Permit ,�,. - -y
a CITY OF TIGARD ELECTRICAL PERMIT
III m.. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00412
Ti CARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/12/2009
Parcel: 2S110DD90622
Jurisdiction: Tigard
Site address: 10820 SW MEADOWBROOK DR 62
Subdivision: Lot: 0
Project: Brookside Condos
Project Description: Panel replacement. Job No. 321530
Owner: FEES
MORRIS, SUSAN W Quantity Description Date Amount
10820 SW MEADOWBROOK DR #62
TIGARD, OR 97224 1 ea Services or Feeders - 200 08/12/2009 $80.30
amps or less
PHONE: 1 ea 12% State Surcharge - 08/12/2009 $9.64
Electrical
Contractor:
ROSENDIN ELECTRIC INC
2925 NW ALOCLEK DR #170
HILLSBORO, OR 97124
PHONE: 503 - 615 -8189
FAX: 503 - 615 -0689
Type of Use: MF
Class of Work: ALT Type of Const: .
Occupancy Grp:
•
Total $89.94
Required Items and Reports (Conditions)
This permit is i -' - •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i - ccordance with - pproved 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. A ENTION: Oregon I w equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR .
952 -001 1010 through OAR 952 00. may obtain a copy of the rules or direct questions to OUNC by calli 03.246.6699 or 1.800.332.2344. t
1 � lam
Issue. By: _ % / / .. . . Permittee Signa ' /0
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' C ,,, 4, J 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.
A
'Electrical Permit Application FOR OFFICE USE ONLY
-
City of Tigard Received o 2 iY A i 1 1 , 4 1I l 2 -
Permit No.: i
lig
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
Permit
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juriss - El See Page 2 for
Internet: www.tigard -or.gov i Notified/Method: / r Supplemental Information
TYPE OF WORK PLAN REVIEW ' .
❑ 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.
C ATEGORY 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 ❑ Cotnmercial/industrial ❑ Accessory building amps for all other installations. buildings.
® Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION - - _ ❑ Emergency system. larger separately derived system.
- _ ❑ Additien of new motor load of ❑ "A ", "E , "1 -2 ", "1 -3"
100HP or more. occupancy.
Job no.: (2I Job site address: 10820 SW Meadowbrook Dr. .S.au
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard OR 97224 /Nair /'S' ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. ..: 62 Project name: pmt ta- y.,.;..t Ho alb L ❑ Service or feeder 600 amps or more.
v FEE SCHEDULE
Cross street/directions to job site: Brookside 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
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
• - DESCRIPTION OF WORK - (with above sq. ft) 75.00 2
' Limited energy, multi- family 75.00 2
Replace old federal pacific electrical panel with new main breaker panel. residential (with above sq. ft)
Services or feeders installation,alteration, and/or relocation
200 amps or less 1 80.30 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 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 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
Branch circuits - new, alteration, or extension, per panel •
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Rosendin Electric B. Fee for branch circuits
Contact name: Steve Hogberg without service or feeder fee, 46.85 2
g g first branch circuit
Address: 2925 NW Aloclek #.170 Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Hillsboro OR 97124 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 615 -8189 Fax: : (503 -) 615 -0689 Reconnect only 66.85 2
E -mail: shogberg @rosendin.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting _ 53.40 2
Signal cirt:uit(s) or limited -
Business name: Rosendin Electric
energy panel, alteration, or
•
Address: 2925 NW Aloclek # 170 extension. Describe: Page 2 2
City/ State/ZIP: Hillsboro OR 97124 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 615 -8189 Fax: (503 -) 615 -0689 Investigation per hour (1 h min) 62.50
CCB Lic.: 103939 Electrical Lic.: 37 -692c Suprv. Lic.: 3991s Industrial plant per hour 73.75
. ELECTRICAL PE RMTT FEES . , -
Suprv. Electrician signature, required: _ Subtotal: 80.30
(�'� Plan review (25% of permit fee):
Print name: 1'61 I��: %1'= i.. t/
V1:
—
4�� State surcharge (12% of permit fee): _ 9.63
Authorized signature.. TOTAL PERM[T FEE: jta_____ This permit application expires if a permit is not obtainea within trio
Print name: I Date: 5 2 � days after it has been accepted as complete. 5('g
• Number of inspections allowed per permit.
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