Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00186
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/26/2015
Parcel: 2S105DA17500
Jurisdiction: Tigard
Site address: 14560 SW CATALINA DR
Project: Bunkofske Subdivision: PACIFIC CREST Lot: 63
Project Description: Alteration of(1)branch circuit for lighting change.
Contractor: OWNER Owner: BUNKOFSKE, RAYMOND J &
RAYMOND BUNKOFSKE BROOKS-BUNKOFSKE, MARY M
14560 SW CATALINA DR 14560 SW CATALINA DR
TIGARD,OR 97223 TIGARD,OR 97223
PHONE: 503-720-7972 PHONE: 503-720-7972
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 03/26/2015 $56.18
Specifics:, Service or Feeder
1 ea 12%State Surcharge- 03/26/2015 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 acco• - • 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. ATT• • ION: Oregon I. requir ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 -010 throug OAR 952-001 I S, You a •• -in a copy of the rules or direct questions to OUNC by callin•503.232.1987 or 1.800.332.2344.
Iss d By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own is not intended for sale,lease or rent
OWNER'S SIGNATURE I / Date: S/16/
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.
: . .5/ //5" CL..03 f c,ci O/5-,acs 10
Electrical Permit Application I
City of Tigard Rye„�' PLAN REVIEW
• DaIeBy:
3125 SW Hall Blvd.,Tigard,OR 97223 Permit Yo: PLEASE CHECK.tLL THAT APPLY(SUBMIT j SETS OF PLANS
1111 B w,TTEMS CHECKED BELOW):
Phone: 503.718 2439 Fax: 503.598. :.r
T I G A R D Si-” - SERVICE OR FEEDER 400 BUILDING
°...go J a.6i T:i�a�R�a Tit 1 • AMPS OR.MORE OVER THREE STORIES.
. I Plan Re�ien WHERE THE AVAILABLE MARINAS
Dan Re
Other Paint: FAULT CURRENT AND BOATYARDS.
1 a - 1 Date ReadrBy: I)See Page 2 for EXCEEDS 10,000 AMPS Al FLOATING
'Nort6ed/hlethod: ®
Su plemrnrai Information 150 VOLTS OR BUILDINGS.
Information
LESS TO GROUND,OR COMMERC
BUILDING DIVISION EXCEEDS 14,000 AL-USE AGRICULTURAL
AMPS FOR.ALL OTHER BUILDINGS
TYPE OF WORK INSTALLATIONS. INSTALLATt
New construction Addition alterations replacement PUMP. ON OF 150 KV;1 OR
EMERGENCY SYSTEM LARGER
Demolition Other: SEPARATELY DERIVED
ADDITION OF NEW SYSTEM
CATEGORY OF CONSTRUCTION MOTOR LOAD OF
1-and 2- y dwelling Commercial/industrial Accessory building 1001111 OR MORE. 2","1-3",OCCUPANCY.
Multi-family Master builder Other SIX OR MORE RECREATIC
RESIDENTIAL UNITS. NAL VEHICLE PARKS.
JOB SITE INFORMATION AND LOCATION HEALTH-CARE SUPPLY
Job no.: !Job site address: I q514,,0 5' j ,�,... ,)t-• FACILITIES. VOLTAGE FOR MORE THAN
City/State/ZIP: T, (2){� Ci 1 2 HAZARDOUS LOCATIONS. 600 VOLTS
( 1 C SERVICE OR FEEDER 600h�`ll'
Suite/bldg./apt no.. !Project name: AMPS OR MORE.
Cross streevdirections to job site: P n FEE SCHEDULE
DESCRIPTION I QTY.I FEE. I rar,U. •
NEW RESIDENTIAL SINGLE-OR MULTI-FAMILY
Subdivision:Vka `1� c Cam,,(2,-'� !Lot no.: (D 3 DWELLING UNTL
INCLUDES ATTACHED GARAGE.
Tax map parcel no.: 1,000 SQ.FT.OR LESS 168.54 .1
DESCRIPTION OF WORK EA ADD'L 500 SQ.FT.OR
1 PORTION 33.94 1
_c -',�i-,r l (1.Q._,_,:.* \.i Nhit )(A -J a-S LIMITED ENERGY,RESIDENTIAL
75.00
(WITH ABOVE SQ.Fr.)
PROPERTY OWNER I TENANT LIMITED ENERGY,MULTI-FAMILY
(� ,J (� ` _ 75.00
Name:i'�.1 U,N- 1 Ci,..."V<4.7`�jK ABOVE SQ.FCE:N'IIAL(WITH -
Address: ?l y C.7‘.... 584; (-':mod.\' -t„0. Cr--• RENEWABLE ENERGY SEE PAGE 2
City/State/ZIP: � C,-.),A,.. L ,-�' SERVICES OR FEEDERS INSTtI.I.ATION,ALTERATION,
may 1 AND/OR RELOCATION
Phone:0 5)3 -- 7. - ( 1 [2_ IFax:Q 200 AMPS OR I FCC .-�_ 100.70 2
201 AMPS TO 400 AMPS __ 133.56 2
Owner installation:This installation is being made on pr that I own which is not 401 AMPS TO 600 AMPS 200.34 2
intended for sale,lease,rent,or exxA e, cordin O ,449,670, 701.
Owner Si Ila - D j J/ / 601 AMPS TO 1,000 AMPS I 301.04 2
g 2 4/ -(----
OVER 1,000 AMPS OR VOLTS• 1 552.26 2
APPLIC NT I `CONTACT TEMPORARY SERVICES OR FEEDERS INSTALLATION,
ALTERATION,AND/OR RELOCATION
Business name:
200 AMPS OR LESS 59.36 1
Contact name: 201 AMPS TO 400 AMPS 125.08 2
401 AMPS TO 599 AMPS 168.54 _ 2
Address: BRANCH CIRCUITS-NEW,ALTERATION,OR
City/State/ZIP: EXTENSION,PER PANEL
Fax:: A FEE FOR BRANCH
Phone:
0 I 0 CIRCUITS WITH ABOVE
E-mail: SERVICE OR FEEDER FEE, 7.42 2
EACH BRANCH CItCLTr
CONntACI -
Business name: O GC) /0 e B. FEE FOR BRANCH
Ctacurrs IRTHOU TSERVICE
FEEDER OR
Address: BRANCH CIRCUIT
56.18 2
City/State/ZIP: EACH ADM.BRANCH CIRCUIT _ 7.42 - .
MISCELLANEOUS(SERVICE OR FEEDER NOT
Phone:0 IFax:0 INCLUDED)
EACH MANUFACTURED OR
CCB Lie.: 'Electrical Lic.: ISuprv.Lie.: MODULAR DWELLING.SERVICE 67.84
AND;OR FEEDER
Suprv.Electrician signature,required: BONN My 67.84 -
Print name: (Date: PUMP OR IRRIGATION CIRCLE 67.84 -
SIGN OR OUTLINE LIGHTING 67.84
Authorized signature: SIGNAL CIRCUITS)OR LIMITED- SEE
ENERGY PANEL,ALTERATION,OR PAGE 2
Print name: 'Date: EXTENSION.
- -
EACH ADDITIONAL INSPECTION OVER ALLOWABLE IN
ANY OF THE ABOVE /I(
.56:71
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