Permit (15) 1114 CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit#: ELC2016 00196
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2016
T[UARL' Parcel: 2S110DD08700
Jurisdiction: Tigard
Site address: 15810 SW HIGHLAND CT
Project: STARK Subdivision: SUMMERFIELD NO.6 Lot: 303
Project Description: (2)branch circuits for HVAC and outside receptacle.
Contractor: BADGER ELECTRIC INC. Owner: STARK, RONALD F
4415 NE SANDY BLVD STE 205 WEAVERSTARK, KATHRYN L
PORTLAND, OR 97123 15810 SW HIGHLAND CT
TIGARD, OR 97224
PHONE: 503-288-4756 PHONE.
FAX: 503-493-7173
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 03/15/2016 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/15/2016 $7.63
Type of Use: SF 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: 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 952-001-0090. You may obtain a copydirect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _i Permittee Signature: �—
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.
�I 'a'
Irl- ' 'k. lectrical Permit Application Project#
`d- Washington County,155 N.1"AV,Suite 350,MS 12,Hillsboro,OR 97124, ��,- �� /
Phone:503446-3470,Fax: 503-846-3993/Iutbidg@co.washington.or.us permit# J j a �flj CO 17
Inspection Requests:503-846-3699/www.co.washington.or.us/piro
TYPE OF WORKPLAN� �� PLAN REVIEW
❑New construction �Additio llalteration/replacement Please check all that apply.
0 Service or feeder 400 amps 0 Hazardous locations
MAR i
t • 4 2013 or more where the available❑ Service or feeder 600 amps or more
CATEGORY OF CONSTRUCTION
fault current exceeds ❑ Building over three stories
SI-and 2-family dwelling 0 Commercial/industrial 0 A 't 1r j GA R J 1°'"amps
at 150 volts"1-3 Marinas and er
+ less to ground,or exceeds
❑Multi-family ❑Master builder ❑t L 1 i1'G O oil ❑ Floating buildings
A . S 1!J 1'� 14,c10o amps for all other
JOB SITE INFORMATION AND LOCATION installations. ❑ Commercial-use agricultural
buildings
Job no.: lob address: Q 1 ❑ Fire pip ❑ Installation of 150 KVA or larger
'S V O 3 �,�1rti1C e}, ❑ system separately derived system
City/State/ZIP:T\C,CL l 9N �aTU ❑ Addition of new motor
load of IOOHP or more
Suite/bldg./apt.no.: Project name: V 1 due y ❑ Siti ar tore residential units ❑ tions!vehicle paries
— T� ❑ Health-care facilities 0 Supply voltage for more than
• Cross street/directions to job site: \\ ) > mux ci,tx& fir. ,A_ 600 volts nominal
�*VS 1:\1 t C. FEE SCHEDULE E
\ Descriptiea Qty, Fee Total I '
Subdivision: Lot no.: Residential sing!-or saki-family dwell's'suit
Includes attached garage.
Tax map/parcel no.: 1,000 sq.R or less 167.00 4
DESCRIPTION OF WORK la add'1500 sq.ft.or portion 47.00
' -& Oc\e ` 9\c Limited energy,residential
Ul> > re- �""yyY+J\` (with above sq.ft) 107 00 2
C�s. I Limited alh(wit,abovefatsti
residential(with above sq.ft) 107,00 2
jEKPROPERTY OWNER 0 TENANT Service or feeders installation,eftertiden,and/or relocation
Name:
'\ 200 amps or less 107.00 2
�
` \3{ 201 amps to 400 amps 161.00 2
Q171
t J 0
Address: 1\\Q Yl\arN6cic. 401 amps to 600 amps r , 214.00 2
City/State/Z1P:TNi (;,47_,.. G�'�-� 601 amps 1.000 amps 321.00 2
Over 1,000 amps or volts 642.00 2
Phone:(SG))(,,p' —Q 4 vC Fax:( ) Temporary services or feeders installation,,/Merano.,and/or
v relocation
Owner infatuation:This installation is being made on readmusal or farm property owned by me ora member of 200 amps or less 107.00 2
my immediate family. This property is not intended for sale,exchange or rant.(ORS 479.540(1)and 479.560(1). 201 amps to 400 amps 161.00 2
Owner signature: Date: 401 amps to 599 amps 214.00 2
•
❑ APPLICANT ❑ CONTACT PERSON Bra°ebefeesits-pew,alteration,or eltsssioa,per Pagel
A.Fee for branch circuits with
Business name: above service or feeder fee, Jo
each branch circuit 2
Contact name: B.Fee for branch circuits 4.5t 1
ridsoat service or feeder
Address. fee,fast branch circuit 2
rir�/State/ZIP:
: Each add'/branch circuit
(service ar'lfeeder sot Waded) 7/.1)
Phone:( ) Fax:( ) Each manufactured or modular .
dwelling,service,and/or feeder 113.50 2
E-mail: Reconnect only 107.00 I
CONTRACTOR Pump or irrigation circle 107.00 2
Business name: (AZY' c 1'c e +`` Sign or outline lighting 107.00 2
t, C �w Signal circuit(s)or limited-
Address: L—1 S �� v V\v � d � energy pastel,alteration,or
r�1 extension.Describe: 107.00
City/State/ZIP: pk` 8 I C� 0( d�l� . 2
�-(3 CEach additional inspectias over allowable in say of Ibe abovePho>se:(S(33)
�' 1.,��, Fax:( TIS) "iC t.'�13 Per inspection t07.00
E-mail: CCB lie.no.: 15(.93W i Investigation fee(see oospimwe)
Electrical lie.no.: )_5-4_ter City or metro lie.:—47+ 1C Other
PERMIT FE
Supervising electrician ^ ELECTRiCAl. �
signature,required: `�\ ! L Subtotal a
Print name: Date: Plan review(25a1e of permit fee)
State surcharge or/a of permit fee) i ,s S. 763
Authorized '
IA � TOTAL PERMIT FEE i _..'
signature: c,y� ..........
This permit application expires if a permit ,, obtained 7/ 22
Print name: Date: within 180 days after it has been accepted as complete ,
Number of inspections allowed per permit Revision 6/13