Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
PERMIT ISSUED: E 5/2008 00318
DATE ISSUED: 6/5/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 CB -00500
SITE ADDRESS: 14805 SW 103RD AVE ZONING: R -3.5
SUBDIVISION: DEL MONTE SUBDIVISION LOT : 004 JURISDICTION: TIG
PROJECT: MUN HALL
Project Description: Installing (2) branch circuits for furnace and A/C.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: -
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WALT MUNHALL BADGER ELECTRIC INC.
14805 SW 103RD AVE 4415 NE SANDY BLVD STE 205
TIGARD, OR 97223 PORTLAND, OR 97123
Phone: 503 - 620 -6830 Contact #: PRI 503 - 288 -4756
FAX 503 - 493 -7173
FEES
Description Date Amount Reg #: ELE 3 -571C
[ELPRMT] ELC Permit 6/5/2008 $53.50 LIC 156581
[TAX] 12% State Surchar 6/5/2008 $6.42 SUP 3596S
Total $59.92 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By:' / ` Perm ittee Signature: . 5 ? %j?C
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'N: 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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City of T i g a r d U a t e / B - ICJ " v ;mu nil No.: [e, a /�
13 t 25 S W Hell Blvd., Tigard, o, C Y fi i f G A Fib Plant Review t> �,,,,;�
-Tr P ho ne: 503.639.4171 Fax: 503 .'.�1 O1i nq Date/B . '
Inspection Line: 503.639.4175 .V Dale Ready/By: flair la see Page 2 for
i t,.. 1I 1] Internet: www.tigard- or_gov Nntified/Metbod: $ Supplemeatallnforasation
TYPE OF WORK PLAN REVIEW
❑ New construction ddition/alteration/reptacement Mast check oll tint apply (submit a sets of pima w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other. where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION a deeds 10,000 amps at 150 volts or 0 Floating buildings.
kas to ground, or exceeds 14,000 Q Commercial -use agricultural
r - and 2- family dwelling ❑ Commercial/industrial 0 Accessory building antra for all other installations. buildings.
❑ Multi- family ❑ Master builder (] Other: 0 Fire pump. ❑ Installation of 75 KVA or
0 Emergency system. larger separately derived system
JOB SiTE INFORMATION AND LOCATION [ Addition anew motor load of
II� 100HP or more. occupancy. •
Job no.: Job site address: ) y 05 5 W /0 6 ❑ Six or lama residential units. ❑ Recreational vehicle parks.
,
City/State/ZIP: O Hazardous I i io n s. supply voitage far moue than
tY ._.—i./ J�. !�� ❑ Hazardous locations. 600 volts nominal.
5uite/bldgJapL no.: Project name: " , : l L° - 1. / ❑ Setvica or fcedcr600 xmps or Wore.
FEE SCHEDULE
Cross street/directions to job site: ( Qtr. I Y«. 1 Toml 1 •
New residential single- or multi- family dwelling unit.
Includes attacked garage. .
Subdivision: I 1 o f no 1,000 sq. IL or Less 145.15 4
Ea. add'' 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. a,) 75.00 2
Limited energy, mufti- family above a 75.00
2
tJ\ . ith h) residential (w Services or feeders installation. alteration, and/or relocation
200 amps or less 80.30 2
24 OPERTY 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
Temporary or feeders installation, alteration, and/or '
City/Slate/ZIP:
Phone: ( ) l Fax: ( ) 200 amps or less 66.85 ' I
Owner installation: This installation is being made on property that I 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
Brock circuits- sew, alteration, or extension, 1 r panel
Owner signature: Date: A. Fee for branch circuits with
0 APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee. I 6.65 1 c'
each branch circuit 1
Business name: B. Fee for branch circuits Q�
without service or feeder fee, 1 46.85 ° ' 2
Contact name: first branch circuit �r
Address: _ Each add'l branch circuit L 6.65_, , 6 7 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
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 natme: Signal circuit(s) or limited -
��.�je�./C� energy panel, alteration, or
Address: ^ ' ` ` "�,A (�_/I {B t. extension. Describe: Page 2 2
City /Stale/ZIP: q _ 1 :s Eaell additional Iuspectlmr over allowable in an of the above
Phone: (110'5) 7_% ., q-S"( Fax: V5 493 -1 cr3 investigation per hour it hr min) 62.50
CCB Lie.: ' Electrical Lic.: S u rv. Lic.: Industrial plant hour 73.75
15(�5� 1 3 -s It c .l p 359 5 p ELECTRICAL ''
ELECTRICAL PERMIT FE ' ,��
Suprv. Electrician signature, required: P � l � Subtotal: r
Print name: * �- + , - Die; Plan review (25% of permit f- ' : / • , ��
�] ?.fY11V- �GJJVJ State surcharge (12% of permit fee): r ., fi t
Authorized signature: ;
'TOTAL PERMIT FEE: /
This penult application expires If a permit b not o ...: . in
Print name: I Date: days after it has bees accepted "co '� 5- 4.11?"
2'd 096T86S20S:01 ELTL- 26b -20S ONI `OI2i10313 2i 3901J8 :WOdd 462:60 8002- b -Nflf
CITY OF TIpARD
BUILDING DIVISION PERMIT #: ELC200B -00318
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: CW5/2008
Phone: (503) 639 -4171 �° °Nlm iq���
Inspection Requests (24 Hrs.): (503) 639-4175 -_ �
INSPECTION WORKSHEET FOR DATE: 7/10/2008 TIME: 7:00AM PAGE: 23
SITE ADDRESS: 14805 SW 103RD AVE CLASS OF WORK:
SUBDIVISION: DEL MONTE SUBDIVISION LOT #: 004 TYPE OF USE:
PROJECT NAME: MUNHALL
DESCRIPTION: Installing (2) branch circuits for furnace and NC.
OWNER: MUNHALL, WALT PHONE #: 503 -620 -6830
CONTRACTOR: BADGER ELECTRIC INC. PHONE #: 503.288 -4766
Inspection Request Scheduled For: Date: 7/10/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 072437 -01 503.234 -7331 Y
7
Corrections /Comments /Instructions:
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KPASS U PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
IL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 3' 6 Date: 1-10 r v V Phone #: (503) 718- 16