Permit , CITY OF TIGARD ELECTRICAL PERMIT
s • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00205
T IA R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/03/2013
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Parcel: 2S112ACO2200
Jurisdiction: Tigard
Site address: 14835 SW 72ND AVE
Project: GeoPacific Engineering Subdivision: FANNO CREEK ACRE TRACTS Lot: 48
Project Description: (2) branch circuits
Contractor: PRAIRIE ELECTRIC INC Owner: HONEY BADGER LLC
6000 NE 88TH ST 24560 SW MIDDLETON RD
VANCOUVER, WA 98665 SHERWOOD, OR 97140
PHONE: 800 - 573 -2750 PHONE:
FAX: 360 - 573 -9866
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 04/03/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/03/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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' I - e • • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 - 0010th gh OAR 95 0' * r '0. You may obtain a copy of the rules or direct questions to OUNC by callin .232.1987 or 1.800.332.2344.
Issued By: l / Perm ittee Signature C` 4---
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' e ��� 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.
04/02/2013 15:06 FAX 360 573 9866 Prairie Electric Inc. go01 /002
Electrical Permit Application RECEIVED � voR OF1 1(E I .1 O \1.1
Ci of Ti and Received
�' g Date/6 : y Permit No.: � LGoipI3- ODAO3-
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
_ Phone: 503 - 718.2439 Fax: 503.598.196 R 0 2 2013 Dare/B Other Permit:
'11 G A R D Inspection Line: 503.639 -4175 Date Ready/By: Jurist 0 See Page 2 for
Internet: www.tigard-or gov Notified/Method, Supplemental Ieforwatioe
t I' a i a: v.: �: I x;:
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, 4, b[ 949 al p . .. �� ! IR .. I ri.._., -. >. ,. .: •,M. ..... .
❑ New construction c ddition /alteration /ren]acement Please check all that apply (submit 2 sets of plans w /items checked below).
a ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other
-- = € >< :r , � .. � _ ,. where the available fault current ❑ Marinas and boatyards.
4''' , j •, - i 4 . �iTa ' ' w c 'RtiCTI exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
' ' " 4 ' - {r5 " "` ' less to ground, or exceeds 14,000 ❑ Commercial -use
1- and 2- family dwelling ?: Commercial /industrial ❑ Accessory building amps for all other installations. buildings. agricultural
L Nultt family • aster builder ` I Other: ❑ Fire pump. ❑ installation of 75 KVA or t
i. S i c'41 M t tt;ii > D] lli t ''d ~ � ❑ Emergency system. larger separately derived system.
_..... �... .< � •, . • � s... , . - .., ..., �. ...;:. ='. ,' .. Addition of new motor load of ❑ • „ E�" "1_2 ••1_3
Job no.5 ( ! ( Job site address: / . ' ?�,, "..-48OHP or more occupancy.
Six or more residential units ❑ Recreational vehicle parks.
City/State/ZIP: "'- 6, . L4 ❑ Health -care facilities 0 Supply voltage for more than
/ 2. v I - ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name �6/�,cr Service or feeder 600 amps or more.
Cross street/directions to job site: T Description Vii a r T r ! •
P 1 Qty. Y .. __� . Fae. 1 Toad j
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'I 500 sq. ft. or ponion 33.92 1
Tax map /parcel no
Limited residential
v
:, Z , 1 4ii .i? i :: a D,t,01J'jQ r µ 10F WORK . . 4 -Z .. : (with above sq ft.) 75.00 2
1. - --/ Limited e nergy, multi- family
/ � / 7,� residential (with above sq. R.) 75.00 2
, „ f7 ._ � �-�/� � __) 200 a men or feeders installation, alt�ntion, and/or relocation
��j lf�` /� O V e�i"A/ 7 /Y 200 a or less L I 100 ' . . 1 2
.. 1 1 OPI k ''0Wt ^ - PENNY . - 201 amps to 400 amps 133,56 2
Name:
401 amps to 600 amps 200.34 2
. . 601 amps to I ,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 i - . / I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447. 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: circuits Fee f or branch circwts rvuh t •
„r w ;:
jJ ARPLJ .! T ; CONTACT;PER "' above service or feeder fee, 7 -42 2
each branch circuit
Business name: PRAIRIE ELECTRIC, INC. B. Fee for branch circuits without
service or feeder fee, first t M.18 043 2
Contact name: ANITA PASO branch circuit -
Each add'i branch circuit 7.42
Address: 6000 NE 88 STREET Miscellaneous (service or feeder not Included)
City/State/ZIP: VANCOUVER, WA 98665 Each manufactured or modula 67.84 2
dwelling, service and/or feeder
Phone: ( ) 503.286.9209 Fax: : (360) 573.9866 Reconnect only 67.84 _ 2
Pump or irrigation circle 67.84 2
E -mail anitap®prairtelectric com
r "r t .fi r7 a° r . 3 1 '. . , , .., ,. .,:• „ Sign or outline lighting 67.84 2
: 1:a • .- n ii: , ta°� , 1 i4:r -rte. A wfi :, .``rte.?=
�= =.•� Signal circuit(s) or limited-energy
Business name: PRAIRIE ELECTRIC, INC. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 6000 NE 88 STREET Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: VANCOUVER, WA 98665
Investigation (I hr men) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) 503.286.9209 Fax: (360) 573.9866 Inspections for which no fee is 90.00 / hr
specifically listed (54 hr min)
CCB Lie.: 60178 Electrical Lie' 3 491C Sur ...•c.: 4.2'f 7 '-:" • '. a; x,:,, r
-
Suprv. Electrician signature, required
Subtotal- 6
Plan review (25 %ofpermit fee): _
Print name: BILL HALBERG Date - 17 - �� ' State surcharge (12 %ofpermit fee): i
Authorized signature: TOTAL PERMIT FEE: 1/
ignature: �{✓ pe application p permit is not °bta.,L.. Kith 1 e
This rmit a lication ex irm if a
Print nom � days after it has been accepted as complete
J7 Dat ' Nunpw ' lP L r / 1 x40. 4 CO3 oS fl . ,, •
1�1Building
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