Permit CITY OF TIGARD ELECTRICAL PERMIT
I I � COMMUNITY DEVELOPMENT Permit ft: ELC2012 -00198
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2012
Parcel: 2S102AD03450
Jurisdiction: Tigard
Site address: 8777 SW BURNHAM ST
Project: Siemen's AT &T Cell Tower Subdivision: TIGARD HIGHWAY TRACTS Lot: 18 & 20
Project Description: (2) branch circuits for A/C in cell tower maintenance room.
Contractor: BADGER ELECTRIC INC. Owner: TIGARD, CITY OF
4415 NE SANDY BLVD STE 205 13125 SW HALL BLVD
PORTLAND, OR 97123 TIGARD, OR 97223
PHONE: 503 - 288 -4756 PHONE:
FAX: 503 - 493 -7173
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 04/06/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/06/2012 $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. 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 OA 952 - 001 -0090. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. , /
Issued By: Permittee Signature: C7/11
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 603.639.4175 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.
APR -4 -2012 12:10P FROM: BADGER ELECTRIC, INC 503 - 493 -7173 TO:50359819E0 P.2
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- Internet: �.ligard -or.gov ��� I ltatrfied I �cr tell
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I _ _ + OF 3 RK PLAN REVIEW — I n a . .. - -r. ' 1 / • .. ,., ph, Ara n11 dial mil/ {snhae+17 sMe ref td.w: , itrnr. a 1mt•1H hskrp+ ■
I l f'Mmntition n Other ! u d I
where dm available bon caned teas a M and boatyards l
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• r— !- ant 2-I . and i ,. 1e- c!%tnu Cwnmcrcialrouite trial Accessory building ❑ t'Y >; � erns Rr all taker mediations tc•:!:t+nv-
! ❑Multi- family 0 Master builder ❑Other, 0 Fire pump, O Installation of75KVAor
1 - -- _ ; , • • AND 9D s tr..e ! ION ❑ Eme geary omens. larger system' ely derived
O wadi dae Glow motor land of O •A ". - i
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Job no._ • 1 4 I 1 Job site address r/� S rJI � 1,1 IOO1IP ormom Y•
1- 1 �[/ V'�I1� r ! lie m Tit= r tbl omt�i 0 Ranumened Vehicle pmts
City/Stale/7i P' 1 I Q tlalthr DWU
aro illoa. O Supply voltage for more time I I _ fit . j� - i l Itmudo�s Ltt�titum CO Notts nominal
I SuiteibldgJapt: no.. I Prolrx•t name. /� 4 s f - r r U a or feeder eau naps or more
"_K 77-77/0 �p _ FE6 SCHEDULE
a. ►u+�'u..:.u. , . , ..r.: n..,r w ji,l:.eir: CZ L G /�' . I,CiOnn a 1 Wt. 1 •sa• i VOA : " 1
New 'addenda] alma or midd-fatnlly dwelling unit.
r.M4entr;% nil iohod psis?". ape.
t Rubdivision: I Lotno.: 1.000 at 0- t lm 168.54 4 l
� ___ — _
id mail 33.92 1 •
I Ina map/parcel no.: Landed energy. residential
67
svldl shave q. ill .84 7
DESCRIPTION OF Vr'CtZ't� � l t
S ,^ n ' Ltmt energy. dia(ith above iq. 67.84 2
`" t � W residential (with hove va s ti.) - ,.
Sc fires or feeders installation alteration. and/or relocation
200 am or tass I I 100.70 I 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 4Ogmpe 133.56 2
Name: 401 ornp+ 600 amps 200.34 2
601 turps to 1.000 wan 301.04 2
Adder: Over 1;000 maps or volts 552.26 2
Temporary servkts or feeders LaMantia, atterstion. and/o
City/State/ZIP: relocation r
Phone: ( ) I Pat: ( ) 200 imps err kes 59.36 I
Owner installation: This installation is being made on property that I own which is not zol onus fO400amps 123.08 , 2
intended for sale, tease, tent, or exchange, according to ORS 447, 449, 670, and 701. 401 amp , 161134 2
Branch dwelt' - sew, alteration, or erntulon. p panel
Owner signature: Data:: A. Fee tar fur ndi circuits with
❑ APPLICAN I ❑ CON PERSON t branch (be 7.42 2
Business name: B. Fee for branch circuits rrldrear
service or Roder fee. flat I 56.18 50' !4 2
g
Contact name: branch afraid
Fwd► add9 branch circuit f 7.42 7, tt p 2
— Address: Miscellaneous (service or feeder not Included)
Cily1S18trJZIP:
Each ntm1h
wcU'retformodular 67.84 I2
dwelling. setvloO feeder
J
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump to irrigation circle 67.84 2
E-mail: • Sign or outline lighting 67.84 2
CONTRACTOR r Signal circuuts) or limited - energy
z
-tom L panel, tllmadon or extension. Page 2
Business name: r, p 1� - r \ r 1x i( ( . L (\ t1 - -1 Each additional lnspecdoo ova allowable In any of the above
Address: ( c , 1)5_ Sr.'. rt)nl f1 IIro i ;) Additional itupmxion (I hr min) 66.25/ hr
� Investigation (1 hr min) 66.25/ hr
City/State/ZIP: �( c t 5 l fA /L i; l �vJ )lti x C )1)' Industrial pleat (I hr min) 78.18/ hr
P. ' : (? 1 5S , - 7t l.G' Fax: ( ' C ) (. _1 t 1 Inspections for which no fro is 90.00/ hr
� , i
specifically IlsredL hr min)
CCB Lic.: ! Suprv. Lie.: l. 76 _ ELECTRICAL PERMIT FEES
Subtotal: ( . ii.)
Suprv. Electrician signature. required: I Plan review (25% of permit fee):
,� ' Date: i J L4 `L Slate surcharge (12%ofpermit fee): '7.49.3) Print rams '7. (
,� , (r ur TOTAL PERMIT FEE: "71,
Authorized sigpato're� . (1. l )Li . Thb permit applicable expires If a pawn b rat obtained within 1
l(i Li/y4//s
days tiler a m berm acsmted n ooen*K.
Print namerT) i) y `..�L t.ILsd •'1 I Date: s • Number
of iropeaiot allowed per puma