Permit IN q CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELC2012 -00134
Date Issued: 03/09/2012
T I GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S101AD01400
Jurisdiction: Tigard
Site address: 12700 SW 68TH AVE
Project: Oregon Ki Society Subdivision: WEST PORTLAND HEIGHTS Lot: 31
Project Description: (2) branch circuits
Contractor: BADGER ELECTRIC INC. Owner: OREGON KI SOCIETY
4415 NE SANDY BLVD STE 205 PO BOX 2143
PORTLAND, OR 97123 LAKE OSWEGO, OR 97035
PHONE: 503 - 288 -4756 PHONE:
FAX: 503 - 493 -7173
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 03/09/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/09/2012 $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. AT EN1iON: 0 •n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -7(010 through OAR • • • 8 -Os • 6 You may obtain a copy of the rules or direct questions to OUNC by calli .232.1987 or 1.800.331.2344.
Issuety: / `�� '�� ` � � Permittee Signature: 7 fe9.--A----d
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:
CONTRACTQR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'
ARM., _.` 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.
MAR -8 -2012 12:53P FROM:BADGER ELECTRIC,INC 503 - 493 -7173 TO:5035981980 P.2
City of Tigard (.0% o\ 8 r� Pem{t lb : Z,c�a %g -400/3V
13125 SW Hell Blvd„ Tigard, , c. ti Plan Review
Phone: 503.639.4171 Fax: IT.. r,., , (.- DatdBr Other Permit
Inspection Una 503.639.4175 \\\`'L • \ \c) J Natir \\c) 0. `p1" Date Ready /ay: l ■ see Page 2 for
Internet www.tigardcr.gov ��� llrtewea I Supplemental r.mrm.aoo
T! E OF WOR \ l." PLAN REVIEW
❑ New eonswetion , 4 - J , , r Please check all that apply ( 1 se of plans wrumm checked below).
� D service or tinder 400 amps or mom D Building over items stories.
❑ Demolition ❑ Other: stem rho available Oast currant D Marinas and boatyards.
CATEGORY OF COPEDRUCI ION exceeds 10,000 amps at I50 volts or 0 Pho bm'ldings.
❑ 1 - and 2-1i al dwelling mmerclaVardusWal ❑ Accessory building hsa mgrad,etr instat ms. OC agricultural
8 g eaWs for anther imt.aNioos. buildings.
❑ Multi - family ❑ Master builder ❑ Other: D Fir pomp. D Instauation of 75 KVA or
J08 SITE INFORMATION AND LOCATION D � 0 ition d drew Mem motor �y te
�Addi� afcew motabsdof ❑ "A ". "E'. "1-2 ". "1,3 ".
Job no.: I Job site address: j).7 Q 0 5 tij ca 8 D six or more .l ear D Recreational %thicle maim 100HP or more.
City/State/ZIP: r /_ ,fl.... cr, a a 5 O theme dwilides. D Supply silage for mom than
CI Hazardous locations. 600 volts nominal_
Suite/bldg./apt no.: Project name: Ar I MEM D Service or !bake 600 aptps or more.
FEE SCHEDULE
Cross street/directions to job site: D....I.. . I oar, I v... I rat I •
New residential dagle- or taeltidaettly dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. II or less 168.54 4
Fa add'1 S00 sq. fL or party 33.92 1
Tax map/parcel no.: Limited mterg,. tesidentiol
DESCRIPTION OF WORK (with above sq. (1) 67.84 2
42 Wl Limited anew. ( above 67.84 2
/�
residential (with bove vo sq. sq. R.)
Services or faders inslalladoa, atteraton. and/or relocation
200 amps or lees 100.70 2
❑ PROPERTY OWNER I ❑ IENANT 201 amps to 400 amps 133.56 2
Name: i 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
Te �
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner Installation: This installation is being made on property that I own which is not 201 amps fD 403 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. I acre to 499 amps 16834 2
Branch circuits - new, alteration, or extension. per panel
Owner signature: Date: A. Fee fbr Mandl circuits with
❑ APPLICANT I ❑ CONTACT PERSON tend e t Ran 7.42 2
Business name: B. Fee for branch circuits without
service or feeder (be. Asst I 56•18 , (p 2
Contact name: brunch circuit
Each add'I branch a ireu t i 7.42 7, 47_, _ 2
Address: Miscellaneous (service or feeder not included)
Each mandactured or modular
City/State/ZIP: dwelling, service andler s feed 67.84 2
Phone: ( ) . I Fax: : ( )
Reconnect only 67.84 2
Pump or inigadon circle 67.84 2
E
Signer outline lighting 67.84 2
CONTRACTOR Signal circ ids) or limited-energy
Business name: penal, alteration, or extension. Pope 2 2
11 � 4 1..1/44 1f ( 4-4' Each ( a Each additional Inkwell= over allowable In any of the above
Address:446 nil irvi..y I, hit ii,Du AdditiombinspeWon(1lumin) 66.25/lr
Clty/sttlae/zIP: /ten l e r r , ,, y �,�2 Investigation (1 hr min) 66.25/ hr
O c I \ (A.f i l 1 — 1 r O r 7 � Industrial plant (1 hr min) 78.18/ hr
Ptmne: ('SOW - 4 GI ` „ p I Fax: ( ) L/� M "-/ (17
specifically is De is 90 00/ hr
CCB Lic.: 5 4 � Ellectrical Lic.: S1 t Suprv. Lic.: 73 ELECTRICAL PERMIT FEES
Subtotal: (o.') (On
Suprv. Electrician signature, required:
Plan review (25% of permit fee):
Print name - 1 n,rl d ( Date: 5'' g1 2, State surcharge (12% of permit fee): 7. 613
Authorized Si j(xJ .,,a , n I // TOTAL PERMIT PEE • ,
1 (f ,y/l/ , p Thb permit appsadss alpha, If a permit is not &w aged wtrola leq,
.�� X1&1, I Date: 0 u has tee p .. complete.
Print name g
Vy ' 1 IL. • Number allowed u.