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Permit
CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2013-00591 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2013 Parcel: 2S110DD90061 Jurisdiction: Tigard Site address: 10970 SW MEADOWBROOK DR 6 Project: Curtis Subdivision:SUMMERFIELD BROOKSIDE CONDO Lot: 6 Project Description: Replace service panel Contractor: PACIFIC NORTHWEST ELECTRIC INC Owner: CURTIS, EDITH A PO BOX 310' 10970 SW MEADOWBROOK DR#6 OREGON CITY, OR 97045 TIGARD,OR 97224 PHONE: 503-657-1188 PHONE: 503-481-3859 FAX: 503-722-9058 FEES Quantity Description Date Amount • 1 ea Services or Feeders-200 10/02/2013 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 10/02/2013 $12.08 Type of Use: MF Electrical 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 = .- +- 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: Oregon :w requi you to follow the rules adopted by the Oregon Utility Notifi = •• enter. Those rules are set forth in OAR 952-0r -0010 through OAR 952-0 r a- 0. You ay obtain a copy o the rules or direct questions to OUNC • -= 32.1987 or 1.800.332.234'.' , Iss ed By: Permittee Signat = •= -=- 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' 41111111111 e I. %� a Date: lar 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. To: 1..n0 0 2 of 3 2013-09-30 17:05:49(GMT) 15037229058 From: John Romiraz 1,-, C . Electrical Permit Applicatio> E E V 'I FOR OFI7ICT.USE ONLY �' Tigard SEP 3 0 2013 E!iew l ©/�ire� permitNm97223 = Phone: 503.718.2439 Fax: 503.5'98.196 Date/BV: Other Lout- Inspect ..T1.6A.RD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: 'will E Sec Page 2 for Internet: wwn.tigard-or.gov I Notified/Mc:hod: Supplemental information I TYPI% Ok'_�Vb1;1C PI AN;REVIE�i ❑New CO11Sn'tictlori Addition/alteIation/replacement Please check all that apply(submit 2 sets of plans w•:itcros checked below) ❑Service or feeder 400 amps or more ❑Building over three stories ❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATLGORI`Yir'_(;ONiSTRUCTION - .- 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 130 KVA or ❑Emergency system larger separately derived system. . -3011 SITE-INFORMATION AND-LOCATION ❑Addition oinenmow:lcadof ❑"A' "F:" 1-3" "I-' Job no.: Job site address: ( e C1 1 sA tit l,\', / L 16011.1,or man:. 0 Si c or more residential units occupancy 0 Recreational vehicle parks City/State/ZIP: o r ❑lleaith-care facilities. ❑Supply voltage for more th,r, 1J�G-1(�Y(�t�o T' `s' ❑}hazardous locations. 6(0(t volts nominal Suite/bldg./apt.11o.:-�Y' 1 t"rO]ecL name: ❑Service or leedcr 600 amps nr more. 1 EE SC.1iTDI.TLE ('Joss street/directions to job site: Ueserl dos Vn• — fee. I futon New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.tt.or less 168.54 4 Ea.add'l 500 sq.It.or portion 35.92 — 1 Tax map/parcel ilo.: Limited energy,residen ial - i�'DESCRIPTION OF WOR . (with above aq.R) 75.00 2 Limited energy,multi-family residential(with above sq.fl.) 75.00 2 Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation w.PROPERTY OWN. ER• ❑ '1'L NANT 200 amps or less f 1(]0.70 R1, )I { 2 - 201 amps to 400 amps 133.56 2 Nutne: i {fo C t 1.� rl 401 am s to 600 am a 200.=4 I 2 -Address: 601 amps to 1,000 amps 301.04 1 12 Over 1,000 amps or volts 552.26 I 2 City/StatwZ.P: Temporary services or feeders installation,alteration,and/or r) � relocation Phone:( ,�) �' �"] Fax:( ) -- 200 amps or less 59.36 1 Owner installation:This installation is bein 'noQde on property that 1 owl which is not 20)amps to 400 amps 125.08 2 intended for sale,lease,rent,or exchange,according,to ORS 447,449,670,and 701. - 401 arnps to 599 amps 165.54 2 Chester signature: ". Dale: Branch circuits-new,alteration,or extension,per panel■ 'i APPLICANT .. l! CONTAC.,f .PERSON A.Fee for branch circuits tart/I -_ aboveserviceorfeederfee, 7.42 2 lousiness name: each branch circuit B.Foe for branch cavults without Conlacl.ntal sawice or feeder fee,first 56.18 2 branch circuit Address:------/ Each add-t branch circuit 7.42 i_ 2 ' Miscel aneous(service or feeder not included) Cil)'/SlatelZlP: Each manufactured ortnodular 1 Phone:( ) :( ) dwelling,clling,ser ice and/or feeder 67.8-( 2 Ihax: Reumncet only 67.84 I E-mail: I Pump or irrigation circle 67.84 CON TRACTOR _ . Sign or outline lighting 1 67.84 2 �'S Ita111C ,i [,}}-�� Q "-' Sipal cireuit(s)or limited-energy Sec 13t1Sn �)C,. �"i?E L r/� �f�'f ct- ;��;��i�° panel,alteration,or extension. I Page 2 I 2 Address: �v x -tb Each additional inspection over allowable In any of the above l Additional inspection(1 hr min) —I C6.?S.hr c City/State/ZIP: lrP�0 IN �/ttl c Investigation(I hr min) I 66.25/hr Phone: ) v t Fax:( ,a) Z- f ( _( industrial plant(1 hr min) I 78.18.•"hr . htspcetions for vchidt no fee is I 9(1(l0i hr . CCB Lie.:f`(1r•2, t(? Electrical Lie.: C Sllpry_1.ic_,) 9,S spc iG ally liotcd(s;ltr ntin) g� v �O / El.P:C1TtUC:AL PERMIT FEES Supra.Electricit �tS' er quired:/ oA h � / /, — Subtotal: Point na1t1C: Dal(: r 2�� Plan review•(25%of permit fee): QQ A(;)irk.� ^_ YYi`,e.t, Ci,... T t3 Stntesurhurgc(12 &ofpcnnilfcc): ic J1�} Authorized signature:! .. t.i�� f0'1'N.i'ER i1'L'1'1 1: / � p � This permit application czpires if a pennil is not obtained wllhin 180 1))l ill dame: -)l-1 L�'+,� l- -G,(_ firs,I f.(l!J Dote �7 � J 3 days suer it has been accepted as complete. _/- Jj- r F r 7 l ' isumber of inspections allowed per permit. �'fY 1.Buildsg\Pemrisa,.I.c_PennirApp-EI.R,.F.RF.doc Rev 01.221.2013 440-.1615T(I iiOSJCOM!Wil3 To: Po g8 I of 3 2013-00-30 17:OS 40(CoI4T) 15037220058 From: Jonn 13onilroi FAX COVER SHEET TO COMPANY FAX NUMBER 15035981960 FROM John Ramirez DATE 2013-09-30 17:05:18 GMT RE electrical permit app. COVER MESSAGE electrical permit app WWW.MYFAX.COM