Permit n
•
; ITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00501 •
T t G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/24/2009
Parcel: 2S110DD04000
Jurisdiction: Tigard
Site address: 15695 SW OLD ORCHARD PL
Subdivision: Lot: 0
Project: Fitzwater -Henry
Project Description: Add /alter (3) branch circuits for a heat pump and to extend circuit.
Owner: FEES
FITZWATER- HENRY, MILLICENT Quantity Description Date Amount
15695 SW OLD ORCHARD PL
TIGARD, OR 97224 3 crt Branch Circuits 09/24/2009 $60.15
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/24/2009 $7.22
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 $67.37
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: Cu r 10lX �y�Q \,l z f><J Permittee Signature: 2 Q A
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.
RECEIVED
amaeva• ore as a Sol MRS r'aI/a,ram6aowsa
City of Tigard SEP 2 3 200 , "No.: e lC io09 ‘ 00501
13125 SW Hall Blvd., Tigard, OR 97223 pan ReviewOther
2OOq ' (30 y Qo
Phone: 503.639A171 Fax: 503.598.1960 mt.
Inspection Lino 503.639.4175 CITY OF TIGAR t< y: ® Sae page 2 far
Internet: www.tigptd•or gov BUILDING DNIS 1 tbpplemental informative
E OF WORK PLAN REVIEW
Please check an ❑ New construction Addition /alteeation/repleaernent tit apply (submit a sob of plans whims checked below):
O Salvino or [batty 400 amps or more Cl nwldine over three stories.
❑ Demolition ❑ Other. where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION eacoeds 10,000 amps at ISO votes or 0 Floating buildings.
less to mend, or exceeds 14,600 ❑ Coeeneawial -use agricultural
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all Wier installations. buildings.
❑ Multi - family 0 Master builder ❑ Other o pore pomp. O installation of 73 KVA or
D aunb:racy syslcm. larger separately derived system.
JOB SITE INFORMATION AND LOCATION °Addition anew motor load of I] "A ", "E ", "I -2 ". "1 -3",
Job no.: Job site address: � -j / 10°'°`� occupancy.
❑ Sac m mono residential units.
❑ oc Recreational pnty. vehicle parts. licatiNcern
City/Slate/ZIP: 0 Hszmdom toeotions. 0 � volts nominal. more than
Stlite/bldgJapt no.: I Project 111trne:3-•••r7 �.� ko J _ 1� Cl Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site meant elan 1 Qty. 1 Pra, 1 Tool 1 •
New residential single- or multi- family dwelling unit.
Includes attacked garage.
Subdivision: I Lot no .: 1,000 sq. ft. or less 145.15 4
Ea. odd 500 sq. R or portion 33.40 t
Tax map/parcel no.: Limited energy, residential 75.00 2
DESCRIPT ON OF WORK (with above sq. n.)
Limited energy, multi - family 75.00 2
L d . I • I A A �- � 1 ' _ice �, residential (with flow a4• ft.) .
. j),)( kArert Services or feeders installation. alteration, and/or rNucadon
200 amps or less 8030 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps (06.85 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
Ciry /State2lP: Temporary services or feeders (mtallatIon, alteration, and/or
relocation
Phone: ( ) I Fax( ) 200 amps or less 66.85 l
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. 40l amps to 599 maps 133.75 _ 2
Brascb circuits- new, alteration, or extension, panel
Owner signature: Date: A. Fee for brooch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or fbeder foe, 2_ 6.65 130 2
each branch circuit
Business name: B. Fee for branch circuits
without =vim or feeder fee, 46.85 2
sor
Contact name: first branch circuit
Address: Each add'1 branch circuit 6.65 2
Misedlancoas (service or feeder not included)
City /StateJZIP: Each manufactured or modular T 90.90 ' 2
dwelling service and/or limier
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
Signal circult(s) or limited -
Business name: �G � energy paid, alteration, or
Address: 441 S 13 t/t J extension. Describe: Page 2 2
City/State/ZIP: �") IS Each additional Inspection over alloarable loan of the above
Per inspection 62.50
it ' Fox: ("S'e3)
Phone: ('9o'S) 228 e 41 3 '1 C1 Investigation per hour (1 hr min) 62.50
CCB Lic.• 15(5-0 I I Electrical Lie.: 5 1 ety
I Su. Lic. 7 - Industrial plant per hour 73.75
� ?)0 ELECTRICAL PERMIT FE
Suprv. Electrician signatory, required Subtotal:
Plan review (25 %ofpermit fee):
Print name: State surcharge (12% of permit fee): � r a
Authorized signature: • TOTAL PERMIT FEE:
'nib permit application expires ifs permit Is not chained within 18o
Print name: - I Date: days after ft has been accepted as complet
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