Permit 7 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00437
TL+GA.R.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/03/2011
Parcel: 2S103BC04000
Jurisdiction: Tigard
Site address: 12490 SW WALNUT ST
Project: Cameron Subdivision: Lot:
Project Description: (1) branch circuit to ground panel.
Contractor: BADGER ELECTRIC INC. Owner: CAMERON, DONNA IRENE
4415 NE SANDY BLVD STE 205 12490 SW WALNUT ST
PORTLAND, OR 97123 TIGARD, OR 97223
PHONE: 503 - 288 -4756 PHONE:
FAX: 503 - 493 -7173
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 08/03/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/03/2011 $6.74
Type of Use: SF Electrical
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 -0090. You may obtain a copy of the rul direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: J 1i_ Permittee Signature: 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.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
AUG -2 -2011 09:28A FRDM:BADGER ELECTRIC, INC 503- 493 -7173 TO:5035981960 P.2
RECENED
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City of Tigard AUG — 2 2 010 Received /I Permit No.: . I --WI..
13125 SW Hall Bivd., Tigard, OR 97223 Plan Review Other Penult: * Phone: 503.639.4171 Fax: st,. ?& l TIGARD Date/By: Inspection Line: 503.639.41 ,bran ®gee Page 2 for
ILDING DIVISION Date Notified/Method: Sapi�atal Iafor"ratiaa
Internet www.tigerd- or.gov
TYPE OF WORK PLAN REVIEW
o New construction eAddition/alter8tion/replacement Please Check ill that apply (submit a acts of plans wlitcwa checked below):
b St rohm or reader 400 amps or mom 0 Building over three stories.
Demolition ❑ Other: where the available ihult current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or D Floating buildings.
lam to ground. or exceeds 14.000 0 Commercial -use agricultural
13 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for an other installations. buildings.
❑ Multi- Ibmily ❑ Master builder ❑ Other 0 Fite pump. D installation of75 KVA or
0 Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ^^ Q Addition of new motor load of ❑ "A ". "E", "1 -2 ", "1.3 ".
Job no.: ( Job site address: 1 - -
I t � � O S W LL t (21-( IOOHP or man. occupancy. 0 six or rase 'cadential units. 0 Recreational vehicle parka. City/State/ZI P: -- ()A A��. j0 4„ 4 -)e3 -?- 3 D health. ate facilities. ❑supply voltage the mote ttwa
6 „` _ V ❑ ttmedous locations. 000 volts nominal.
Suite/bldgJapt. no.: I Project name: C j 't ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: nearoitho i Qty, 1 rest 1 Taal I •
New residential single- or,anitl- faally dwelling unit.
Includes attached garage.
Subdivision: ' Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'1500 sp. R, or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. it)
(., C Limited energy, multi -family 67.84 2
tasidentid (with above ove sq. q, ft.)
Services or feeders instaitation and/or relocation
200 amps or leas 100.70 2
❑ PROPERTY OWNER I 0 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: ( )
1 Fax: ( ) 200 amps or less 59.36 1
r 201 amps to 400 amps 125.08 2
Owner Installation: This installation is being made on property that I own which is not 401 to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits -new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 0 CONTACT PERSON each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee. first 56.18(p, (g 2
Contact name: branch circuit
Each add') branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular ' 67.84 2
City/State/ZIP: dwelling, service and/or feeder
`
Phone: ( ) Fax: ( ) Reconnect only 67.84
I 2
Pump or irrigation Miele 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
(�, X �� P l —tom panel, alteration, or extensitsi. , Payee 2 2
Business name:
1 A P IQ c . . IL i ` L 1r\ 1,- Each additional Inspection over allowable In any of the above
Address: LI .4 6 '1)52 i. b 10 . D 6' Additional inspection (1 hr min) 66.25/ lir
n 2 Investigation (1 hr rain) 66.25/ hr
City/State/ZIP: t e C l/c.t1,d (� -Q C '1) 7 Industrial plant (1 hr min) 78.18/ hr
Phone: ( , 11f}, ��tc 4 I Fox: (5S ) La1,2, —, ( --I 3 Inspections for which no fee is 90.00J hr
1 A M ) specificallylisted (%hrmin)
CCB Lic.: 1( 0.5c1 1 Electrical Lie.: : 3-51 i d Suprv. Lic.:5(17 S ELECTRICAL. PERMIT FEES •
Subtotal: ,5(p i
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name:. -1 j J (- t ti ,' l Date: 0 l' Slate surcharge (12% of permit fee): (n.24
( TOTAL PERMIT FEE: (Q _ j a- ,
at v t
Authorized si �Lo This persrlt application expires If a permit is mot obtained within 180
ItJ' °�' days alter It boa ben accepted a cnrmpkte.
PrintrtarrlC:���� �(� Date: $� • Nu mber of inspections allowed per permit.