Permit Support Document (158) CITY71 OFTIGARD ELECTRICAL PERMIT
'` COMMUNITY DEVELOPMENT
Permit#: ELC2016-00370
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2016
Parcel: 1S134CA00528
Jurisdiction: Tigard
Site address: 11605 SW MANZANITA ST
Project: 0 Subdivision: PANORAMA NO.2 Lot: 40
Project Description: mini split indoor,outdoor,outlet,6/22/16,REPRINTED to add(1)additional branch circuit,for a total of(3)branch
circuits.
Contractor: BEAR ELECTRIC Owner: TACKER, BRIAN E&JAMIE L
PO BOX 389 11605 SW MANZANITA ST
DONALD, OR 97020 TIGARD, OR 97223
PHONE: 503-678-1355 PHONE:
FAX: 503-678-1108
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 06/22/2016 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/22/2016 $8.52
Type of Use: SF Electrical
Class of Work: ALT 45 Misc Administration Fee 06/22/2016 $45.00
Type of Const:
Occupancy Grp:
Total $124.54
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTIO1.• e --••n law requires you to follow the rules adopted by the Oregon Utility Notification C- ter. Those rules are set forth in OAR
952-001-001• rough OAR 95 61-01.1i.♦ Yo may obtain a copy of the rules or direct questions to OUNC by calling ='. 3 1987 or 1. 00.332.2344.
Issued =y: r f /.0/ ` i Permittee Signatur a - 7iC lit
. OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
JUN-21-2016(TUE) 12: 21 Bear Electric (FAX)5036781108 P. 001/001
t r
Electrical Permit Applicati�il ,' ,, ' /;�' ';. FOR(WFIC!USE ONLY
City of Tigard 4.��dle ' 11.0010,-- ► .`0) Zr'...
, + 13125 SW Hall Blvd..Tigard.OR 97223 Plan Review
Phone: 503.7182439 Fax 50339&j$ ( !it Date/B : Related Permit W;
T I GAK17 Inspection Line: 503.639.4175 Ready Date/By. Awns; fi0 See Paget for
Internee www.ti•50d-or,•ov Notified/Method: Supplemental Information
1 S ( i 3 •A 4 "'► H
li .^✓ A �f�A Yryt .I YVI N� AAM. 1' , N N i¢W ;µr4 rMYrY I'4'ANW Ml NY h r 5'R MW @w.'' 4 11 . 9',t'
s.r�t_z.,;�ri,a�f �*1'.M"�" .. _�",� xM .�' s 't -� S � _.., .�,�,i. � �+•rl?G:,, � �. P,1AAN.xrRJ:,"\{,I�1""'
f .�, . `TYPE'• „'. � � _.wl „r.a.: �.w�'ll��s ����:.
0 New constructionAdditiot�(!It tt t i ''i' Please check all that apply(submit juts of plans whims checked):
• tt
❑Serwce orfeeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault con:- '—
Viii g"A ' 7 : 41:g . . �r"(.":CAiIGO1 OF*CONSTRUGTlON x-.104*`:1•' r' . eacsx4110.000empsat150v
1-and 2-family dwelling ElCommercial/industrial 0 Accessory building_g
1....m ground,or exceeds I4,t 4/�
amps for all other installations
Multi-family 0 Master builder Other UFirepum
°. r-.•tt$:"?:.=5°.. IMMOWISI TEA. IF.ORMA'TIO1V y`A1VD.:1;,OCAT,ION .;i.It .: "., CI El"reen"sr*malor toad of !1
•67
❑Addition of new m 0
Job#: I Job site address: 111�p5 ySw Ma_ ni , 100HP or more.
Ci /State/ZIP' t;] o n ry Q Six or more residential units,
� �����'�J �.� .- 1��.�-l.J `' ❑1•leolth-tate futilities. /C147
Suite/bldg./upt.#: IProject name: CI Hazardous locations.
0 Service or feeder 600 amps or r
Cross street/directions to job site: atli t.titatra : IS-„.„.,.. ry, ,jam&
beseripthaa I O . 1 E.ch I Tmai I -
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel i/ 1,000 sq,R or less 168.54 4
Ea.addi 500 sq.tt or partial 33.92 1
w . .. v1 . ► SGRIIfrOKO.I ORIOMMEeridF
iet „ 4imitcd energy.residential 75.00 2
Q/���.]/'�, .}� r ,}.�, p� may, r 1 (with above sq.R)
!-1V_*t/”_-...__tf ,�_t!Q��_I rr�tr(� 1(�C J�4_t��1.1 1�(^ Limited energy,multi-fhmity .
U 75.00 2
' 1 . r .h # b. p v ex e '�'
residential S� a
1�
Renewable energy 0 See Page 2
"0t' ,n u�rw P.RO ' • T AIMR A }'"`�'' NWM "IMN Services or feeders installation alteration,and/or relocation
Name: 200 amps or less 100,70 2
Address: 201 amps to 400 amps 133.56 . 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301,04 2
Phone:( ) f Fax ( ) Over 1,000 amps or volts 55226 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 ' I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signatu : Date: 401 amps to 599 amps 168.54 2
,, , m. , 1 , ,,- ,, , ": Branch circuits—new,alteration,or extension,per panel
wpm Nom:: AI'L t r0°.CbNi1�L.. 1F.Ji (7 ="3 A.Fcc for branch circuits with
Business name: • c 's',' l .f _r above service or feeder fee, 7 42 2
each branch circuit
Contact name: 5 S/'i l B,Fee far branch circuits without'
D 5i - branch
or feederstfee,first 56.18 2
Address: 3�� branch circuit
City/State/ZIP_ a�OLj4 0 K DO Each add')branch circuit 1 7.42 1�e. 2
+ � `t Miscellaneous(service or feeder not included)
Phone' •—1 1 11L 1 - _ Fax:: �,, ii 6 . ii t Each manufactured or modular 6784 2
Email: 0" 1 e y1 :p,(e (�.e f') Reconnect service and/or feeder 67.tt4 2
J f `C Y dwelling
ilielittatafilM
rt ".n..t r CQ GrOR SESiiitit):iii," ii ii w..t �' Pump or Irrigation circle 67.84 2
Business name: A/_ iggi gii yr - a • Signor outline lighting 67.84 2
0 (Cg � C pinna, tt(s)or limited-energyextension.
ID Sec Page 2 2
Address: 0 panel,alteration,orexiensian.
City/State/ZIP: DC )04-(ti K �ri 0 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 6625/hr
Phone: di* )CO *' I •S Fax: iin) 1R' 0 . Invesdl ation(1 hr min) 90.00/hr
Email: ?errn I . ea_(s- f&c Gr-co Industrial plant(I hr min) 7&lW hr
Inspections for which no tee is
90.00/hr
eCCB Lic1.c Electrical Lic.:2-4-1 uprv.Lie.: szecrt,cally listed0 lir min)
�N+MYi k a� etIE
SI'� rt'
:x
y Suety.Electrician signature,required: t�J"�. 0 Subtotal;
•
Print name: V f"r ante: r/G0 Pan Review Required(25%of permit fe): 1
State surcharge(12%of permit fee):
Authorized signature: I'O'I'AL PERMIT FEE: gy _
'fitly permit application expires If a permit is not obtained within 180
•Print name: �/ '�� Date: L - days after 1t has been accepted as complete.
V
' Number of inspections allowed per permit._.— 1 a ,
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13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
11605 SW MANZAN ITA ST, TIGARD, OR, 97223
Record Type:
Residential - Electrical
Inspection Type:
199 Electrical final
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
ELC2016-00370
Inspector:
Jeff Grove
Contractor