 l p f
! Each additional inspection over alIowablc in any of the above
Address: 7 Additional inspection(I hr min) 66.251 hi
--1 r � Investigation(1 hr min) 66.25/hr
City/Slats/ZIP: r � C C`-"1Y0 i -
Industrial plant(1 In min) 78.18/1a
Phone: �'(�r Fax: 'j Inspections for which no fee is
1 Q_ l l� ( " ` ���''� l � , specifically listed(95 hr min) 90.00/lu
CCB Lic.:'�Qc /47 Electrical Lic it Iva Suprv.I.ig' •z 6,2-. ELECTRICAL PERMIT.FEES ,e, L1
n cr Subtotal: h3
Suprv.Electrician signature,required( rr Plan review(25%of permit fee): -~
Print dams. pi G2.4v mod. r a t,<.d Date: /•///S State surcharge(12%of permit fee):
.,_-
Authorized Signature!' �� TOTAL PERMIT FEE: �,
,t i� / JJJ This permit application expires if a penult is oat obtained within Jan.
Print name:'//1 c [`/�J. /`,r-x`2.1� iz.) DN1C: i//1} � .. • days after it Was been accepted as complete•
V
l/L 1G k J r L���IKC�t C ! `/ Number of inspections'allowed per permit.
1:1Duitao.eU' rn lrJ..1,C-PermnApp.doc 05101115 4411-4b MI 11105,COM/WF,'B