Permit 71 C I Y OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00637
° COMMUNITY DEVELOPMENT DATE ISSUED: 9/13/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S13400-00600
SITE ADDRESS: 12175 SW MERESTONE CT ZONING: R -4.5
SUBDIVISION: MERESTONE LOT : 005 JURISDICTION: TIG
PROJECT: HEDRICK
Project Description: Panel change -out.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA /SPEC OCC:
Owner: Contractor:
HOWARD R. HEDRICK PREMIER ELECTRICAL SERVICES INC
12175 SW MERESTONE CT 4548 SW TAYLORS FERRY RD
TIGARD, OR 97223 PORTLAND, OR 97219
Phone: Contact #: PRI 503 - 293 -3060
FAX 503 - 293 -3061
FEES
Description Date Amount Reg #: ELE C53
[ELPRMT] ELC Permit 9/13/2007 $80.30 LIC 163299
[TAX] 8% State Surcharge 9/13/2007 $6.43 SUP 51425
Total $86.73 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws, All
work will be d• - - in ac . .ance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than :0 days. ATTENTJON: Oregon law requires you to follow rules adopted by the Oregon Utility No ication Center. Those rules are set forth in
OAR 952 '01 -0010 through OA' •5 0100. You may obtain copies of these rules or direct questio to NC at 503.246.6699 or 1.800.332.2344.
Issued :y: 't eL,41/0(14) Perm'ittee Signat ' f � _ice /AV r,/ ,
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:
•NThhACTOR INST LATION ONLY
SIGNATURE OF SUPR. ELEC'N: % �` ^ DATE:
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.
F'' / 8
(3 Electrical Permit Appl : ri ! ,
City of Tigard 1 it L �+ Re e
Z / el- 0 Permit No.( f�,G�
�T��0 ,3
s 13125 SW Hall Blvd., Tigard, OR 97Eir 2007 Review
view RD Phone: 503.639.4171 Fax: 503.598.1960 � [� Plan RDate/Be Other permit:
T 1 0 A R D Inspection Line: 503.639.4117M Of 1 -i. Date Ready /By: �Jur Sec Page 2 for
Internet: www.tigard or.gov 1 , N otified/Method: - . w Supplemental Information
lG�' 'er i■ ' G DIVISION PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ® Addition /alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Cl 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 ", "1 -2 ", "l -3 ",
lob no.: Job site address: 12175 SW Merestone @__r 100 W' or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR El Health -care facilities. El Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: FPE Panel change ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW 121" & Merestone Description I Qty. I Fee. i Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'] 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
125A FPE panel replacement, replace with new 125A main breaker panel residential (with above sq. rt.)
Services or feeders installation, alteration, and/or relocation
200 amps or less / 80.30 8D , 30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 4-0 w A. 2-c- 4 ifID �\ C_ IL 401 amps to 600 amps 160.60 2
` 601 amps to 1,000 amps 240.60 2
Address: l rd,l 7 - 3 L et,-.3 _l i_oW7 -ro,3 t QT Over 1,000 amps or volts 454.65 2
City /State /ZIP: .-- A. (L� Q et 7 4?,..-d___j 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 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
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
0 APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit _
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: Premier Electrical Services, Inc. energy panel, alteration, or
•
Address: 4548 SW Taylors Ferry Rd. extension. Describe: Page 2 2
City/State /ZIP: Portland, OR 97219 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 293 -3060 Fax: (503) 293 -3061 Investigation per hour (t hr min) 62.50
CCB Lic.: 163299 Electrical Lie.: C53 1 Suprv. Lie.: 5142S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required . �— , Subtotal: 80-3
Print name: Michael Rushing Date: 9 -11 -07 Plan review (25% of permit fee):
—
1 State surcharge (8% of permit fee): 6 . Y3
Authorized signature: TOTAL PERMIT FEE: gG . -73
Print name: Date: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
T - T9DE E6Z - E0 S AJaS teoT- 1..oai3 JeTwaJd d22 :EO LO 21 daS
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00637
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/13/2007
Phone: (503) 639 -4171 A 4Mgjt
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/17/2007 TIME: 7:00AM PAGE: 10
SITE ADDRESS: 12175 SW MERESTONE CT CLASS OF WORK:
SUBDIVISION: MERESTONE LOT #: 005 TYPE OF USE:
PROJECT NAME: HEDRICK
DESCRIPTION: Panel change-out,
OWNER: HEDRICK, HOWARD PHONE #:
CONTRACTOR: PREMIER ELECTRICAL SERVICES INC �Y1 y E _ PHONE #: 503-293
Inspection Request Scheduled For: Date: 9/17/2007 , Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final - ' 0551 19-0' 503-887 -7526 \ V
Corrections /Comments /Instructions: O PEN
•
X I PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
n FAIL I j CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: u LE Date: Mk) t)1 Phone #: (503) 718- VI*