Permit • CITY OF tTICARD — 1 O ELECTRICAL PERMIT
i ° " ✓✓ PERMIT #: ELC2007 -00284
COMMUNITY DEVELOPMENT DATE ISSUED: 5/1/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S133DA-07100
SITE ADDRESS: 12980 SW HAWK'S BEARD ST ZONING: R -
SUBDIVISION: AMART SUMMERLAKE LOT : 093 JURISDICTION: TIG
PROJECT: KRUSE
Project Description: (2) branch circuits for a/c & service outlet.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
KARL KRUSE BADGER ELECTRIC INC.
12980 SW HAWKS BEARD PO BOX 55446
TIGARD, OR 97223 PORTLAND, OR 97238 -5446
Phone: Contact #: PRI 503 288 - 4756
FAX 503 - 493 -7173
FEES
Description Date Amount Reg #: ELE 3 -5710
[ELPRMT] ELC Permit 5/1/2007 $53.50 LIC 156851
[TAX] 8% State Surcharge 5/1/2007 $4.28 SUP 4951 S
Total $57.78 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will b- • • • - 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 t• -n 180 days. . TTE ON: Oregon law requires you to follow rules adopted by the Oregon Utility No ication Center. Those rules are set forth in
OAR •52- 001 -0010 thro 0 • R •..2- 001 -0100. You may obtain copies of these rules or direct questio o OUNC at 503.246.6699 or 1.800.332.2344.
Il / h 11 \1 / Permittee Si gnat
Iss d By: • g i �.:..
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'N: C _6-at� 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.
AiR- 24007 02:06P FROM :BADGER ELECTRIC,INC 503- 493 -7173 TO:5035981960 P.1
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City of Tigard / ma q . 'ols/ D 7 ) e l�etmit rte.: f j �,C 7—ooA8
13125 SW Hall Blvd., Tigard, OR 9722 RECEIVE Plan Review ,
Phone: 503,639.4171 Fax: 503.598.1960 Date/By: Other P
Inspection Line: 503.6394175 4.1 2 4 2 0 P - ' I 1� Date Ready/By: 1 0 See Page 2 for
Internet www.ci.tigard.or.us ' Notified/Method: / /Ilk 1 Supplemental information
CITN 'WARD PLAN REVIEW
IRfI IVISION
❑ New construction M Addition /alteration/replacetnent Please check all that apply:
❑ Demolition CI Other: ❑Service over 225 amps, comm'I ❑Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., • CATEGORY OF CONSTRUCTION of 1- and 2- ibmily dwellings 4 or more new residential
and 2- family dwelling ❑ CommerciaVindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
El Multi-family ❑Master builder ❑Outer. ['occupant load over 99 persons OManufactured structures or
JOB SITE INFORMATION AND "LOCATION ❑Egressdlighting plan RV park
d�1 s,.., „„, � ❑Health -care facility ['Other ['Other Job no.: I Job site address: Mai g I Submit j sets of plans with any of the above.
City /State/ZIP: The above are not applicable to temporary construction service.
FEE” SCHEDULE
Suite/bldg./ apt no.: 1 Project name: 1 o<,cdotrao i tny. I Pee, l That I ..—
1
Cross street/directions to job site: New residential single- or mntti -amity dwelling unit.
Includes attached garage. _
1,000 sq. ft. or less 145.15 4
—
Subdivision: I Lot no.: Ea. ndd'l 500 sq. R. or portion 33.40 I
Limited energy. residential 75.00 2
Tax map/parcel no.: Limited energy, non - residential 75.00 2
. DESCRWI' Obi OF WORK Each manutbctured or modular
' dwelling, service and/or feeder 90.90 2
AL, r,E LJa Services or feeders Installation, alteration, and/or relocation
/ _ 200 amps or less 80.30 2
201 amps to 4110 amps 106.85 2
❑ PROPERTY OWNER TENANT 401 amps to 600 amps 160.60 2
Name: Ku.s E. )1)62,/___-- 601 amps to 1,000 amps 240.60 2
Address: Q a ! t77
I , I Over 1,000 amps or volts 454.65 2
_ � ls s K (� �� Reconnect only 66.85 2
City/ State/ZIP: t ( n _2 1 ,-, 6 2_ q 7 9 2 . 3 Temporary services or feeders installation, alteration. and/or
I
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 I
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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
0 APPLICANT l 0 CONTACT PERSON A. Fee for branch circuits wish
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, ' 46.85 4 t s5 2
run
each brunch circuit
Address: Each add9 branch circuit ` _ 6.65 6, b5 2
City/State/ZIP: Miscellaneous (service or feeder not Included)
Pump or irrigation circle 53.40 2 1
Phone: ( ) I Fax : : ( ) Sign or outline lighting 53. 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: $fL J �,,�
I Each additional Inspection over allowable in any of the above
Address: �, O - ' Sae SS4 Per Inspection 62.50
City /State/ZIP: r 6. k A. • 11.236 Investigation per hour (I hr min) 62.50
Phone: (� , ,A s • ( Fax: (Sp?)) 4 "', I"13 industrial plant per hour 73.75
ELECTRICAL PERMIT TREES"
CCD Lic.: 1 eafifS ' Electrical Lic.: 3 —S1 i C, Suprv. Lie.: 49515 Subtotal 5
Suprv. Electrician signature, required: Plan review (25%ofpcmlit fee)
P
State surcharge (8% of permit fee)
Print name: �` t A,C�yJ Jule: �,) . )4 71
TOTAL PERMIT FEE
Authorized signature: Mk permit application expires its permit is not obtained within IRO
days alter It bas been accepted as complete
Print name: I Date: • Fee methodology act by Tri- County Building industry Service Board
•° Number of inspections oar permit allowed,