Permit CITY OF TIGARD ELECTRICAL PERMIT
J ° PERMIT #: ELC2008 -00460
COMMUNITY DEVELOPMENT DATE ISSUED: 8/8/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 110 D D -90211
SITE ADDRESS: 10935 SW MEADOWBROOK DR 21 ZONING: R -7
SUBDIVISION: SUMMERFIELD BROOKSIDE CONDO LOT : 021 JURISDICTION: TIG
PROJECT: TAGUE
Project Description: Change panel, install ground rods
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:
TAGUE, DONALD DUANE + DOROTHY MA WINNER ELECTRIC INC
10935 SW MEADOWBROOK DR #21 5950 SW PROSPERITY PK
TIGARD, OR 97224 TUALATIN, OR 97062
Phone: 503 -413 -9335 Contact #: PRI 503- 638 -5028
FAX 503- 638 -4242
FEES
Description Date Amount Reg #: ELE 34 - 150C
[ELPRMT] ELC Permit 8/8/2008 $80.30 LIC 14794
[TAX] 12% State Surchar 8/8/2008 $9.64 SUP 28255
Total $89.94 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 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: J
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'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.
r S
F ectrual Permit Application FOR c)rrlc h: USE ONLY
of Tigard � �L ` Date/B : ./ Permit No.: f _, ,�OD ; -d 0 , (�
IN Phone: 503.639.4171 Fax: 503.5` ; t • 13125 SW Hall Blvd., Tigard, O R j O� Date /By: Plan Review
7 q e1 o Other Permit:
TI G A R D Inspection Line: 503.639.4175 r - Date Ready/By: inns: 63 See Page 2 for
Internet: www.tigard- or.gov [w � � O Notified/Method: Supplemental Information
TYPE OF WORIsI J PLAN REVIEW
0 New construction A ddition /alteratiotQQl�Cmen[ Please check all that apply (submit 2 sets of plans wlitetns checked below):
❑ Demolition Other: V ❑ Service or feeder 400 amps or more ❑ Building over three stories.
I where the available !cult current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION cNcecds 10.000 :imps at 150 volts .,r ❑ Floating buildings.
��� less to around, or exceeds 14.000 ❑ Commercial - use agricultural
p
tPU 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
9 p ❑ "A "E ", "I -2 ", "I -; ",
Job no.: Job site address: / 0 SW �'�1ea,of� &o 't IOOor more e res. Recreational 9 3 5 0 or more residential units. ❑Recreational vehicle parks.
City /State /ZIP: 7 0 q � � � � 0 0 Health-care locations. ❑ Supply voltage for more than
`7 722y r Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 1ko R t C \ S ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description � Descpnon I Qt,•. t Fee. I Total t - -
c? New residential single- or multi- family dwelling unit.
.5 . 1)Pvt I've - ✓ Y Includes attached garage.
Subdivision: St, ON At e n, re- b co Lot no.: 1.000 sq. ft. or less 145.15 4
�d S
Ea. add'! 500 sq. ft. or portion 33.40 !
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00
/�
w �� Limited energy, multi - family
P A 4P . L 1r a v/ 620 e residential (wall above ski. It. ; 75.00
i 1 Services or feeders installation, alteration, and /or relocation
200 amps or less ` 80.30 :ba 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.35 2
Name: q:;, �J i� �' � ^ ► 401 amps to 1. 600 amps 160.60 I
601 amps to 1.000 amps
240.60 L
Address: i �� Over 1,000 amps or volts 454.65 2
City/State/ZIP: Cam � �j Temporary services or feeders installation, alteration, and /or
9 T 2 ■ relocation i
Phone: ( ) .. Li 13 _ 9 3 i � , . . ( ) 1 200 amps or less 66.35 i
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amp 1 100.30 2
intcndeu ibr sale. :ease. rent. or exchange, according to ORS 447. 449. 671). and 70 401 amps to 599 amps I 133.75 l ,
Branch circuits — new, alteration, ur extension, per panel
Owner sienature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON I above service or feeder fee,
6.65 ?
each branch circuit
Business name: B. Fee for branch circuits
.vithoul service or feeder lee. I 46 >5 ,
Contact name: first branch circuit I
Address: 1 Each add'I branch circuit I I 6.65 2
Miscellaneous (service or feeder not included)
City /State/71P: Each manufactured or modular I 90.90
'hvelling, ; ervice and/or feeder
Phone: I ) I Fax:: 1 ) Reconnect only I 66.35_
. - mail: ; i Pump nr irrigation circle i I 5, 1
CONTRACTOR ' Sign or outline lighting j 53.40 t ? i
Business name: Signal p alteration. or
circuit(s) or limited- I
r energy p
Address: SC� (� S w Polo$ Pe /h �lek Ad extension. Describe: Page 2 2
laity/State /Li P: �U-4 /. #4 "w ort. 9 7O 2 I Each additional inspection over allowable in any of the above
Per
Phone: (,G3 ) tb3? So Z g I Fax: l 6 O 3) / 3 �j 9 Viz- l' . t) Investigation 62.50
G if, n per hour (I hr min) 62.50
CCB Lie.: 1147epy lkOcitltIc • L /5oc_ Suprv. Lie.: a$ds , Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: (t) t�C/i L Subtotal: VA 30
�Plan review (25 ° %n of permit fe
Print name: Date: 8 r
e� W� 7 _ 6 G, 6 State surcharge (12% of permit fee): 7
Authorized signature: TOTAL PERMIT FEE: A, 9 t
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• .r....J ,,., ,. r :_ .. 11 ....- .,.�,..
r.f.r ., :.
CITY OF TIGARD _ _
BUILDING DIVISION PERMIT #: ELC2008 -00460
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/8/2008
Phone: (503) 639 -4171 �c,�{ .�
Inspection Requests (24 Hrs.): (503) 639 -4175 ` __
INSPECTION WORKSHEET FOR DATE: 8/21/2008 TIME: 7 :02AM PAGE: 25
SITE ADDRESS: 10935 SW MEADOWBROOK DR 21 CLASS OF WORK:
SUBDIVISION: SUMMERFIELD BROOKSIDE CONDO LOT #: 021 TYPE OF USE:
PROJECT NAME: TAGUE
DESCRIPTION: Change panel, install ground rods
OWNER: TAGUE, DONALD DUANE + DOROTHY MA, PHONE #: 503.413 -9335
CONTRACTOR: WINNER ELECTRIC INC PHONE #: 503- 638 -5028
Inspection Request Scheduled For: Date: 8/21/2008 Pour Time:
Code # Inspection Description Confir * Contact # Message
199 Electrical final 074461-01\ 503 -638 -5028 Y
Corrections /Comments /Instructions: 3 3
Q o NO ANs c3 1.;12-NY-
Z ? (s(Zsz, .>Ot• � ekvaii
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � 1 v� v Date: dt' 1 ' Phone #: (503) 718- lifig