Permit rt CITY OF TIGARD ELECTRICAL PERMIT
S COMMUNITY DEVELOPMENT Permit #: ELC2013 -00396
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/16/2013
Parcel: 2S 110DD90082
Jurisdiction: Tigard
Site address: 10970 SW MEADOWBROOK DR 8
Project: DeRose Subdivision: SUMMERFIELD BROOKSIDE CONDO Lot: 8
Project Description: 200 amp service and (1) branch circuit
Contractor: PACIFIC NORTHWEST ELECTRIC INC Owner: DEROSE, DEREK
PO BOX 310 245 SW 143RD AVE
OREGON CITY, OR 97045 BEAVERTON, OR 97006
PHONE: 503-657-1188 PHONE: 760- 518 -0086
FAX: 503 - 722 -9058
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/16/2013 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 07/16/2013 $7.42
Type of Use: SF Service or Feeder
Class of Work: NEW 1 ea 12% State Surcharge - 07/16/2013 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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. ATTENT • . e -gon law requires you to follow the rules adopted by the Oregon Utility Notific Center. Those rules are set forth in OAR
952- 001 -001+ rough OA : +090. You may obtain a copy of the rules or direct questions to OUNC by .i.e .1987 or 1.800.332.2344.
Issued By: 111 " Permittee Signat . M—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' 41111111b, , , Ir renrir • Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Electrical Permit Application RECEIVE ; • •
II a t eiv l f ( ( 3 ELCao / 3— ,..)63 City of Tigard T e c6, y Permit t lo.
a 13125 SW Hall 131vd.. Tigard, OR 97223 JUL 1 1 2013 Plan Review
C i Other Permit:
P hone: 503.718.2439 Fax: 503.598.1960 �Datal�3v. _
' Inspection Line: 503.639.4175 ( (�� Date Ready/By: Jun, l See Page 2 for
: t EZ _ 1 g g CITY TIGA IDI -- g
Internet: vwvw.ti itrd - or. ov totified74ethod: supplemental Information
Wt� tJ.
❑ New construction L Addit ion /alteration/replacement Please cheek all that apply (submit 2 sets of plans tot /items checked below):
❑ Senva: or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault cu -lust ❑ Marinas and boatyards.
CATEGORY: OF CO5 STRLi(:TIOP4 ' " - , - - - - exceeds 10,000 amps at 150 volts or ❑ Floating buildings
' - - = ---- -= less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
0 1 r�oad 2- family dwelling ❑ Couuitercial/nldtlslrial ❑ Accessory building amps for all other installations. buildings.
(i'1Ciulti- family Q Master builder ❑ Other: , ❑ Fire pump ❑ Installation of 150 KVA or
- - ❑ Emergency system larger separately derived system.
. . 7033• SE L, 1asFO1MA 'IlO)4,AND,EOC:A'PIO\';' 0 Adeb ton of 'sew motor loud of
l . - 100H1 or more. occupancy.
lob no,: Job site address: �i \ 1 (001 y
L _ J T.f 0 �� �� 1 vu�l�l �l ��1G i ❑ Sig or more residential unit. ❑ Recreational vehicle puts.
City/State/ZIP: IP: ClVc1 O . 91 L. i ,• ❑Idealth -care facilittes. ❑ Supply voltage for more than
_._. 0 Hazardous locations. 600 volts nominal.
Sulte/bld.g. /apt, ilo.: 1 Project name: ❑ Service or feeder 600 rungs or more. •
Cross street/directions to job site: �_.._._._..._. -.. -. _.- _.........__... �_.._ Z L: r esldcntial single- p �nult r r I y dwelling emit. -.
' Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or leas 168.54 4
Tax map/parcel 110. — Ea. add'I 501) sq. ft. or portion 33.92 1
T,imitcd energy, residential
. DESCRIPTION,.OT: ;WORK - - - ,, . ' - (with abovesq. ft.) I 75.00 2 i
(� �, - Limited energy, multi- family
�t) C,yi l l
� g,y — I i L,l i' lif1/4 V , {' ,1 T i t - ],� residential (with above sq. ft.) 75.00 2
" l ' ` _L ! !" j . Reite vable Energy . - : ' - , 0 See Page 2 •
C,� U r `C 'v\ l f � t P
t V) Services or feeders installation, alteration, and/or relocation
- (3-7ROP.1s1LL1' .O%\'NER ' ' 200 amps or km I 100.70 lbogG 2
0 TF *PA —
Gk• ' 1 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 20034 2
. Address: 1 09 1 C b\.0 ALL, c_ DC 601 amps to 1,000 amps - 301.04 2
Over 1,000 amps or volts 552.26 I 2
C ity � 1Stat '
J t / VI T Temporary services or feeders installation, alteration, and /or
Phone: ( 110 5 1Q[. -O Fax: ( ) relocation _J
Q 200 amps or Icss 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps F'5.08 2
intended for sale, lease, ant, or exchange, according to ORS 447, 449, 670, and 701. - - -- —
401 amps to 599 saps 168.54 2
Owner signature: Date. Branch circuits - new, alteration, or extens'on, per panel
A. Fea, for branch circuits with
�4P]'hTCA�� T - 0 CD`Tii{- PLON above service or feeder fee. 'r 7.42 2
Business name: _, CA i : ei At r. _ each branch circuit , 2
B. Fee lax branch circuits without
Contact name: .service or feeder fee, first
-- - branch circuit 56.13 2
Address. y . :. o_ Each add'l branch circuit - 7 7.42 2
1. /� _ ,�... _
City /State/ZlI . Q rem r GI- 0 `' 1 'Miscellaneous (service or modular
ce or feeder not included)
(,
Each manufactured or I
I �p dwelling, service and /or feeder 6784 2
Phone: �)(,Q.S �' 11( ( Fax: : � G .3 )12� —(1a e - - --
Reconnect only 67.84 2
1- matt: `1 ` ', 1 v 1
• ' • Pum or irri _ation circle 67.84 - 2
CONTRA TOA
Sign or outline lighting ____ 2
13usiness name. i - �� CAT) ) t- N c ' 1 t F}-- - r+, Shoran circuit(s) or limited- energy -.�_~ See -- ----- -- - -___.
v' 11 \ p at l I t panel, alteration, or extension. Page 2 2
Address: _ 1 Each additional inspection over allowable in any of the above
City/State/ZIP: r ih^{ (( ( Additional inspection (lbrmin) 66.25 / hr
s�•� y I \ �� ] ` I V I 6� L lnvestigation (1 hr min) 66.25/ hr
Phone: ( ) Fax: ( ) I Industrial plant (I hr min) 78.18 / hr
t(.9 rinsptxtions for which no fee is 90 00,' hr
LCCB Lie.: Electrical Li '.} J Suprv. Lic.: g I specifically listed (V! hr min)
Suprv. Elcchic si g n at u re, required: / o i l ,: - ...-
1�T_ t 7 r i r / o// // t.: EL EC°1 RICAL,1' RNIIT FEES... -
JR / t~ r Subtotal: ILYz( /Z
} Plan re 25 °ro o f omit f cc >
I
I Print smog: _)C� h x � — ate I ( permit — - ; State surcharge (12% of permit 12. g"f
Authorized signature: 17 TOTAL PERMIT FEE: I I • 1
y Th permit appli cation expires ira p is not obtai within 180
days after it has been accepted as complete.
Print name: ( /
�')G 1 �� /, ' {, �2 Dater % I / /�
CC vt " Number of inspections allowed per pcm!it
1:\ Building' PennirsttLC _Pemtit-\pp_ELR_ItR.E.doc Rev 05/2112013 •140 -4615T(11 /05/COM,W1i0
zoJ,u.,, ,j uuor :UOJ QSOBZZLEOS L (1V.1O) Z£:6£ L L L LOZ £ ao 3 a Sad .01
To: Page 1 of 3 20'13 -07 -11 10:39:32 (OMT) 15037229059 From: John R®mlrez
FAX COVER SHEET
TO
COMPANY
FAX NUMBER 15035981960
FROM John Ramirez
DATE 2013 -07 -11 16:39:16 GMT
RE UNKNOWN
COVER MESSAGE
Electrical permit application and credit card payment
WWW.MYFAX.COM
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10970 SW MEADOWBROOK DR 8, TIGARD, 2013 -11 -26 (null)
OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2013 - 00396
Inspection Type: Result:
199 Electrical final PASS - No C of 0
Comments:
Violation Summary:
Inspector Contractor