Permit E
," CITY OF TIGARD ELECTRICAL PERMIT •
• �v
' COMMUNITY DEVELOPMENT Permit #: ELC2010 -00290
T1GrlRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/16/2010
Parcel: 2S103CD01600
Jurisdiction: Tigard
Site address: 13755 SW FAIRVIEW CT
Subdivision: HOLLYTREE Lot 16
Project: Holt
Project Description: (2) branch circuits for A/C.
Owner: FEES
HOLT, ROY Quantity Description Date Amount
13755 SW FAIRVIEW CT
TIGARD, OR 97223 2 crt Branch Circuits 06/16/2010 $63.60
wo /Purchase Service or
PHONE: 503 - 603 -9896 Feeder
1 ea 12% State Surcharge - 06/16/2010 $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.
Issued By: �fJ — Permittee Signature: e /9-70/ /c �0/✓
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.
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' of Tigard • ,
�� ,� " �° ' veal //a � ;; .. „ No 6 --0/ 70
± 13125 SW HalBlvd., Tigrd, OR 97223 '1,f1 ' ;, ' Plan R eview // c
0 ® Phone: 503.639.4171 Fax 503.598.1 ' , e .t Q , ally: other Pamir
s; Inspection Line: 503.639.4175 1 1 �' Date Ready /By: Ms Rl See Page 2 far
X t4d Internet: www.tigard of.gov 0 D faed/Mcthod: . V Suppkauntallaformation
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TYPE OF WORK .. O t \ \ O ' PLAN REVIEW
❑ New construction dition/alteration/teplarc lento �� . Pk check all that apply (submit g arts of plans whams checked below):
4)' Q Services or feeder 400 amps or more 0 Building over thus stories.
❑ Demolition ❑Other where the available dull current 0 Merinos and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 snips d 150 volts or ❑ Floating buildings.
-and 2 - titmil dwelt' ❑ Comatercitil/indtrstrial lase to ground, or exceeds 14,000 ❑ Commerclal -use agricultural
y ins 0 Accessory building amps far Mother installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other Cl Fits pump. 0 Installation of 75 KVA or
100 SITE INFORMATION AND LOCATION ORm y huger separately lydurvedsystem.
❑ Addition of new motor IoM of 0"A". "E ", "I -2 ", "1 -3 ",
Job no.: I Job site address: ��5(,v� 1 IOOIIP or tnoro. occupancy. 1 (� l V El Six or mom residential units. 0 Recreational vehicle perks.
City /State/Zlt ‘ �}�� 3 Healthcam facilities. 0 more then
Hazardous locations, 600 volts nominal.
0
Suite/bidgJapt no.: { I Project name: 4 0 Service or lbeder 600 amps or more.
job site:
FEE SCHEDULE oo.
Cross street/directions to )
J De>cAplrsa too.) � Fee. 1 Tad I •
New residential Wage- or multi - family dwelling unit.
Indedes attached garage.
Subdivision: I Lot no.: 1,000 sq. R. or lea! 168.54 4
Es. add') 500 sq. ft. or portion 33.92 1
Tax map/parcel 00.: Limited energy, residential -
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
n Limited energy, multi -family
(_,i„/+�/�` CA 4" residential 2 identiat (with above eq. ft.) 67.84
or feeders installatioa.alteratlon. and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ' 0 TENANT 201 amps to 400 amps 133.56 2
Name: He L T y c 4-Re/ Ooh amps to 600 amps 200.34 2
601 amps l0 1.000 amps 301.04 2
Address: / 37 5L5 sj t.-' fL (//e-,46, (r Ovar 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State/LIP: 7 7 --46 9 7A,,2 5 relocation
Phone: . .3 4 4 -, -- 9,9a I Fax: ( ) - 200 amps or Less 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 - 2
t 401 amps to 599 amps 168.54 2
intended for sale, ease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Owner signature: Branch circuits- new, alteration, or extension, r panel
$n�re: Date: A. Fee for branch circuits with (,�
❑ APPLICANT 1 0 CONTACT' PERSON above service or feeder fee, 7.42 '7 + d' 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 su 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
Each manufactured ur modular
City/SiateJZ1P: dwelling, service and/or fender 1 67.sa 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited-energy
Business name: t( 9 r n Ik f .(� tI . _ panel, alteration, or extension. nsion. , Page 2 2
` ` . 1 , Each additional inspection over allowable in any of the abov
Address: q L{ 15 ng wank_ J tUb A Q s - Additional inspection (t hr min) 66.25! hr
City /State/ZIP: oC� .1 NCI — i J tnrestigation(1hrmin) 66.25/ hi
Industrial plant (I hr min) 78.18/ hr
Phone: i - Fax: ( A) tr — , I Inspections fbr which no fee 0 90.00/ hr j_ & C.
r /specifically listed 04 hr min) U' /
i C CB Lic.: Ic�Ss� Electrical Lie.: S I Suprv. Lic.:5(4735 t ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: . Subtotal: , A
Plan review (25% of permit fee): 3
Print name ;--To Date: h i 0 State surcharge (12�sofpcmtit fee): Dr �
Authorized SigpatRi� TOTAL PERMIT FEE c am`
I f ( � 1 J r / I 7'hla permit application e x p i r e s a permit b not obhi 10 i 1
Print name:100 Date: Number days after It has been merited as ample .
U I • of impatiens allowed pa permit. /
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