Permit , . �� ELECTRICAL PERMIT
CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00134
GARO;' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/24/2010
T
Parcel: 2S111CA05600
Jurisdiction: Tigard
Site address: 9440 SW LAKESIDE DR
Subdivision: Lot: 0
Project: Rossman
Project Description: Panel change and (2) branch circuits.
Owner: FEES
ROSSMAN, JO Quantity Description Date Amount
9440 SW LAKESIDE DR
TIGARD, OR 97224 1 ea Services or Feeders - 200 03/24/2010 $100.70
amps or less
PHONE: 2 crt Branch Circuits w /Purchase 03/24/2010 $14.84
Service or Feeder
1 ea 12% State Surcharge - 03/24/2010 $13.86
Contractor: Electrical
MULTIPHASE ELECTRIC
20701 S. MONPANO OVERLOOK DR.
OREGON CITY, OR 97045
PHONE: 503 - 631 -4649
FAX: 503 - 631 -4659
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
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 wit
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 AR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued Permittee Signatur iisi �/rL[+
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 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.
Electrical Permit.A Application i `,- r i` ` - � " 't- 3 k �3 r n ee
pp } -- I R J 1 � 'tOR ()FFICf4 ' S EO \ �1 1� - . ,
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.. City of Tigard Rzceivca a !D Permit No.: �/�Ct�?Ol0' �/���
. , DateiBv:
Rr' ° 13125 SW Hall Blvd., Tigard, OR 97223 MAR:.2 2 2013 plan Review
8 Phone: 503.639.4171 Fax 503.598.1960 Date/ B Other Perin&
TIG �` ' *� K Inspection Line: 503.639.4175 1� Date Read /Bv lens El See Page 2 far
AD. l �� i �tt�
t o r. -w4;; Internet: www.tieard- or.gov t t Noti6edlbfztlrod: Supplemental Information
+.t II ri:Mr^ [,,I ile— ,;,.
TYPE OF WORK tr s"'
PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans wiitems checked below!:
LIScrsicc or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- and 2 dwelling less to ground, or exceeds i4 000 ❑ Commercial -use agricultural
y g ❑Commercial /industrial 0 building amps for all other installations. buildings.
Multi- family ❑ Master builder ❑Other: ❑ Fire pump.
ty .1 ❑Emergency system.
❑Addition of new motor load of
❑Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION forger separately derived system.
❑ "A" "E ", "1•T' "1 -3
Job n o.: Job site address: 9440 see Lakeside Dr. ICOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/Stale/ZIP: Tigard ❑Health -care facilities. ❑ Supply voltage for more than
['Hazardous locations. 600 volts nominal.
Su/le/bldg. /apt- no,: Project name: ❑ Service or feeder 600 amps or Mort.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total i, '
—" - - -- -- New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.:
1,000 sq. It or less 168.54 1 4
Ea. add'I 500 sq, ft. or portion 33.92 1
7 ax map/parcel no.: Limited energy, residential 67.84 2
1-- DESCRIPTION OF WORK (with above sq. fl.)
Panel Change Limited energy, multi-famil 67.54 2
g residential (with above sq. 11.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2�
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Jo Rosman 401 amps to 600 amps 200.34 1 2
601 amps to 1,000 amps 301.04 i 2
Address: Over 1,000 amps or volts I 1 552.26 2
City' /StateiZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 j 1
201 amps to 400 amps 1 25.08 2
Owner installation: This installation is being made on property that I own which is not 491 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. -
Branch circuits - new. alteration, or ex_ tension. per panel
Owner signature: Date: A. Fe• for branch circuits with
® APPLICANT El CONTACT PERSON above service or feeder fee, 2 7 42 14 2
each branch circuit
Business name: Multiphase Electric, LLC 13. Fez for branch circuits without -
service or feeder fee, first 56.18 2
Contact name: Dave Gackle branch circuit
Each add'I branch circuit 1 7.42 2
Address: 29701 S. Monpano Overlook Dr. Aliscellaneous (service or feeder not included)
City /State/ZlP: Oregon City OR 97045 Each manufactured o modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 631 -4649 Fax: : (503) 631 -4659 Reconnect only 67.84 2
E -mail: multiph @ccwebster.oet Pump or irrigation circle 67.84 2 j
Sign or outline lighting 67.84 2
CONTRACTOR S ignal circuit(s) or limited energy
Business name: Multiphase Electric, LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 20701 S. Monpano Overlook Dr Additional inspxtion (1 Itt min) 66.25/ hr 1
Cily'State/ZlP: Oregon City OR 97045 Investigation (1 hr min) 66.25 / hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 631 -4649 Fax: (503) 631 -4659 Inspections far which no fee is 90.00r hr
specifically listed (% hr min)
CCB Lic.: 162827 Electrical Lic.: 5122s Suprv. Lic.: 5122s ELECTRICAL PERMIT FEES
' ,,e__ Subtotal: 115.54
Suprv. Electrician Signature, required: C' Plan r eview (25 %ofpetmit it fee):
`__
Print name: Dave Cackle Date: 03/22/10 State surcharge (12% of pennit fee): 13.86 `' 4
,, / — TOTAL PERMIT FEE: 129.40
Authorized signature: . r___4,. - ,./ c t This permit application expires if a permit is not obtained within 180
Print name: Dave Cackle h= SS� j ezt� Date: 03/22/10 days after it has been accepted as complete.
Number of inspections allowed per permit.
19BuildinglPcrmits \ELC- PcmmirApp.doc 10 440-4615T( I 1105 /COMIwEB
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