Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00699
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/12/2012
Parcel: 2S111 BCO2000
Jurisdiction: Tigard
Site address: 10070 SW INEZ ST
Project: Baker Subdivision: TIGARDVILLE HEIGHTS Lot: 21
Project Description: (2) branch circuits for furnace and heat pump
Contractor: BADGER ELECTRIC INC. Owner: BAKER, HELENE
4415 NE SANDY BLVD STE 205 10070 SW INEZ ST
PORTLAND, OR 97123 TIGARD, OR 97224
PHONE: 503 - 288 -4756 PHONE
FAX. 503 -493 -7173
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 12/12/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/12/2012 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71 23
Required Items and Reports (Conditions)
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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 95 - 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1.800 332.2344
Issued By: '1 �— Permittee Signature: /69 �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.
CaII 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.
DEC -11 -2012 02:45P FROM: BADGER ELECTRIC ,INC 503 - 493 -7173 TO:5035981960 P.2
Electrical Permit ApplicaRE _EI I t I City of Tigard v Received • Permit Mo. •
;� 11 2012 Dat :. 1.2 4 /� •►r�I — _ i , —//
131 SW Hall Blvd., Tigard, OR 97. i Plan Review • Phone: 503.718.2439 Fax: 503.598.' ". I Dale/B . Other Permit:
i t . n nt i , Inspection Line: 503.639.4175 �/ /t[ -rink On Dale Ready/By: 0 See Page 2 for
Internet: www.tigard-or.gov L I 1 Ur 1 N.IIIftu Notified/Method: hod: �" Supplemental Information
A
TYPE t A6R G DIVISIOPd PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
ID Demolition ❑ Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less so ground,
other or installations. ns 00 ❑
® I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all otlux installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other. 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system larger separately derived system.
0 Addition of now motor toad of ❑ "A", "E", "1-2", "1 -3 ",
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Job no.: I Job site address: 10070 SW Inez St 100HP or more. Zupan%'.
0 Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 0 Health -care facilities. 0 Supply voltage far more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: I Project name: Jacobs/Helene Baker 0 Service or feeder 600 amps or more,
FEE SCHEDULE
Cross street/directions to job site: De artnuan 1 Oar. I, Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less 168.54 4
Tax map/parcel no.: En. add'l 500 sq. R. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. R.)
Limited energy, multi - family 75.00 2
Reconnect furnace, new circuit for heat pump residential (with above sq. R.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 •
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
40I amps 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 I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each brunch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit I 7.42 7.42 2
Address: Miscellaneous (service or feeder not included)
City/Stale/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E- mail' Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy -
Business name: Badger Electric Inc panel. alteration, or extension. Page 2 2
Each additional Inspection over allowable In any of the above
Address: 4415 NE Sandy Blvd, #205 Additional inspection (I hr min) 66,25/ hr
City/State /ZIP: Portland, OR 97213 Investigation (I hr min) 66251 tit
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 288 -4756 Fax: (503) 473 -7173 Inspections for which no fee is
90.00/ lir
specifically listed (SS hr min)
CCB Lic.: 156581 ✓I Electrical Lie.: 3.571C Suprv. Lic.: 5473S ✓ ELECTRICAL PERMIT FEES
v -� Subtotal: 63.60
Suprv. Electrician signature, required :� l Plan review (25% of permit fee):
Print name: Todd Gaber Date: 12/11/12 State surcharge (12% of permit fee): 7.63 v
TOTAL PERMIT FEE: 71.23 `°'
Authorized signature: Thus permli application expires if a permit Is not obtained within 180
Print name: I Date: days after It has been accepted as complete.
• Number of inspections allowed per permit.
I,Vlutidini, PermltstE1.C- Pum4Appdoe 07/01/10 410461Sf(1I /OS/COM/WEB