Permit CITY OF TIGARD ELECTRICAL PERMIT
. • COMMUNITY DEVELOPMENT Permit #: ELC2010 00536
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/29/2010
Parcel: 2S109AB10500
Jurisdiction: Tigard
Site address: 13109 SW WILMINGTON LN
Subdivision: Lot: 0
Project: Bivens
Project Description: (1) branch circuit for hot tub.
Owner: FEES
BIVENS, ELIZABETH Quantity Description Date Amount
13109 SW WILMINGTON LN
TIGARD, OR 97224 1 crt Branch Circuits 09/29/2010 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/29/2010 $6.74
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 $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 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 _ 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' Date:
LICENSE NO.
Call 503.638.4175 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.
SEP -27 -2010 11:49A FROM: BADGER ly3- 493 -7173 TO:5035981960 P.2
Ar..._..._ »• 4......... _r..--- -__ --- S E P 2 8 2010
City of Tigard Dan / higrirstrom Permit No.: . o — Cb ro
13123 SW Hall Blvd., Tigard, OR 90fl QF TIGARD Pl Review
Phone: 503.639.4171 Fax: 503 ffent ING DIVISION Date/By: Caber Permit:
inspection Line: 503.639.4175 Date Ready/Ely: I El See Page 2 for
Internet www.tigard-or.gov
' ` Notifred/blethod: ro Supplement' Information
E OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Picaso check all that apply (submit 1 sets of plans wrt«ns cued below):
❑ Service ar feeder 400 amps or more ❑ Building aver three stories.
❑ Demolition ❑ Other: where the available fault entreat 0 Marinas and l nyard&
CATEGORY OF CONSTRUCTION meats 10.000 amps at 150 oohs or D Floating buildings.
less to gmund, or exceeds 14,000 0 Commercial -use agricultural
Ciand 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps torah oduninstallations. buildings.
❑ Multi- family ❑ Master builder ❑ Other. O Fire pump. ❑ Installation of 73 KVA or
.108 SITE INFORMATION AND LOCATION I3 Addition o f ay m otor load of Q "A". "E". "1-2 ", "1-3".
6� w "- system.
p Addion o new motor
Job no.: I Job site address: M10 1 0 S\11 v R sun 1 MI W p Six or more residential aaita p Recreational vile paw
City /State/ZIP: Elstealth -earn facilities. 0 Sup Supply ol for more Ilan
1] Ham u rdo locations
Suite/bldg./opt.no.: I Project name: 1}..Aj s OService feeder 600 amps or more.
FEE SCHEDULE
Cross street/dircctions to job sitc: neatmteu I Orr. I Pee. 1 Tend 1 •
New retddenttal'Ingle- or multi - family dwelling unit.
Includes attached garage.
Subdivision: [ Lot no.: 1,000 set. R. or less 168.54 4
Ea. add'I 500 sq. R. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. R.)
Limited energy, multi - family 75.00 2
4- (n •I1N residential (with above sq. R.)
Services or feeders lostallatlon and/or relocation _
200 amps or Tess 100.70 2
❑ PROPERTY OWNER 1 0 TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: i S t F ( tom 2,t‘4(1.,, 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or voles 552.26 2
Temporary services or feeders Installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or Is 59.36 t
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 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Brands circuits- new, alteradoa, or e>tteasion, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPWCANP!' i ❑CONTACT PENSON Witch ci cui t feeder fee. 7.42 2
each Business name: B. Fee for branch circuits without
service or feeder fee. first ' 56.18 5 2
Contact name: branch circuit J�+
Each WW1 branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/Stato lZlP: Each mwnuilicturcd or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Signor outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -merry
Business name: • ,� panel, alteration, or extension. - Page 2 2
Each additional Iaspecdon over allowable In env of the above
Address: 44 IS NE, sp .) Additional inspection (1 hr min) 66.25/ hr
TO-AAA/02) �,Z� Indst p e hr min) 66.25/ hr
City/State/ZIP: Industrial plant m(Ihr min) 78.18/ hr
� +� 1 `� Insp4ctimis for which no fee is 90.00/ hr
Phone: ) `Z.<<72- Fax: (5V;) °t3 1 ` ■
specifically listed (SS hr min)
CCB Lic.: ieS1.58 t I Electrical Uc.:'Z,5 1 V ... I Suprv. Lic.: 91135 ELECTRICAL PERMIT FEES
Subtotal: 5 ,
Suprv. Electrician signature, required: ..--", 0 Plan review (25% of permit feu):
Print name: ""' (` AD rz_ I Date: State surcharge (12% of permit fee): 6 .15
S
TOTAL PERMIT FEE:. ,
Authorized signature: Ths permit application aspirea tf a permit Is not obi IMiryl ')
day' after It Ass been accepted u am�
Print name: 1 Date: • Number of inspections allowed per penrnit. '
I l& 11d1m8 nl dMELGMmUApp.doe 07101/10 440.461ST(11/O1ICOMIWE9
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