Permit CITY OF TIGARD ELECTRICAL PERMIT
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11111 C : • COMMUNITY DEVELOPMENT Permit #: ELC2009 -00492
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/22/2009
Parcel: 2S110DD90401
Jurisdiction: Tigard
Site address: 10895 SW MEADOWBROOK DR 40
Subdivision: Lot: 0
Project: Kadel
Project Description: Residential panel replacement.
Owner: FEES
KADEL, PATRICIA H Quantity Description Date - Amount
2809 NE 80TH ST
VANCOUVER, WA 98665 15 crt Branch Circuits 09/22/2009 $139.95
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/22/2009 $16.79
Electrical
Contractor:
ROSENDIN ELECTRIC INC
2925 NW ALOCLEK DR #170
HILLSBORO, OR 97124
PHONE: 503 - 615 -8189
FAX: 503- 615 -0689 .
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Type of Use: SFA
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $156.74
Required Items and Reports (Conditions)
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This permit is ' ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance with roved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
ipt
days. TENTION: Oregon law' .requires you , • folio the rules adopted by the Oregon Utility Notificatio enter. Those rules are set forth in OAR
952 -0 1 -0010 through OAR 952 -00 -0160. You b a p of the rules or direct questions to OUNC by calling . • .246.6699 or 1.800.332.23444.
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Issu d By: �� /_ .Y. � / /., ...4 /. Permittee Signal L
OWNER INSTALLATION ONLY
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The installation is being made on property I own which is not intended for sale, lease or rent.
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OWNER'S SIGNATURE Date:
CONTRACTOR INST • LLATION ONLY
SIGNATURE OF SUPR. ELEC' .4I / ;; _i......,/ _ ' 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.
:Iectrical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: ; 2 0 9 0 / Permit No.:eze, 9,R
III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TI G A It D Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ 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
® I- 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 o of new new motor load of ❑ "A ", "E E"", , " "1I -2 "", , "1-3",
Job no.: 3 5 Job site address: 10895 SW Meadowbrook Dr #40 Six or more re rest occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 40 Project name: Kadel Panel Replacement ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
panel replacement Limited energy, multi -family
residential 75.00 2
p p residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Patty Kadel 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: same as jobsite Over 1,000 amps or volts 454.65 2
City/State /ZIP: 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 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
® APPLICANT 0 CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Rosendin Electric, Inc. B. Fee for branch circuits
Contact name: Steve Hogberg without service or feeder fee, 1 46.85 46.85 2
g g first branch circuit
Address: 2925 NW Aloclek Dr #170 Each add'I branch circuit 14 6.65 93.10 _ 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Hillsboro, Or 97124 Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (503) 615 8189 Fax: : (503) 615 0689 Reconnect only 66.85 2
E -mail: shogberg @rosendin.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: same as applicant Signal circuit(s) or limited -
pp energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: 103939 Electr' al Lie.: 37 -692C Suprv. Lie.: 3991S Industrial plant per hour 73.75 _
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'= ELECTRICAL PERMIT FEES
Suprv. Electrician signature, requires lb Subtotal: 139.95
Print name: Stephen Lawhead Date: 9/21/09 Plan review (25 % of permit fee):
State surcharge (12% of permit fee): 16.79
Authorized signature: TOTAL PERMIT FEE: 156.74
This permit application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440 -4615T(I I /O5 /COM/WEB