Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00370
13125 SW H all Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2012
T i G A li D g Parcel: 2S110DD90331
Jurisdiction: Tigard
Site address: 10930 SW MEADOWBROOK DR 33
Project: Livermore Subdivision: SUMMERFIELD BROOKSIDE CONDO Lot: 33
Project Description: (1) 200 amps or less replace electrical panel.
6/28/12 ; REPRINTED TO CORRECT ADDRESS
Contractor: ROSE CITY ELECTRIC CO Owner: LIVERMORE
PO BOX 10004 10930 SW MEADOWBROOK DR #33
PORTLAND, OR 97296 TIGARD, OR 97223
PHONE: 503 - 287 -6164 PHONE:
FAX: 503 - 282 -1060
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/18/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/18/2012 $12.08
Type of Use: MF Electrical
Class of Work: FND
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. 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 -0090. You may obtain A a ,/ copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
�
Issued By: (t/ts^iT p 1"" Permittee 0/U ' p• /2L.
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' Date:
LICENSE NO.
Call 603.639.4176 by 7:00 a.m. for the next available inspection date.
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.
Electrical Permit Application 1(m t>rrli I.: Ill ()NI .1
• Ppm City of Tigard • Received . 4 / t / s Permit No.: 6L 3 - • • 37D
.- 13125 SW Hall Blvd, Tigard, OR 97223 pl R ev 1 ew
v ' Phone: 503.718.2439 Fax: 503.598.1960 JUN 1 8 2012 DatelB • Other Permit:
i• 1 G ` R 1 .) Inspection Line: 503.639.4175 Date Ready/By RI See Page 2 for
Internet www.tigard- or.gov CITY OF TIGARID Notified/Method: Supplemental Information
TYPE OF WELDING l) t0 J P RE W
❑ New construction ❑ Addition /alteration/replacement Please check all that apply (submit a sets of plans w/items chocked below):
❑ Service or feeder 400 amps or more ❑ Budding over three stories.
❑ Demolition ❑ Qom;
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at I50 volts or ❑ Floating buildings.
❑ 1 and 2 family dwelling ❑ CommerciaU'mdustrial ❑ Accessory buildin sni to or a o e exceeds ons. ❑ commercial - use egricuttaral
g amps far all other installations. buildings.
® Multi family ❑ Master builder ❑ Other: ❑ Fue pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: I Job site address:48960SW Meadowbrook Dr I00HP o r more. occupancy.
/ OCI 3 0 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: Tigard OR 97224 � ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: x'33 I Project name: Livermore ❑ Service or feeder 600 amps or more.
Cross str et/directions to job site: FEE 3C 1 Q t y . I
1 ntyerlot I Roy. I Fee. I coral ( .
New residential single- or multi- family dweWng unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. f . or less 168.54 ; 4
Tax map /parcel no.: Ea. add'I 500 sq. R or portion 33.92 1
Limited energy, rodential 75.00 2
DESCRIPTION OF WORK (with above sq.IL)
Replace Electrical panel L residem� th ab s4 ft) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 maps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 55226 2
City /$tetP�Z1P: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not 401 amps 68.5 99 5
t4 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch to 599 —too w, alteration, or elite 1 Qer pattoe)
Owner signature: Date: A. Fee for bnmch cirurits with
❑ APPLICANT I ' ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits witlto t
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7A2 2
Address: Miscellaneous (service or feeder not included)
Each manufactu ed or modular
City / State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) I Fax:: ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation, circle 67.84 , 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited -energy
Business name: Rose City Electric Co panel, alteration, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: PO Box 10004 Additional inspection (l br min) 66.25/ br
City/State/ZIP: Portland, OR 972% Investigation (1 tuner) 66.25/ hr
Industrial plain (1 hr min) 78.1 8/ hr
Phone: (503) 287 -6164 I Fax: (503) 282 -1060 Inspections for which no fee is 90.00/ hr
specifically listed (1 hr min)
CCB Lic.: 193652 I I Electrical Lic.: C729 4 (I Suprv. Lic.: 50585 V ELECTRICAL PERMIT FEES -
G,- W Subtotal:
Suprv. Electrician signature, required: i1/• ! plan review (25% of permit fee):
Print name: John Wilkins I Date: 6 0i/ Z State surcharge (12% of permit fee):
Authorized signature: 7, TOTAL PERMiTFEE: / (�- ��
tJ This p ermit application U
aspires a permit b trot obtained within 180
Print name: V ��/ / 1 JJ _ Date: // /- . days alter n ices hoer. accepted as complete.
y G v / ` 1 ( f I G (� J Number of inspections allowed per permit.
L don 07/01/10 4404615T(11/05/COMIWFB
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00370
T t G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2012
Parcel: 2S110DD90091
Jurisdiction: Tigard
Site address: 10960 SW MEADOWBROOK DR 9
Project: Livermore Subdivision: SUMMERFIELD BROOKSIDE CONDO Lot: 9
Project Description: (1) 200 amps or less replace electrical panel
Contractor: ROSE CITY ELECTRIC CO Owner: LIVERMORE
PO BOX 10004 10960 SW MEADOWBROOK DR #9
PORTLAND, OR 97296 TIGARD, OR 97223
•
PHONE: 503 - 287 -6164 PHONE:
FAX: 503 - 282 -1060
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/18/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/18/2012 $12.08
Type of Use: MF Electrical
Class of Work: FND
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. 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 01 -009 You may obt ccopp of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,
Issued By: Permittee Signature: �G /`�/.
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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
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.
Electrical Permit Application F•OR OFFICE USE ONLY
R �
City of Tigard RECEIVE � . Received (e I tfix W ee..sOra. — op 37D
Permit No.:
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Ill Phone: 503.718.2439 Fax: 503.598.1960 , IN 1 8 2012 Date/B : Other Permit:
TI RD Inspection Line: 503.639.4175 Date Ready/By: OM 55 See Page 2 for
Internet: www.tigard - or.gov CITY OF (n D Notified/Method: Supplemental Information
TYPE OF wettliLDING DIVISION 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.
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 ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "1 -3 ",
Job no.: Job site address: 10960 SW Meadowbrook Dr 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: e Project name: Livermore ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75 00 2
Replace Electrical panel residential (with above sq. ft)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/ State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Rose City Electric Co panel, alteration or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: PO Box 10004 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Portland, OR 97296 Investigation (1 hr min) 66.25/hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 287 - 6164 Fax: (503) 282 - 1060 Inspections for which no fee is
90.00/ hr
CCB Lie.: 193652 *1
specifically listed (V2 hr min)
ELECTRICAL PERMIT FEES
Electrical Lic.: C729 `�tk Suprv. Lic.: 5 058S ` ` I
Suprv. Electrician signature, required: ��jj� W Subtotal:
/ �/ Plan review (25% of permit fee):
Print name: John Wilkins Date: 6, f �0'i Z State surcharge (12% of permit fee):
Authorized si afore: TOTAL PERMIT FEE: I ( A- 7g' sr
t% This permit application expires if a permit is not obtained within 180 x
1 �r Date: p days after It has been accepted as complete.
Print name:
W/ t .� to 0 1 L • Number of inspections allowed per permit.
I:\ Bui ldng\Pcmnts\Et.C- PenaitApp.doc 07/01/10 440.4615T(I1 /05 /COM/WEB