Permit •
"N. CITY OF TIGARD ELECTRICAL PERMIT
i q
D COMMUNITY DEVELOPMENT Permit #: ELC2009 -00522
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009
Parcel: 2S110DD90241
Jurisdiction: Tigard
• Site address: 10875 SW MEADOWBROOK DR 24
Subdivision: Lot: 0
Project: Yesmet
Project Description: Replace panel.
Owner: FEES
YESMANT, FLORENCE Quantity Description Date Amount
10875 SW MEADOWBROOK DR #24
TIGARD, OR 97223 1 ea Services or Feeders - 200 10/07/2009 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 10/07/2009 $12.08
Electrical
Contractor:
ROSENDIN ELECTRIC INC
2925 NW ALOCLEK DR #170
HILLSBORO, OR 97124 •
PHONE: 503 - 615 -8189
FAX: 503 - 615 -0689
Type of Use: SFA
Class of Work: ALT • Type of Const:
Occupancy Grp: -
Total $112.78
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 • • . 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. A ' NTION: Ore, • n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 010 through OAR • 5 101 1100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue. =y: ��LL��� PermitteeSignature:
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' �� I Date:
/F
LICENSE NO.
Call 503.839.4175 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.
l',lectrical Permit Application FOR OFFICE USE ONLY
City of Tigard Dat a , 7 ,7 Permit No.: &A pp .5
li
° 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
C • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TI G A IZ D Inspection Line: 503.639.4175 Date Ready/By: 3uri ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: ..!'//Q1. Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction X 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.
42] Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
. Emergency system. larger separately derived system.
. • • . - • • , JOB. SITE INFORMATION :,AND` : • : ._ •L,, .. 0 Addition of new motor load of ❑ "A", "E", "1 -2 ",' 1 -3 ", •
Job no.321551' 7 Job site address: " ■adowbrook Dr # I00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, Or 97223 L / 2
6 7 /� � v 7-' ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Yesment Panel Replacement ❑ Service or feeder 600 amps or more.
' j .. ; FEE' SCHEDULE . ' . . t •
Cross street/directions to job site: Description 1 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'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
residential panel replacement residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less ( BBesb' fo6.1O 2
.;,. ® PROPERTY OWNER . , • 1• g TENANT . • 201 amps to 400 amps 106.85 2
Name
Florence Yesment 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: same as jobsite Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503) 639 2392 Fax: ( ) 200 amps or less 66.85 I
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:
n/a Date: A. Fee for branch circuits with
® APPLICANT 1 : N. CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Rosendin Electric, Inc. B. Fee for branch circuits
without service or feeder fee 1 �b.85 4 2
Contact name: Steve Hogberg first branch circuit
Address: 2925 NW Aloclek Dr #170 Each add'I 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 . corn Pump or irrigation circle 53.40 2
. , . CON TRA CTOR . , . , , • , • ' • , , • Sign or outline lighting 53.40 2
applicant
Signal p a n el, a) or do limited-
Business name: same as a or
PP energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour ( hr min) 62.50
CCB Lic.: 103939 Electrical Lic.: 37 -692C Suprv. Lic.: 91S Industrial plant per hour 73.75
\ � J ELECTRICAL PERMIT FEES 9D
Suprv. Electrician signature, required. i \red:_+- Subtotal: 4-:8'5 Q(J •
Print name: Stephen Lawhead Date: 10/6/09 .— . Plan review (25%of permit fee): — 0
State surcharge (12% of permit fee): 6' a.
Authorized signature: n /a TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete. A 9 $
• N of inspections allowed per permit. 1 1 " •
I \ Building \Permits\ELC- PermitApp.doc 05/23/06 440 -4615T(11 /05 /COM/WEB ^ _