Permit CITY OF TIGARD ELECTRICAL PERMIT
�' 1 PERMIT #: ELC2007 -00194
ih° COMMUNITY DEVELOPMENT DATE ISSUED: 3/30/2007
'T,t 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S110DD -90271
SITE ADDRESS: 10825 SW MEADOWBROOK DR 27 ZONING: R -7
SUBDIVISION: SUMMERFIELD BROOKSIDE CONDO LOT : 027 JURISDICTION: TIG
PROJECT: SCHMITT
Project Description: Replace service panel.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PAT SCHMITT HARVEY ROSE ELECTRIC SERVICES
10825 SW MEADOWBROOK DR #27 PO BOX 128
TIGARD, OR 97224 NORTH PLAINS, OR 97133
Phone: Contact #: FAX 503 - 648 -8254
PRI 503 - 789 -3284
FEES
Description Date Amount Reg #: ELE 34 -130C
[ELPRMT] ELC Permit 3/30/2007 $80.30 LIC 43084
[TAX] 8% State Surcharge 3/30/2007 $6.42 SUP 2767S
Total $86.72 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 • - s. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 95 * 11 -0010 thr• gh 1 -0100. You may obtain copies of these rules or direct questions to OU C at 503.246.6699 or 1.800.332.2344.
Issue By: _4/i Permittee Signature: -Zile/ 2-0/IL__
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'N: ��!' /%? ' .....1._ 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 Application .., ,z ,.-1----...'. ''`' - -`
ail
City of Tigard oa e/Be � 7., 00/,?, Permit No.: �G�007,. I9 �
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1- 1 .: ' Phone: 503.639.4171 Fax: 503.598.1 Date/By. Other Permit.
»ca J uris fa See Page 2 for
Pa
( q. -... A +It -l�
Inspection Line 503 Da Ready/By g
;{r•.`seb�+�1 Internet: www.tigard- or.gov Notified/Method: � � � Supplemental Information
TYPE OF •WORK PLAN REVIEW
•
❑ New construction ,RT Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION • exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
. • ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE -INFORMATION AND LOCATION . . ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "I -3 ",
JOb no.: Job site address: - I • 100HP or more. occupancy.
/d g� 5 5 w /'�' eari-c Oet.ivonP ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: -1-: A V G � � / q D. ❑ Health -care facilities. ❑ Supply voltage for more than
1 tela?.rCA f ri 11 1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: . 2 7 Project name: ,! ).,(t - r' ❑ Service or feeder 600 amps or more.
- - . - FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
. DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
6A Q , _ " p '� 1 �� t [,( • residential (with above sq. ft.) -
y \ Services or feeders installation, alteration, and /or relocation
200 amps or less 1 80.30 e(.), 3t; 2
P OPERTY OWNER I : ' ❑ TENANT 201 amps to 400 amps 106.85 4
Name: T T
( � L) 1 � (1 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT • - ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
�/ r Signal circuit(s) or limited -
Business name:
i laude Re,s e. Cie C7 /r ..l ,S..09_ /al.( Q energy panel, alteration, or
Address: J, U " l a extension. Describe: Page 2 2
City /State/ZIP: A \- k 7, cA•, A s t 0Z 4 i1 13 3 Each additional inspection over allowable in any_of the above
Per inspection 62.50
Phone: (So i) (, L Gas a..l Fax: (56 1 64 $ - 9a 5'4 Investigation per hour (1 hr min) 62.50
CCB Lic.: 1-1/0 9 4 Electrical Lic.: 314_ k-so ( Suprv. Lic.: d 74 5 Industrial plant per hour 73.75
ELECTRICAL PERMIT . FEES
Suprv. Electrician signature, required: Wev Subtotal: so ' - ° —
Print name: Ale i/E Date: O 3 / 3 0 / O - Plan review (25% of permit fee):
Y W O 3 t State surcharge (8% of permit fee): r e T 2.
Authorized signature: TOTAL PERMIT FEE: sic .1
'Ibis permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building \Penn its \ELC- PermitApp.doc 05/23/06 440-4615T(1l /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener* •
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
[ WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No' licenses are required. Licenses are required
for all other installations
1: \ Building \Pe mits\ELC- PcmitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007-00194
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/2007
Phone: (503) 639 -4171 /� 1
Inspection Requests (24 Hrs.): (503) 639 -4175 `:
INSPECTION WORKSHEET FOR DATE: 4/3/2007 TIME: 7:00AM PAGE: 53
SITE ADDRESS: 10825 SW MEADOWBROOK DR 27 CLASS OF WORK:
SUBDIVISION: SUMMERFIELD BROOKSIDE CONDO LOT #: 027 TYPE OF USE:
PROJECT NAME: SCHMITT
DESCRIPTION: Roplace service panel.
OWNER: SCHMITT, PAT PHONE #:
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 503 - 789-3284
Inspection Request Scheduled For: Date: 4/3/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 045894 -02 503 -803- 14 N
Corrections/Comments/Instructions:
' / .
•
)4 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CAL OR i • ION ❑ ADDITION L FEES ASSESSED
7 /
' Mr 4- 3 a'-
Inspector: D ate: Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00194
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/2007
Phone: (503) 639 -4171 A �l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/3/2007 TIME: 7:00AM PAGE: 54
SITE ADDRESS: 10825 SW MEADOWBROOK DR 27 CLASS OF WORK:
SUBDIVISION: SUMMERFIELD BROOKSIDE CONDO LOT #: 027 TYPE OF USE:
PROJECT NAME: SCHMITT
DESCRIPTION: Replace service panel.
OWNER: SCHMITT, PAT PHONE #:
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 503 - 769 -3284
Inspection Request Scheduled For: Date: 4/3/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service 045894 -01 503.803- 14 N
Corrections /Comments /Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL M ALL PECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: ELC2007 -00194
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/2/2007 TIME: 7:02AM PAGE: 29
SITE ADDRESS: 10825 SW MEADOWBROOK DR 27 CLASS OF WORK:
SUBDIVISION: SUMMERFIELD BROOKSIDE CONDO LOT #: 027 TYPE OF USE:
PROJECT NAME: SCHMITT
DESCRIPTION: Replace service panel.
OWNER: SCHMITT, PAT PHONE #:
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 503-789-3284
Inspection Request Scheduled For: Date: 4/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 045836.02 503 - 803 -1814 N
Corrections /Comments /Instructions:
GL mnv\
N 60 4Ao Mme-'
•
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL X ACCESS
;KIZAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G • , t �� Date: L i' 1 ' f1/4) Phone #: (503) 718- 244
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00194
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/2007
Phone: (503) 639- 41710 'i
Inspection Requests (24 Hrs.): (503) 639 -4175 I L!
INSPECTION WORKSHEET FOR DATE: 4/2/2007 TIME: 7:02AM PAGE: 30
SITE ADDRESS: 10825 SW MEADOWBROOK DR 27 CLASS OF WORK:
SUBDIVISION: SUMMERFIELD BROOKSIDE CONDO LOT #: 027 TYPE OF USE:
PROJECT NAME: SCHMITT
DESCRIPTION: Replace service panel.
OWNER: SCHMITT, PAT PHONE #:
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 503 - 789-3284
Inspection Request Scheduled For: Date: 4/2/2007 Pour Time:
Code # Inspection Description onfirm • Contact # Message
115 Electrical service 0458360/ 503-803-1814 N
Corrections /Comments /Instructions:
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
A FAIL )4CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ___C _ `� t D ate : I t. 2 Phone #: (503) 718- A14____