Permit CITY OF TIGARQ Q.. ELECTRICAL PERMIT
° PERMIT #: ELC2007 - 00501
COMMUNITY DEVELOPMENT DATE ISSUED: 7/20/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 110 D D -90551
SITE ADDRESS: 10860 SW MEADOWBROOK DR 55 ZONING: •R -
SUBDIVISION: SUMMERFIELD BROOKSIDE CONDO LOT : 055 JURISDICTION: TIG
PROJECT: LADEEN
Project Description: 200 amp panel change.
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:
LADEEN, RUBY T & T ELECTRIC
10860 SW MEADOWBROOK DR #55 4120 SE INTERNATIONAL WAY
TIGARD, OR 97224 SUITE A -105
MILWAUKIE, OR 97222
Phone: Contact #: PRI 503 - 652 - 7610
FAX 503- 652 -7612
FEES
Description Date Amount Reg #: ELE 3 -605C
[ELPRMT] ELC Permit 7/20/2007 $80.30 LIC 161187
[TAX] 8% State Surcharge 7/20/2007 $6.42 SUP 5176S
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 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: if' Gi / Permittee Signature: S e 9 6pp I ad( On
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.
^- E1eetrical Permit Ap . 'tea '
6'7 -' - - - i rot( OFFICE USE ONLY
City of Tigard !� Received
t Y g ��� /� o-a te/B : Z Lb 0 L Permit No.:
® Y 7 1 / 1 J N �f�L' —00561
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Pax: 503.598.19 ii IL. 1 9 Plan Review
2007 �� „� q'�) By: Other Permit:
Inspection Line: 503.639.4175 p pate RAY /BY: 1+'i ' H See Page 2 for
Internet: www.ci•tigard.or.us
CITY — , t �i�D Notified/Method: Er I Supplemental Information
( s: ° F,: %;33n} : p : :'4T :, '; r. ' i�a.,:ir;.•�.:a-y 'a .1 ti : .,.y, - _ .'- - - s �
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❑ New construction Addition /alteration /replacement M Please check all that apply: --
❑ Demolition ❑ Other: ['Service over 225 amps, comm'I ❑Hazardous location
T,u T� •_� ; Y , �?� x ,,,,, A ❑Service over 320 amps rating ❑Buildngover10,000sc
.., ... ..1.: y' " +F' - 6` �. J : r�Jj ri' s, iF. �.:~ ey: C: t _ iLtz j�j[ ,.°jI' -'.: - �. ; i•a: . e. l5 Of
7 ,_ -s, t air r `'' =' ° "�'!it: 0 !);; • :_. - and 2 - family dwellings 4 or more new resident
, ,IP - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal [nits in one structure
❑ Multi ❑Mster builder ❑Other: ❑Building over three stories ['Feeders. 400 amps or n
st y ", d c � ,•� �.� ['Occupant cupant load over 99 persons ['Manufactured actured structure
iR, z E :" ��. a a.:; Star a } ^- .la '' = 1 � 7 . - '`'S'r if* Egress/Iighting plan RV park
Job no.: Job site address :1D led 574, A b b 7L ❑Health -care facility ❑other.
C •a ' �� ��) Submit 2 sets of plans with any of the above.
City/State/ZIP: 7 O0 g. 7 g,R q The above are not applicable t porary
T _ o ten construct! on service
y
Suite/bld /a t no.: Pro ect name: r '.i- ,' 'T, =,:,. <:•.-�-. ` o .7'4'71 fi " ..�' I: =
t; P j _ `. f ';' M
I Qty. l Pe
De eriptIoa e. Tout
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15
Subdivision: I Lot no.: Ea. add'I 500 sq. f. or portion 33.40
Limited energy, residential 75.00
Tax map /parcel no.: {asidential 7500
.
�r ;df >'x` :rij. >F3i:,..d,",'.'t .a ? , ' ,, . �, T . ,r Limited energy, non
• . }= � - •. rFre. rt;;;. Each manufactured or modular
dwelling, service and/or feeder 90.90 i
AST P 4 � Gc Services or feeders installation, alteration, and /or relocatiol
/ 200 amps or less ' 80.30 In
: ^a :.. ;c ? : f41 " 7. t : :::<.:. • ; ,_r.-e , :z�,~ .,..a, .- 201 amps to 400 amps
• 'v ia .. t i ' s s . )!C4 a .� ' = fr s ;t' .. u 106.85
- 401 amps to 600 amps 160.60
Name: e P ee,✓I 601 amps to 1,000 amps 240.60
Address: f , 010 C /1 f _L i 4 . r Over 1,000 turps or volts 454.65
7 / �! �r Reconnect only 66.85
City/ State/ZIP: �� 41 r B 1� g7aat/ Temporary services or feeders Installation, alteration, and/c
Phone: ( ) 6 y y/L�D 6 F — I Fax: ( ) relocation
200 amps or less 66,85
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
r . w : ,• ; 7- +' ,; >,, ,�, 4 . '. i?;;F A, Fee for branch circuits wlrh
service or feeder fee, each
Business name: branch circuit 6.65
B. Fee for branch circuits
Contact name: without service or feeder f'ee,
Address:
first branch circuit 46.85
Each add'I branch circuit 6.65
City / State/ZIP: Miscellaneous (service or feeder not included)
Phone: Pump or irrigation circle 53.40
( ) Fax. ) Sign or outline lighting 53.40
E -mai l: Signal circui
,.,,,,�_.,� . „ �•� c ts) or limited -
. _ ,, :,`° „ ;:e- r'� u. •.' I,..Fr a : 'r: r; a 61 . , : 4 ,, -:? r ;.., ene anel alteration, or
extension. Describe: Page 2
Business name: T & T Electrical, LLC
Address: 4120 SE International Way, Suite A -105 Each additional inspection over allowable iD any of the abov
Per inspection 62.50
City /State/ZIP: Milwaukie, OR 97222 Investigation per hour (1 hr min) 62.50
Phone: (503) 652 -7610 Fax: (503) 652 -7612 Indubtrial plant per hour 73.75
CCB Lic.. l 6l 187 ` - tea
Electrical Lic.: 3-605C Suprv. Lic.: 51765
Subtotal st!�t ?d
Suprv. Electrician signature, required: 77 ��'- Plan review (25% of permit fee)
Print name: �/ Date: State surcharge (8% of permit fee) G , y p7
TOTAL PERMIT PEE Q ,7c.?
Authorized signature:
J �f 7 �,.. -,f This permit application expires if a permit Is not obtained within 180
days alter it has been accepted as complete
Ptint name: Date: • Fee methodology set by Tri Btulding Industry Service Board
• • Number of inspections per permit allowed.
NaulldigglPermitsiELC •PemMApp.doo 12/03 440 - 461ST( INE2/COM/W00
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00501
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/20/2007
Phone: (503) 639 -4171 r /�rru.y
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/23/2007 TIME: 7:06AM PAGE: 38
SITE ADDRESS: 10860 SW MEADOWBROOK DR 55 CLASS OF WORK:
SUBDIVISION: SUMMERFIELD BROOKSIDE CONDO LOT #: 055 TYPE OF USE:
PROJECT NAME: LADEEN
DESCRIPTION: 200 amp panel change.
OWNER: LADEEN, RUBY, PHONE #:
CONTRACTOR: T & T ELECTRIC ‘1 K PHONE #: 503 -652 -7610
Inspection Request Scheduled For: Date: 7/33/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 052487 -01 503- 652 -7610 . Y
Corrections /Comments /Instructions:
vJ RA q f ...►PAL. � PP�1 �,� _
V f
c4Nn141 signs tAA44, c vs1) 14 .
%PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CS Lg
Date: MI• Phone #: (503) 718 -244
•