Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit #: ELC2012 00378
T I G AR 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/25/2012
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Parcel: 2S108AB05100
Jurisdiction: Tigard
Site address: 14087 SW 155T11 TER
Project: Phoenix Subdivision: BRENTWOOD ESTATES Lot: 13
Project Description: (1) 200 amps or less, (6) branch circuits fir TI
Contractor: BADGER ELECTRIC INC. Owner: JACOBS
4415 NE SANDY BLVD STE 205 14087 SW 155TH TERR
PORTLAND, OR 97123 TIGARD, OR 97224
PHONE: 503 - 288 -4756 PHONE:
FAX: 503 -493 -7173
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/25/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/25/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 0 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 DAL
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1.800.332.2344.
7 . /
Issued By: Ate Signature: 8
fl� I .PPLI !H 1
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.
JUN -21 -2012 12:13P FROM: BADGER ELECTRIC, INC 503 - 493 -7173 TO:5035981960 P.2
--- REC City of Tigard REC
' cobs' /.1.. S ►� Et.Caip/� 0037 13125 SW Hall Blvd., Tigard, OR 97223 Plea Review
gi
Plume: 503.639.4171 Fax: 503. 1 2O 1 2 nF TIGR DairJBy Other Permit Line 503.639.4175 : "1 k 4 P I R Sapglameatal Idorreetiaoa
Internet www.dganl-0r.gov �, fQ
efLtiralf NNVIsIGN PLAN REVIEW
❑ New construction Additton/alteration/replacemen t Please cheek all thw apply (submit I sew orplans w /hems checked below):
O Service or their 400 =pear moat O Building over Owe Works ❑ DemOtidem 0 Other:
where the audible mdt even ❑ Maims and amp w hoaayardr.
� CATEGORY OF CONSTRUCTION exceeds 10.000 am 1S0 volts or 0 Flowing buildings.
lass m grams, or mends 14,000 ❑ Co
B 1 and 2 -fbmily dwelling ❑ Commcrcialfindustrial ❑ Accessory building other b taia ldin .use agricultural
for all athats aa. lni limp.
❑ Multi- family ❑ Master builder ❑ Other afire pump. O Installation of75 KVA or
O Adam af ` w w separately derived -3", system.
JOB SITE INFORMATION AND LOCATION
rr �� O Addition of new motor tads of "A . "B". "1-2". "W".
Job no.: ")" 1 Job site address: LF Si') 1 1 ' " T+:VI� Gam- p s cc m fcakiential imam 0 Recreational %chicle parka. _ -
City/State/zIP: Ti �,, fr�', ,� CI Nnlhcae facilities. 63 r ities. ❑ Supply vormr more than
� t ,�yr •r ,,, e4r' i) Q O b 600 volts nominal. nominal. al.
Suitdbld gJap t no.: Project name: � p Service or Rieder 600 atop, err more.
FEE SCHEDULE
Cross strcct/directions to job site: Dm.waolo I Ore, I raw 1 Tam 1 •
New residential single or multbfatnlly dwelling unit.
Iodides attached garage.
Subdivision: ( Lot no.: 1,000 era. R or fess 16854 _ 4
. Ea add'1500 sq. R or pardon 33.92 1
Tax map/parcel no.: Limited energy. residential
DESCRIPTION OF WORK (with above aq. O.) 67.94 2
Limited energy. multi-family 6784 2
I ->' )/ [fir, � AM fi t p �`°"`� residential (with above so. it) j • R Services or feeders Ittstalladoa and/or relocation
200 amps or less 1 100.70 ) 2
❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 tulips 133.56 2
Name: 401 amps to 600 Mips 200.34 2
_ 601 amps to 1,003 snips 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: reloca tr ry services or feeders tmauatloa, alteration, and%or
Phone: ( ) J Pax: ( ) 200 amps o r less 59.36 , 1
Owner Installation: This installation is being made on property that 1 own which is not 201 amps to 400 amp, 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 16854 2
Branch circuits- new, alteration, or extessina, per panel
Owner signature: Date: A. Fee for brash circuits with
above service or Ardor fee,
❑ APPLICANT I 0 CONTACT PERSON each branch circuit 7.42 2
Business name: B. Fee for branch circuits wUhom
service or feeder fee. first
56.18 2
Contact name: branch ohouh
Each add'l blanch circuit 7.42 2
Address: Mlsceilaaeoas (service or feeder not Included)
City/State/ZIP: /StateJZIP: Each manufbaured or mahrter 67.84 2
t3' dwelling, service and/or feeder
Phone: ( )
I Fax: : ( ) Reconnect only 67.84 2
. Pump or irrigation circle 67.84 2
E -Rail' w
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuids) or limited -energy
Business name: (wi d n/A P. 1Q f I C t JAL-- pa ts a iastceeion. . In any of the above
n 2
�`�"�'�� ry 1� Eath additional inspection over allowable In
Address: net_ �ftd1� 11fQ >:F� Additional inspeplom (liar min) 6625/ hr
City/Slete/LIP: Q et y t , NU -1 � Investi plant (1 hr min) 7 (1rvtrtirh) 6625/hr
v Industrial 8.18/ hr
Phone: ( (P) 5-S`6 ' l+ CU Fax: ( ) —1 (-1 3 Inspections far which no fee b 90.00f hr
B Lic.: V lecMcal Lic.: rv. L ic (, specifically listed ELECTRICAL PER
,J� 1St ..3 S� tC� � . .:.5173 MIT FEES 100.70
Suprv. Electrician signature, required:
4t(i
Plan review (25% of permit fee):
Print neme/f�n,1) i Date: a., State surcharge (12% of permit fa): i Z or et
Authorized sign J(l TOTAL PERMIT FEE: 1 i 2. .1 g "
l ( Tbb permit applatiaa expires tta permit Is not obtained widths 190
Print name riTh I Date: le 1X j.... days after inspections nallowed accepted n compere. wait