Permit ELECTRICAL PERMIT
CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00160
Date Issued: 04/09/2010
T.1CiARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: 2S 09/201 6500
Jurisdiction: Tigard
Site address: 12160 SW WILDWOOD ST
Subdivision: SHADOW HILLS NO. 2 Lot: 48
Project: Provancha
Project Description: (2) branch circuits for furnace.
Owner: FEES
PROVANCHA, TOM & CINDY Quantity Description Date Amount
12160 SW WILDWOOD ST 2 crt Branch Circuits 04/09/2010 $63.60
TIGARD, OR 97224 wo /Purchase Service or
PHONE: 503 - 522 -9601 Feeder
1 ea 12% State Surcharge - 04/09/2010 $7.63
Electrical
Contractor:
BADGER ELECTRIC INC.
4415 NE SANDY BLVD STE 205
PORTLAND, OR 97123
PHONE: 503 - 288 -4756
FAX: 503 -493 -7173
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 OA 52- 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.
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Issued By: OA
Si AI !/ f �
� Permittee Signature: Q or
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 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.
RECEIVE
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City of Tigard WI OF I`IGAItD o Received le�B : 9 /0 �,.��'j� Permit No
M ® � 1 12 5 SW Hall Blvd., , F� 0 r 4 r t D ING DIVISION Pia Re _LC 020/0 - r / / /
Review � 7
At OtherPennittf a.20/ e�D0�Sp2,
Inspection Line: 503.639.4175 Date Ready/By. 1ur� B See Page 2 for
ai Internet: www.tigard- or.gov Natifed/Method: / Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction tion/alteration/replacement Please check all that apply (submit Isms of plans w /items checked below):
0 Service or feeder 400amps ❑ Making over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
(7,J d 2 dwelling ❑ Commercial/industrial Accessory building
less to for ground. e exceeds ln ❑ Cummerciat- use agricuhural
Y l g l ❑ A rY ildi g amps for all other installations. buildings.
Multi family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ ay system. larger separately derived system.
❑ Addition of now motor toad of
Job no.: 1 Job site address: Ip W CI , (j �� ^� tie e n occupancy.
cJ^' v` + "c' ❑ Six or mmv tcsidrntial units. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Hadtb -caro facilities. ❑ Supply wnagc for more than
❑ Hazardous location. 600 volts nominal.
Suite/bldg./apt. no.: Project name: T V 0, e r O Service or (coder 600 amps or more.
` FEE SCHEDULE
Cross strect/dlrections to job site: Desa1 U.o 1 Qry.1 Fri. 1 Total 1 •
' New residential single or multi family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
1
Tax map/parcel no.: a. add'I 500 sq. ft. or portion 33.40 I
Limited energy. residential
DESCRIPTION OF WORK (with above sq. n.) 75.00 2
Limited energy, mufti- family 75.00 2
I (kl> t ,AA„ .- a residential (with above sq. ft.)
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 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) ` Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 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: Branch circuits - new, alteration, or extension, r panel
'tit A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits 56 i i
Contact name without service or feeder fee, 1 • 6 ,/, first branch circuit
Address: Each add') branch circuit I �, . 5 9, L / 2
Miscellaneous (service or feeder not ioctuded)
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: '3cG V E C._ Signal circuit(s) or limited
energy panel, alteration. or
Address: 44- \S !=�_[ n T t extension. Describe: Page 2 2
City/State/ZIP: --t:bn .4) 1.—,12.. Each additional inspection over allowable In an of the above
I Per inspection 62.50
Phone: (45VS) Z g�
g 41 Fax: ("5 q3 - ( Investigation V
- / �`� " l _� l P� bout (1 h min) -
62.50 V
5 �/ CCB Lic.: \ ' O t ectrical Lis: ' guorv. Lic. -) � , Industrial plant per hour 73.75 V
�) ELECCRICAL PER MIT FE W W�
Suprv. Electrician signature, nxtuirvd���� �� .1�•,�^yCCGG / 9)11i V Subtotal: t ,
�� % 1 / 11 (Cr Plan review (25% of permit fee):
9 Print name: Date: tt i( State surcharge (12%ofpermit fee): _ V t n
Authorized signature: • TOTAL PERMIT FEE: " /
Print name: 1 Date permit application expires if a permit is not obti l� ► �,
days *five it has been accepted as comp, (( f /
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