Permit ripp. CITY OF TIGARD ELECTRICAL PERMIT
. " - COMMUNITY DEVELOPMENT Permit #: ELC2009 -00110
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/05/2009
?ICrARD Parcel: 1 S 134CB13100
Jurisdiction: Tigard
Site address: 12348 SW MILLVIEW CT
Subdivision: Lot: 0
Project: Bullock
Project Description: Install (2) branch circuits.
Owner: FEES
BULLOCK, JOSEPH FRANKLIN & Quantity Description Date Amount
BULLOCK, INGRID ELIZABETH, 12348 SW •
MILLVIEW CT 2 crt Branch Circuits 03/05/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/05/2009 $6.42
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 $59.92
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.
q •
Issued By: 4'l li _ �` _J Permittee Signature: ` • -;' S �J<
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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IN .. City of Tigard RECEIVED v., :`, 3 -a. oq . Permit No.: IC slid C)
13125 SW Hall Blvd., Tigard, OR 972 Plan Review
-
• Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit.
i 1 1 , Inspection Linn 503.639.4175 MAR 0 2 2009 Date Ready/By r,a RI See Page 2 for
Internet: www.tigard- or.gov Notifedlvtetbod: 17 4 I Supplemental Information
OF Wail OF O N PLAN REVIEW
CI New construction dition/a tabCMeht Please check all that apply (submit I sets of plans winces checked below):
13 Demolition ❑Other O Service or feeder 400 mops or norm Cl Building over three stoics.
where the availabto (huit current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
rd 2- f>Imily dwelling ❑ Commercialimdusuial
less p so ground, other e r exceeds 14,000 0 buildings.
lu agricultural
❑ Accessory building � Coral] other t"anitnrh. ms bmldings.
❑ Multi- tbrnily ❑ Master builder 0 Other. 13 Fiprmp• ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION 0 y lea'. larger separately derived system.
n .. ' � ❑ A d d i t i o n new motor load of "A ", "E "l -2 ", "1.3 ". •
Job no.: I lob site address: 9 3 „ a , at) rAt1(V I•t[J,JI) t _,/i 100HP or mons occupancy.
r O Six or more residential ratite. O Recreational vehicle parks.
City/State/ZIP: 1 ./ J � ( 0 Health-taro iheiHdes. ❑ Supply voltage for morn than
Suite/bldg./apt. no.: /"G 11 / Project name: ',�„ f Q u O Service orfeeder GOO amps ormore,
600 volts nominal.
wQ �+�(�(' s/ �• FEE SCHEDULE
Cross street/directions to job site: oriorpra• If q7. I r«. I Tow I •
New residential single- or multi- family dwelling unit.
•
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no.:
Ea. add'I 500 sq. tt or portion 33.40 t
DESCRIPTION OF WORK Limited energy, residential
(with above sq. a.) 75.00 2
41 r Limited energy. multi- family 75.00 2
residential (with above sq. IL)
Services or feeders Installatioa alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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 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
Branch circuits - new, alteration, or extension, r panel
Owner signature: Date:
A. Fee for branch circuits with
❑ APPLICANT I 0 CONTACT PERSON above service or (haler fee, 1 6.65 6 (9`) 2
each branch circuit
Business name: B. Fee for branch circuits
without service or [Ceder fee,
Contact name: first branch circuit ) 46.85 Lilt 2
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City / State/ZIP: Each manufactured or modular 40,90 2
dwelling, service and/or Ceder
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: . 16,D,D V.,(.C.. Signal circuit(s) or limited-
energy panel, alteration, or
Address: 44 \ 5 •
4'�"'� '5 l extension. Describe: Page 2 2
City / State/ZIP: 44 � o�"' 1 ” Each additional Inspection over allowable in an of the above
f Per inspection 62.50
Phone: ('703) 2Q QQ , ��) )
U' � Fax: ( 93 '1 1 Investigation per how (I Ito min) 62.50
CCB Lie.: 15( ` I Electrical Lie.: 3- 5i t c I Suprv. Lie.: ?j's9(o5 Industrial plant per hour 73.75
ELECTRICAL PERMIT FE ,3
Suprv. Electrician signature, required: - Subtotal: 1 )�t�
Print name: '"'"S (t ._, i I Date; plea review (25 % of permit tee):
��v t State surcharge (12% of permit tee): r
Authorized signature: TOTAL PERMIT FEE:
Print name: I DII1e: This permit application expires if a permit boot obtained within 180
days after It has been attested as complete.
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