Permit CITY OF TIGARD ELECTRICAL PERMIT
111;.:.. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00201
Date Issued: 05/06/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S111 CC15300
Jurisdiction: Tigard
Site address: 10065 SW HIGHLAND DR
Subdivision: Lot: 0
Project: Gottlieb
Project Description: Install (1) branch circuit for furnace connection.
Owner: FEES
GOTTLIEB, EDWARD F /MARIAN I Quantity Description Date Amount
C/O GOTTLIEB, MARIAN I CUMMINGS &, 1 crt Branch Circuits 05/06/2009 $46.85
GOTTLIEB, EDWARD F LIFE ESTATE, 10065 SW wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/06/2009 $5.62
Contractor: Electrical
B B BROSELLE INC
2700 NE BURTON ROAD #A
VANCOUVER, WA 98662
PHONE: 360- 254 -7200
FAX: 360- 254 -8219
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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 -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 By: _OA 01 ILRQ Permittee Signature: ■ _ f s_ - �Ir.�
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 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.
1. ._.
t lei °'trical Permit A lication " -. FO O U SE • • '
C I of Tigard L t $ Received PennitNo.: arr• • 6O 4.
I.114 g � _ Date /By: •
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C • Phone: 503.639.4171 Fax: 503.598.196(MAY 0 4 2009 Date /B': Other Permit:
T I GA RD Inspection Line: 503.639 Date Ready /By 8 See Page 2 for
Internet: www.tigard- or.gov Notified /Method. Supplemental Information
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�< t .PLAN -. RE
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['New construction ❑ � 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.
"-:' ,
4 ' °` a „? ” t �" ",, °" " :. ,; t "sue exceeds 10 000 amps at 150 volts or Floating buildin
, , 6ATECtilt ,or4,: ONSTRucTION . ^ " , , '. .. p ❑ gs.
0 Commercial It
t ,..: e <.:- >,�'� r <�a'• -„ . -. . -,. °- ' <' '�„�'.� ;::,,,,,,4,-.,;,,;; ' .? ^` = :;a'r less to ground, or exceeds 14,000 ❑ Commercia - use al,�ricu ura l
® 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
, ^ vwgvv < ti.,tut; nr,,, 4a,"., ❑ Emergency system. larger separately derived system.
t JO$ SITEINFO.„.„,,k.„:„ MAION AND LOCATION
= 1, , ... ^��__ , , ..,,....,. ',a, ... .. - .,. 4%,,;(i ❑Addition of new motor load of ❑ "A „ E „ .. 1 2 . `I -3
Job no.: 09 --425 Job site address: 10065 SW Highland Dr. . Six or or more residential R occupancy. r
I-; ❑ Six or more residential traits. 12 Recreational vehicle parks.
City /State/ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
g a ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
- .i3Ot"'SCHEDi1LE ;s2111
Cross street /directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
", t < -, ; Limited energy, residential 75.00 2
.
:1 €; " ; >DESCRI'P1"ION OE;f;WORK s . a .; ;;- ^ with above sq. ft.
Limited energy, multi - family 75.00 2
Furnace connection residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
."3�':^ Fes,:' = '%k[A`:t8%d:-a :, X�3,�� F.�,{'K:� :.. f`y -+
° „'r, ° % ❑; P:ROP:ERTX <OVi?:NER °; �..a.` TENANT ;� � �,.�:, r 201 amps to 400 amps 106.85 2
Name: Marian amps to 600 amps 160.60 2
Marian Gottlieb 601 amps to 1,000 amps 240.60 2
Address: 10065 SW Highland Drive Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
Tigard, OR 97224 relocation
Phone: ( 503 ) 769 -3564 Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
'`; n,. - == ' APPLICANT:: ,?<; Ft i' i , - ;a`,CUN I A'CTi PERSON.
above service or feeder fee
a
each branch circuit _
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee 1 46.85 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
y Sign outline lighting 53.40 2
�,CONTRAC`fOR
<s
urn �;,< >w l g
0 - €. A€ 14 1C Signal panel, alteration, or t i o n ,
Business name: Bob's Electric or
• � � e� r r ' t�nergy panel, alteration, or
Address: 2700 NE Burton Rd. , Ste. A extension. Describe: Paget 2
City/State /ZIP: Vancouver , WA 98662 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( 360) 254-720 0 Fax: (/3 0) 254-8219 Investigation per hour (1 hr rein) 62.50
j CCB Lic.: 53136 Electrical Lic.: 7_ 31c . Lic.: 4 3225 Industrial plant per hour 73.75
t • Li f • I .t � 'i t C � - L • t O I`` . 1 ' ; ELEGFRICAI411tR trFtgSxr” .5 - ; `
Suprv. Electnctan signature, required: Subtotal: 46.85
Print name: Kevin Broselle Date: 5/1/09 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 5.62
Authorized signature: TOTAL PERMIT FEE: 52. 47
This 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.
I:\ Building \Permits \ELC- PennitApp doc 05/23/06 440- 4615T(t I /05 /COM/WEB