Permit , :'''''7:2'1; CITY OF TIGARD ELECTRICAL PERMIT
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° • COMMUNITY DEVELOPMENT Permit #: ELC2010 00150
.fGAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/01/2010
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Parcel: 2S114BA11100
Jurisdiction: Tigard
Site address: 16455 SW WOODCREST AVE
Subdivision: COPPER CREEK NO. 2 Lot: 64
Project: Dykema
Project Description: Add /alter (2) branch circuits for installation of gas furnace and a /c.
Owner: FEES
DYKEMA, EUGENE Quantity Description Date Amount
16455 SW WOODCREST AVE
TIGARD, OR 97223 2 crt Branch Circuits 04/01/2010 $63.60
wo /Purchase Service or
PHONE: 503 - 598 -9692 Feeder
1 ea 12% State Surcharge - 04/01/2010 $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 OAR 952 - 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.
C::''; / \, n /�
Issued By: C 1 I \ k t ilU .�J i . M 3 Permittee Signature:
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' Q 9 `� Date:
91
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.
i q
CITY OF TIGARD ELECTRICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELC2010 -00150
Date Issued: 04/01/2010
:f 13125 SW Hall Blvd Tigard and OR 97223 503.639.4171
TIGARD 9 Parcel: 2S114BA11100
Jurisdiction: Tigard
Site address: 16455 SW WOODCREST AVE
Subdivision: COPPER CREEK NO. 2 Lot: 64
Project: Dykema
Project Description: Add /alter (2) branch circuits for installation of gas furnace and a /c. 4/14/10: Add (1) branch
circuit.
FEES
Owner:
DYKEMA, EUGENE Quantity Description Date Amount
16455 SW WOODCREST AVE 2 crt Branch Circuits 04/01/2010 $63.60
TIGARD, OR 97223 wo /Purchase Service or
PHONE: 503 - 598 -9692 Feeder
1 ea 12% State Surcharge - 04/01/2010 $7.63
Electrical
Contractor: 7 da Electrical Permit 04/14/2010 $7.42
BADGER ELECTRIC INC. 1 da 12% State Surcharge - 04/14/2010 $0.
4415 NE SANDY BLVD STE 205 Electrical
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 $79.54
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. 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 OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.66999 or1.800.332.2
Issued By: 'f r� Permittee Signature: a� ` o , G i „ /
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.
CaII 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.
Electrical Permit Application . ' g� , ��
lica , 1- , Nt 1: ,T l(. igiska " 1 i 4 r_.;
?5 City of Tigard O 1 20 �ecetved i Permit Nn.
L . 1R
r• ' ° 13125 SW Hall Blvd., Ti aid, OR 97223
t g , Plan Review
a ` a Phone: 503,639.4171 Fax: 503.598.1960 (i �` f ° i BDateBy: Other Permit:
F inspection Line: 503.639.4175 P)U f 1LNY-' It. 'Clare Ready/By. t ld See Page 2 for
" .4iirr Internet: www.tigard•or.gov (: D t AS, ; bfitied/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit sets of plans w /items checked below)
CI New construction �'lCddition/alteration /replacement
❑ Service or feeder 400 amps or snore ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONS 1•KUCI'ION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
,01- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps fur all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately denved system.
.109 SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ,, '.E "1 -2", "1.3 ",
Job no.: Job site address:
It' 5 Sy) tkj ft 6Ocit PAD IMIP°I occupancy.
Si, or more re residential units. ❑ Recreational vehicle parks
City/State/ZIP: ❑ Health -etas facilities. 0 Supply voltage for more than
h ❑ hazardous locations. G00 volts nominal.
Suite/bldg./apt. no.: I Project name: fi V ❑ Service or [feeder 600 maps or more.
"'� FEE SCHEDULE
Cross street/directions to job site: a,xcoptkn 1 Qty. 1 Pee. 1 Toth' 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fl. or toss 1 168.54 4
Ea. add'I 500 sq. fl. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. 11)
Limited energy, multi - family 67.84 2
oil • .. •. .. , ■ 46.1_4...1 . __ I All • A , residential (with above sq. it)
` Services or feeders Installation. alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State/ZIP: relocation
Phone: (503 ) sn 4 R _ C (Q C a l Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not
401 amps to 599 amps 168s4 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with �//
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 `I )- 2
each branch circuit
Business name: n, fee for branch circuits trithau �/
_ service or feeder fee, first ) 56 18 5 � I O 2
Contact name: branch circuit �1(/
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
Each City/State/ZIP: dwelling service nd/or 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited energy
Business name: panel, alteration, or extension_ Page 2 2
Td gar CC CI Ench additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
■ ' ' .4 , ; ii ' • • s ■ Investigation (1 hr min) 66.25/ hr
City/State/ZIP: POR`Oi31A - 97213 Industrial plant (I hr min) 78.18/ hr
Phone: (SLP3 q.41SLD I Fax: Spj gg3y.1 `� Inspections for which no fee is 90.00 / hr
l speeificatly listed (%r hr min)
CCB t.ic.: I5 Li%) Electrical Lic.: i Suprv. Lic.: ELECTRICAL PERMIT FEES /
Suprv. Electrician signature, require o Subtfte �f t ��
Plan review (2S /o of permit fee):
Print ntune16e/1 �� �� Date:4/ j ) / f , State surcharge (12% of permit fee): f (3
ILl1V` l/ TOTAL PERMIT FEE: * 7, l a
Authorized signature: 'Phis permit application expires if o permit Is not obtained with 80
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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a"-,T" '( City of Tigard R. 'CEP V E rewe'era3 Penni1 NaECC -Zo / 00 ,5
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
l7 • Other Pcnnit
4� + Phone: 503.639.4171 Fax: 503.598.1960 1 Date/By:
,- i +i � , lnspection Line: 503 639 4175 1 APR 2 2010 Date Ready/8y Judy RI See Page 2 for C4^? t Internet: www.tigsrd- or.gov Notified/Method. - �1 Supplemental Information
TYPE OF woRkITY OF TIGARD PLAN REVIEW
❑ New construction dition/alleratili�'I�th 1 V I S W N Please check aU that apply (submit 2 sets dolma wlitees checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other where the available fault current ID Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 turps at 150 volts or l] Floating buildings.
Tess to Bound, or meads 14,000 0 Cunnncrciut•use agricultural
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building maps for all other installations. buildings.
❑ Multi - family 0 Master builder 0 Other. 0 fire pump. 0 Installation of 75 K VA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A" "6" "I -2" "1.3"
Job no.: Job site address: ♦ . . ` / // // I00HPormere• occupancy.
41111 AE �l L a [] Six or mum residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more Than
0 Hazardous locutions. 600 volts nominal
Suite/bldg. /apt. no.: I Project name: 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: nrsatprtaa 1. Qty. 1 Pe,. 1 Twat 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: f Lot no.: 1,000 sq. fL or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.. Limited energy, residential 75.00 2
e DESCRIP'T'ION OF WORK (with above sq. R -
► R /C Limited energy, multi -famil 75.00 2
_ tr
residential (with sheer,: sq. R.)
Servkes or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ 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: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 turps 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, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fix, 6.65 2
each branch circuit
Business name: 13. Fee fbr branch circuits
without service or feeder fee, n
Contact name: first brunch circuit 46.85 /r 4 /; / —d 2
Address: Each add'I branch circuit 1 6.65 2
Miscellaneous (service or feeder not included) .
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: ISL VAE.�ltit/Cr Signal circuitls) or limited-
energy panel, alteration, or
Address: 44 1 '5614:1)1 - ( — f) extension. Describe: Page 2 2
City/State/ZIP: 44 ,.,0 e ' , Each additional Inspection over allowable In an of the above
/ Per inspection (�pS) 2488. /1-- j Fax: (a / - -) on 62.50
tt f / - 5 ---1 �, � � nvestigalion per hour (I hr min) 62.50
iV CCB Lic.: 1Jt 1 I4lectrical Lic.: 5,� Lie. .) Industrial plant per hour 73.75 f 4
Suprv. Electrician signature, requir ed 1 C ELECTRICAL PERMIT FEE$ a
- L� I� Subtotal:
! V/ h , (/ , I\
`'�" I b Plan review (25 %of permit q
Print name: Date: it fee):
Q
Slate surcharge (12% of permit fa): ., ` v /
Authorized signature: - TOTAL PERMIT FEE: i
I
Ibis permit application expire: if a permit Is not obis , � within 180 `
Print name: 1 Date: days after It bas been accepted as complete. O ,
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