Permit $ I U 9 —� b a�1 d eve-_3
CITY F TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00442
Date Issued: 09/01/2009
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S134ACO2624
Jurisdiction: Tigard
Site address: 11175 SW BOXWOOD CT
Subdivision: ENGLEWOOD NO.3 Lot: 181
Project: David
Project Description: Replace (1) 200 amp or less panel. 11/18/09, adding additional feeder.
Owner: FEES
DAVID, CHRISTOPHER Quantity Description Date Amount
11175 SW BOXWOOD CT
TIGARD, OR 97223 1 ea Services or Feeders - 200 09/01/2009 $80.30
amps or less
PHONE: 503 - 590 -7290 1 ea 12% State Surcharge - 09/01/2009 $9.64
Electrical
1 ea Services or Feeders - 200 11/18/2009 $100.70
Contractor: amps or less
OWNER 0 ea 12% State Surcharge - 11/18/2009 $12.08
Electrical
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $202.72
Required Items and Reports (Conditions)
This permit ' ' • • su• - o the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don- 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 Notificatio Center. Those rules are set forth in OAR
95 601- 0010 th •ugh OAR 952 -001 -6 r • . Y• m- obtain a copy of the rules or direct questions to OUNC by cal 246.6699 or 1.800.332.2344.
/
sued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own whichr for sale, lease or rent.
OWNER'S SIGNATURE �� ../4 -�} r Date:
CONTRACTOR IIALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
CaII 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.
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00442
IIGAAD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2009
. Parcel: 1 S 134ACO2624
Jurisdiction: Tigard
Site address: 11175 SW BOXWOOD CT
Subdivision: ENGLEWOOD NO.3 Lot: 181
Project: David
Project Description: Replace (1) 200 amp or less panel.
Owner: FEES
DAVID, CHRISTOPHER Quantity Description Date Amount
S
11175 1W BOXWOOD CT
11175 S , OR 97223 1 ea Services or Feeders - 200 09/01/2009 $80.30
amps or less
PHONE: 503 590 - 7290 1 ea 12% State Surcharge - 09/01/2009 $9.64
Electrical
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.94
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 -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: . � Permittee Signature: tefAr /97 C/9
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 503.639.4176 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.
' 146ge'28 09 11:132 Rodgers Instruments LLC 5036810425 p.1
rti r.r�I i1ti,f'
Electrical Permit Application R i
` , F' - I' " � - FOR OFFICE USE ONLY
t Received of d AUG 2 1.0 Date/B `. Permit ho.: J`Q .OQ
ill SW H al l T igar Blvd., Tigard, OR 97223
Cit Plan Review
l iAll
Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 „ fnarl
TI G A R D Inspection Line: 503.639.4175 �, CAF ° f 6GA • Ready /By: B! See Page 2 for
Intemet: www.tigard- or.gov �Uel ®��C ®� tined/Method: FM Supplemental Information
I I PLAN REVIEW
TYPE OF WORK
Li New construction VI Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
— 7
Demolition n Other: EService or feeder 400 amps or more 111 Building over three
CATEGORY OF CONSTRUCTION where the available fault current stories.
exceeds 10,000 amps at 150 volts or ❑ Marinas and boatyards.
X 1 and 2 family dwelling j i Commercial /industrial U Accessory building less to ground, or exceeds 14,000 ❑ Floating buildings.
n Multi - family El Master builder El Other: amps far all other installations. _� Commercial -use
❑Fire pump. agricultural
JOB SITE INFORMATION AND LOCATION ❑Emergency system. buildings.
['Addition of new motor load of ❑ installation of 75 KVA
Job no.: Job site address: 11175 SW Boxwood Ct or
100HP ar more.
larger separately derived system.
City /Statc21P: Tigard, OR 97223 ['Six or more residential units,
01ealth -care facilities. ' "�' -• "l �•' "i -3"
Suite/bldg. /apt. no.: Project name: ❑Hazardous locations. occupancy.
❑ Recreational vehicle
['Service or feeder 600 amps or more.
Cross street/directions to job site: Scholls Ferry to Springwood to Cottonwood parks.
❑ Supply voltage for
to Boxwood more than
600 volts nominal.
Subdivision: Englewood No. 3 Lot no.: 181
Tax map /parcel no.: 15134ACO2624 FEE SCHEDULE
De criptinn J Qty. ' Fee. ' Total I
DESCRIPTION OF WORK New residential single- or multi - family dwelling unit.
Replace Main Circuit Breaker Panel and Meter Box Includes attached garage.
1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
® PROPERTY OWNER ❑ TENANT Limited energy, residential 75.00 2
(with above sq. ft.)
Name: Christopher David Limited energy, multi - family 75.00 2
Address: Same as Jobsite residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
City /State/ZIP: 200 amps or less I 80.30 80.30 2
503 201 amps to 400 amps 106.85 2
Phone:
( )590 7290 Fax: (877)581 4811 401 amps to 600 amps 160.60 2
Owner installation: This i stallation is beitfe tg ma t property that I own which is not 601 amps to 1,000 amps 240.60 2
.7 intended for sale, leas r t, or r�xcha e, ccording,o 447, 449, 670, and 701. Over 1,000 amps or volts 454.65 2
Owner signature: r - /.. /j +7 Date: ' .. a? ,' t.?{ i ' - Temporary services or feeders installation, alteration, and/or
relocation
E APPLICANT v - ' E CONTACT PERSON 2Q0 amps or less 66 -85 i 1
Business name: 201 amps to 400 amps 100.30 2
401 amps to 599 amps 133.75 2
Contact name: Branch circuits — new, alteration, or extension, per panel
Address: A. Fee for branch circuits with
above service or feeder fee. 6.65 2
City /State/ZIP: each branch circuit
13. Fee for branch circuits •
Phone: ( ) Fax: : ( ) without service or feeder fee, 46.85 2
E -mail: first branch circuit
CONTRACTOR Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
Business name. n IAL— Each manufactured or modular 90.90 2
Address: C� dwelling, service and/or feeder _
—
Reconnect only 66.85 2
City /State/ZIP: Pump or in circle 53.40 2
Phone: ( ) Fax: ( ) Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
CCB Lie.: Electrical Lic.: Suprv. Lie.: energy panel, alteration, or
extension. Describe: Page 2 2
Suprv. Electrician signature, required:
Each additional inspection over allowable in ally of the above
Print name: Date: Per inspection 62.50
Investigation per hour (1 hr nun) 62.50
Authorized signature: Industrial plant per hour 73.75
Print name: Date: ELECTRICAL PERMIT FEES
I.%Buildmg \Penuite\ELC -Pc n,iiApp.dec 05/23/06 440-- 1615T( I I/051COM/WEB
Rug. 28 09 11:14a Rodgers Instruments LLC 5036810425 p.2
•
Subtotal: 80.30
Plan review (25% of permit fee): N/A
State surcharge (12% of permit fee): 9.64
TOTAL PERMIT FEE: 89.94 ✓
This permit application expires if a permit is not obtained within 180 days after it has been accepted as
complete.
Number of inspections allowed per permit.
•
Ia EuildinglPennits \ELC- Permit.App.doc 031 23/06
Aug -28 09 11:14a Rodgers Instruments LLC 5036810425 p.3
Electrical Permit Application - City of Total number of commercial systems:
Tigard *No licenses are required. Licenses
Page 2 - Supplemental Information required
for all other installations
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems $75.
combined. 00
Check Type of Work Involved:
Audio and Stereo Systems *
Burglar Alarm
Garage Door Opener *
Li Heating, Ventilation and Air
Conditioning System*
; Vacuum Systems *
Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.
system 00
(SEE OAR 918-309-0000)
Check Type of Work Involved:
I Audio and Stereo Systems
I I Boiler Controls
Clock Systems
I Data Telecommunication Installation
Fire Alarm Installation
HVAC
J Instrumentation
Intercom and Paging Systems
Landscape .Irrigation Control *
I Medical
Nurse Calls
I I Outdoor Landscape Lighting *
Protective Signaling
Other
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