Permit •
CITY OF TIGARD ELECTRICAL PERMIT
.71 '
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00316
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2012
Parcel: 2S 104C D04900
Jurisdiction: Tigard
Site address: 13807 SW HILLSHIRE DR
Project: Leavit Subdivision: HILLSHIRE ESTATES Lot: 49
Project Description: (1) branch circuit for range
Contractor: BADGER ELECTRIC INC. Owner: LEAVITT, THEODORE D & CAROLYN J
4415 NE SANDY BLVD STE 205 13807 SW HILLSHIRE DR
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 05/24/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/24/2012 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
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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 OA 9 - 001 -00 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232,1987 or 1.800.332..22344. �1
Issued By: Permittee Signature: � APPL ► ' d L
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.
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MAY -23 -2012 11:52A FROM: BADGER ELECTRIC3 -7173 T0:5035981960 P.2
tit Az-. P 'If FO
City of Tigard MAY 23 i •ved s , at,t (t. - se t - 16/a - - oo 3 , {,
- 13125 SW Hall Blvd., Tigard, OR 97223 r•
CITY 1 123 6 "`ew
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit BUl�Dl
, , ,: , , Inspection Line: 503.639.4175 J /B . m Sit
Internet: www.ligard•or.gov BUILDING ��! ;a exly r : ' ? Supplem Page ental Inforstadea
E OF WORK PLAN REVIEW
❑ New construction Addition /alteration/repIacement Pkere check all dent apply (submit lams asthma Wilms checked below):
❑ Demolition ❑Other ❑ Service or feeder 400 amps or more O Building over three main.
where the available fault current 13 Marinas and boatyards.
21: and 2 - CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
famil dwelling less to ground, or exceeds 14,000 13 Comm-mild-use agricultural g ❑ Commerclal/industrial ❑ Accessory building far all other installations. buildings.
❑Multi family 0 Master builder 0 Other ❑ Fimpump. ❑ installation of73KVAor
JOB SITE INFORMATION AND LOCATION Cl emergency larger separately derived .
❑ Addition of new motor load of 13 "A ", "E", "I -2", "1-3 ", occupancy.
Job no.: 1 i, q I Job site address: 1 SW t I, C .451( 100HP or more. O Six er mom mat units. O Recreational vehicle parka.
• City/State/ZIP: ¶ n y� ul�
❑ Heecore fatuities. ❑ SWOT %amge for mom than
` \
0 Hazardous Meadow. 600 volts nominal.
S u i t e / b l d g . / a p t , no.: I Project name: Le g U ( ❑ Sege or Rieder 600.mps or mom.
FEE SCHEDULE
Cross street /directions to job site: _oR,rauw ! e)rr. I Fn. I Taal t •
New residential aInala or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.1L or less 168.54 4
Tax map/parcel no.: Ea. add') 500 sq. it. or portion 33.92 I
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. R)
Limited energy, mufti - family 67.84 2
I -' -6 x ( t .. , rai.,1/40- reshhmulal (with above sq. R.)
Services or feeders lnstallation, and/or relocation
200 amps or less 00. 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps , 1 33.5 2
Name: 401 amps to 600 amps 200.3 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 mow volts 55226 2
City/State/ZIP: Temporary services or (betters Installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner Installation: This installation is being made on property that I own which is not 201 to 400 amps 125.08 2
intended (br sale, lease, rent, or =change, tur
according to ORS 447, 449, 670, and 701. 401 cape to 599 caps 16$.54 2
Brandt dreuits new, alteration, or extension, Qer panel
Owner Signature: Date: A. Fee for branch ctrcults with
❑ APPLICANT I ❑ CONTACT PERSON above service or Ruler fbe, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits wvuhonr
service Contact name: branch ci�irsan first 56.18 s� �� 2
Each add'I branch circuit 7.42 2
Address: Misedlaneoussservice or Feder not Included)
City/State/ZIP:
Each mamtbcturnd or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Rewmtectonly 67.84 2
Pump mp or Irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal cinvit(s) or limited - energy
Business name: ell-441A P. V c . tC t1� panel, alteration, orextensio n. Paget 2
( Each additional Inspection over allowable In any of the above
Address:L4 6 ng' /11 I) 1O ioos Additional inspection (I hr min) 6615 / hr - -
City/State/ZIP: QCe ylld NJ C.('J� mvestigatiosa(1 hr min) 6625/hr
Industrial plan (1 hr min) 78.18/ hr
Phone: (56 5•k - St I Fax: (t Q) (d421 , i, 7 Inspections tbrwhich no fee is 90.00/ car
`�-^^ �J specifically lined (4S hr min)
CCB Lie.: 15(05%1 Electrical Lie.: 3 S'1 1 6 Suprv. Lic.:5('J7 S ELECTRICAL PERMIT FEES
Subtotal: (,r • ( Q
Suprv. Electrician signature, required: Plan review (25% or permit fee):
Print name .1 (k '"1 ` I Date: 5 I
7 1 3 + L Slate surdmrge (12'K of Midi foe): (8"
!Lu` �• TOTAL PERMIT FEE:
Authorized sigpat rr , ,1,( d /�
1[}'^r^ k �r. . This permit.ppuaHo. empires us permit m oat obtained rrltbto t Z
days alter h as h been accepted as csmpkta 2'"
Print namerIODO 614,62,1 I Date: 5) ),3) 1 z • Humber of inspections allowed per pcnn