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Permit n CITY OF TIGARD ELECTRICAL PERMIT ss COMMUNITY DEVELOPMENT Permit#: ELC2009 00556 a 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2009 Parcel: 2S110DD90481 Jurisdiction: Tigard Site address: 10855 SW MEADOWBROOK DR 48 Subdivision: Lot: 0 Project: Summerfield Project Description: Change electrical panel and installing ground rod. Owner: FEES MCCABE, CORRINE E & GROSS, E RANDI Quantity Description Date Amount 11777 SW QUEEN ELIZABETH TIGARD, OR 97224 1 ea Services or Feeders - 200 10/21/2009 $100.70 amps or less PHONE: 1 ea 12% State Surcharge - 10/21/2009 $12.08 Electrical Contractor: WINNER ELECTRIC INC 5950 SW PROSPERITY PK TUALATIN, OR 97062 PHONE: 503-638-5028 FAX: 503-638-4242 Type of Use: MF 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. 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 O 01-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 w 1.800.332.2344. Issued By: Permittee Signature: 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' C.) QiA Date: o Cj LICENSE NO. O~ I " S S 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. Eitetrical Permit Application FOR OFFICE t SE ON LN Tigard 4 2(. tC, ' E i ^ 0 Permit No.:,~-L C' goo % -eo e - ~51 BUS, SWI`W- H Bllml- Tl OR 972 13, f`; i l~cR~au~*au Fannit, a( D),_&~~9'.A4171 Far ~ iGAt~Does= ~ Other , 16 rame lms)prrxtim Liinc: 503_094175 Dew Readvl* Au~`I see 2 for 1®m evmstt: aa~Haa.. tntr_ a ~i a&"@ bttllmmd /C~ srpfie~W Informsfim n7E OF 'WVORK I PLAN REN'T"V © a' r~9Il 2i1➢ itiolmQaBtetskGiioni a cheer: all that apph- € subtmt 2 sets of piaas winems checked below ice or feeder 400 amps or more ❑ Building over three stones. obere the available fault current ❑ Marinas and boatvards. CATEGORl OF CO"~STRI"ION l exceeds 10.000 amps at 150 volts or Floating buildings. less to ground. or exceeds 14,000 ❑ Commercial-use agricultural l- and 2-family dwelling F~ CommercialPindustrial ❑ Accessory building amps for all other installations. buildines. Multi-family ❑ Master builder ❑ Othef: ~ ❑ Fire pump. ❑ Installation of 75 K VA or JOB SITE INFORMATION AND LOCATION ~ [I Emergency system. larger separat'ly derived system ❑Addifion of new motor load of ❑ "A F-, -1-- I t~ ~ 9&RMtNHP or more . occupam). loltr, no.: d lob site adds: i Sle,,) k y~ I ❑ Six or more residential traits. ❑ Recreational vehicle pairks. I Citvl"5tateYZIP: ❑ Health-care facilities. El Supply vohage for more than YY- `7 f1 f ❑ hazardous locations. 600 volts nominal. Suitc7bidg-iapt_ no.: Pmiect name: u G~j I E \ ❑ Service or feeder 600 amps or tuore. FEE r j~ zC 1 C L~ SCHEDULE Cnms sta~eudirections to job site: 1 li V f boa"- /i wv,. rL--d t)esniptiou Qn. Fee. Toil i. New residential single- or multi-famiy dwelling unit. Includes attached garage. Saulralivisiott: Lot no.: 1.000 sq. ft. or less 145.15 1 Fa_ add'I 500 sq. ft. or portion 3 3.40 l 1 Ta<e mtaalai~rrl no.: t Limited energy ! , residential ! ! 75.00 DESCRIPTION OF WORK 9vmh above sq ft.) Limiitr d energy, multi-family 75.00 AW ~~C: ~2•C.g1 P1N'=' L m,*sidential (Ndthabove sq.fi.l I F~S f' G2 c a~G Servces or feeders installation, alteration, and/or relocation R G4,,, - J ie G Few Kc,) 2W amps or less c'/ 80.30 p 6 2 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 ~ 401 amps to 600 amps 160.60 2 603 amps to 1.000 amps 240.60 2 <?6x: Over 1,000 amps or volts 454.65 2 Cifa✓Siate"ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) 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 10030 2 inlemded for sale. lease- rent, or exchange. according to ORS 447. 449. 670. and 701. 401 amps to 599 amps 133.75 2 G)K= signature: Date: Branch circuits - new, alteration, or extension, r nel A-Fee for branch circuits 11-irit ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee. each branch circuit 6.6? 2 j Business name: B..1-ct- for branch circuits mrvuhour service or fear fee, C.~mtl aci eta: ~t branch circuit !"8~ 2 Adlailu~ss: Emb Ladd] branch circuit 6.65 Miscellaneous (sen ice or feeder not included) Cite/,'State/ZIP: Each manufactured or modular 90.901 2 dwelling srv ice andfor feeder Phone: Fa.;:: ) Reconnect onh 6615 2 E-ntimril: PUMP or irrigation circle 53.10 2 CONTRACTOR Sien or outline lighting 53.40 2 r. Signal circuit(s) or limited- 6 umess name.- n1 N e-,-f- G!e c. ( , 'c-- energy panel, alteration. or Address. S 5U s i,J P2c~~ d,~ f P~iZ k 2 extension. Describe: Page 2 2 City/State/ZIP: <tJA Cf Lt6 L- Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (mss ) 6 3 8 s6 2 e i Fax: { • -4 'A 4/1 ~ Investigation per hour 41 hr mink h ~ 62.50 C C''C9 L.irc: / y -7 H Ekrti afl U e-- 34-150 e ~I Suggs _ Lie.- oZ o~ 7 S hilusrial plant per hour I 73.75 f ELECTRICAL PERMIT FEES Supra _ Elerlrt .iaat sirmwzv - required. 100,'70 Subtotal: Prittt name: ~f Clinic: 1 Plan review (25% of permit fee): &f- State surcharge (I 20,'G ol'permit fee): Authorized signature: - TOTAL PERMIT FEE: Print name: Date: jgpplication expire if a permit is not obtained within 180 days after it has been accepted as complete- Namber of inspections allowed per prrttut. IJ V6fiiilekce'd'emnits:Lr'A?.ernun?ar+t+.dc .rj,.,^;/{;r;, 5lil>•1`';2~Y7 ;~~•'f.%[AiltRS^c~ h ,, T"O ELECTRICAL PERMIT 1 CITY OF TIGARD w 513 .a, COMMUNITY DEVELOPMENT Permit #: ELC2009 -00556 TiGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2009 . ' Parcel: 2S110DD90481 Jurisdiction: Tigard Site address: 10855 SW MEADOWBROOK DR 48 Subdivision: Lot: 0 Project: Summerfield Project Description: Change electrical panel and installing ground rod. Owner: FEES MCCABE, CORRINE E & GROSS, E RANDI Quantity Description Date Amount 11777 SW QUEEN ELIZABETH TIGARD, OR 97224 1 ea Services or Feeders - 200 10/21/2009 $100.70 amps or less PHONE: 1 ea 12% State Surcharge - 10/21/2009 $12.08 Electrical Contractor: WINNER ELECTRIC INC 5950 SW PROSPERITY PK TUALATIN, OR 97062 PHONE: 503- 638 -5028 FAX: 503 - 638 -4242 Type of Use: MF 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. 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 0 -101 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: r i7 — .- Permittee Signature: 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 N o _ SIGNATURE OF SUPR. ELEC' ( ,),t,u Date: /0 — ZU- O C LICENSE NO. a S 5 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. i I \/ED �t R " a lug i ! .J+ "h "' 1 r', d Electrical Permit Application ? � ! `' },, , ,a � 1 OR O F F I C E t.S F O N L 1, 0 CT 2 1 2009 � I e. ti � t ,14m . :rf ���• ia -m. l ,r, _ . , .t, 1 } „ },, , w c � �f / - P �� e too 9 —00 5.5 Permit No.: '-125 smv Blati-1* -Art -' °< R , >w�aR�ieav r ' »: 5A 3.639.4151 Fat 5(0/3 i 1LDING DIVISION DarR , . . , f F l IGARD Other Peimi L •∎ ••,u.,ow.t,i Lilac 503.639.4175 t• a�y:By. tacnc 1S See 2for .: r . long: VI '. ° r_goa' t ria d 9lattmmdi' 77&--- 1 Supplemental isaformatialt TYPE OF WORi: I PLAN REVIEW © a.. cn $�1lllitit)im!i�la9 te tliQin�')1 iD � R'i a check all that apph t submit 2 sets of plans wiitems checked below l: � 1 ❑ Service or feeder 400 amps or more ❑ Building over three stories. ® >gitii 0 on I where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings. less to Bound. or exceeds 14,000 ❑ Commercial -use agricultural ❑; 1 - and 2-family dwelling ❑ Commercialr'indiustrial ❑ Accessory buiiding amps for all other installations. buildings K klulti- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 ti VA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system ['Addition of new motor load of ❑ "A "E ", "I -Z ", "1 -3 ", addr lb no.: bolt( site `\ G q 5 �j / Itt'lOHP or more. occupancy. Ko 1 U a V +� J ��Uw r " k 0six or more residential units. ❑ Recreational vehicle parks City /State /ZIP: t � ( 0 locations. ❑Health-care facilities. ❑ Supply voltage for more than 5 p � U �- 600 volts nominal f' ,(� �j, SaiteibIdi JapL no.: 1 Project name: S u / Mb -- A I ❑ Service or feeder 600 amps or more FEE SCHEDULE Cmt7s see to job site: 0 ff bu(2-4- 4" 4 1 neSeT:ptl °n 1 Qty. 1 Fee. 1 Twat k - 1 New residential single- or multi-fami r dwelling unit. Includes attached garage. Satladivisiott: Lot no.: 1.000 sq. ft. or less 145.15 4 f Ea add'l 500 sq. ft. or portion 33.40 I 1 Tax mmapiparrel no.: t Limited energy, residential A E 75.00 ' DES+CRiPTION OF WORK (with above sq fi.) E I — ( _ ' Limited energy', multi - family Ch A w g -F c /Ce i:ti r• 4C_ RiAk, L 1 ivsA t ( mw:idential (with above sq. 6.) 71.00 1 2 AY / Services or feeders installation. alteration, and/or relocation 4 G-40e, -1 Lo G FZ .� F � $ 1 '5 Geeu�,i i'C 20i() amps orless 80 go,ia 11 2 0 PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1.000 amps 240.60 2 Artio1mess: Over 1,000 amps or volts 454.65 2 Cil s'Statei7_IP Temporary services or feeders installation, alteration. and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 I Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.3() 2 intended for sale. lease, rent or exchanee, according to ORS 447. 449. 670. and 701. 401 amps to 599 amps 133.75 2 Owner xi matluru : D t Branch circuits — new. alteration, or extension. per panel A_ Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee. earth branch circuit 6.65 ''ansmners name: B. Fee for branch circuits Contact name: nr 6iour service or feeder fee, (Fast branch circuit .8 2 Address: F:arih add'I branch circuit 1 j 6.65 2 Mlscellaneons (service or feeder not included) Citv /iStaie?ZIP: Each manufactured or modular t . dwelling. service and /or feeder ' 2 MoMottle: ;� e: ( ) 1 Fax:: ( ) Reconnect only t 66.85 ' 2 E- Tamil: Pump or irrigation circle 53.40 2 CONTRACTOR Sigh or outline lighting 53.40 2 IDltty aiotess . Signal circuit(s) or limited- (AI: Ai n/ e., . GI c. e t., 1 L-- energy panel, alteration, or 5-s Address: SS: S a/ extension. Describe: Page 2 2 5 s w Pa-ospe� / / n�� K 2 ) Ciry /State /Z1P: i to /141 '''' O 4 .-- q ? 06 i„ Each additional inspection over allowable in any of the above 1 Phone: ( S ) Per inspection 62.50 i " Fax: i tj b 3) 433 a did I nvestigation per hour (1 hr mini 62.50 o 5 1 �38So2� I � � pe 6_..- CC'S Lic_: 1,17 ci y Ellectricall Lie.: 34—/50 c Sugsr. Lic.: Sa SS it ' Industrial plant per hour I 73.75 t it ELECTRICAL PERMIT FEES Sawn Electrician s9..t.".7'tattare_ it qd ire,"'+: i.A5 � d /00 1 '7Q I �(t. ;0 Subtotal: Print name: ,3 A CK_ WA e i Bate: f b ,... - , 6 j Plan review (25% of permit fee): ( �a S tate surcharge (12% of permit fee): q 6K Authorized signature: C / 7 fi ') TOTAL PERMIT FEE: 6 q Lt • < • l eAld 'cation expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete_ r ?wnnilrer of inspections allowed per permit. U V6luildag2?ernin r- PermisApphoz •:5 =s1k d+ltra.i51-(t4n!5.7:d97.t!ia