Permit •
a CITY OF TIGARD ELECTRICAL PERMIT
I1 m COMMUNITY DEVELOPMENT . Permit #: ELC2009 -00527
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009
Parcel: 2S110DD90472
Jurisdiction: Tigard
Site address: 10845 SW MEADOWBROOK DR 47
Subdivision: Lot: 0
Project: Emmer
Project Description: Replace panel.
Owner: FEES .
EMMER, MARY K Quantity Description Date Amount
10845 SW MEADOWBROOK DR #47 1 ea Services or Feeders - 200 10/07/2009 $100.70
TIGARD, OR 97224 amps or less
PHONE: 503 - 620 -4323 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 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. ATTE on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 0 through OAR 2- 100. You may obtain a copy of the rules or direct questions to OUNC by callin$69S2+t6,6699 or 1.800.332.2344.
Issued y: _-e .d PermitteeSignatur : =[ &-
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 l Date: i .
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.
E lectrical Permit Application F OFFICE USE ONLY
City of Tigard Da e/By� / 7 4 Ii gG C ,' Gd 9" ed 5
t ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
. Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TI GARD Inspection Line: 503.639.4175 Date Ready/By: Ju�ris ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: / I,/ 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 stones.
❑ 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 0 Master builder 0 Other:
❑ Fire pump. ❑ Installation of 75 KVA or
- ... ,. ,�`,' .....-. — ❑ Emergency system. larger separately derived system.
JOB; SITE INFORMATION\AN)!LOC T1 ON � < ,.:=1.;.::-,:s : ' , :i. t. , ❑ Addition of new motor load of ❑ "A", "E ", "1 - 2 ", "1 - 3 ",
1001iP or more. occupancy. Job no 32155.(p Job site address: 1 SW MEadowbrook Dr # ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, Or 97223 / an', 5 ' ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Project name: re.
Suite bldg. /apt no.: j Emmer Panel Replacement ❑ Service or feeder 600 amps or mo
t._�- 5, 7, ; ;1LE"SGHED13LE+ `;4'? ' _ ;'..
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
Ea. add'I 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
residential panel replacement residential (with above sq. fi.)
Services or feeders installation alteration and/or relocation
200 amps or less Wallirri ,., .70 2
.,; ®.;PROPERTY OWNER Igt TENANT ., , :• ,• 201 amps to 400 amps 106.85 2
Name Mary Emmer 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) 620 4323 b 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
73/d Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
•
r,.' 0 PPLICNT AA • .. CONTACT PER • ,
�.''.. ®.:.... 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, 2
Contact name: Steve Hogberg first branch circuit 4
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.com Pump or irrigation circle 53.40 2
- ' / 1 • ., CONTRACTOR'g �„ `; ; Ya_y; :_�, ' ': • :`" • ".' ,'' Sign or outline lighting 53.40
applicant Signal circuit(s) or limited -
Business name: same as a
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.•13991S Industrial plant per hour 73.75 _
ELECTRICAL PERMIT FEES 'O
Suprv. Electrician signature, required �, � _ Subtotal: �,►(�!85 � DD'
Print name: Stephen Lawhead Date: 1100/6/09 Plan review (25% of permit fee): 0 State surcharge (12% of permit fee): /A•s'b
Authorized signature: n / a TOTAL PERMIT FEE: •
This permit application expires if a permit is not obt ned within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit. / / 2.
IABuilding \Pcrmits\ELC- PcrmitApp doc 05/23/06 440- 4615T(1 I /O5 /COM/WEB ( I