Permit 4:;;. ELECTRICAL PERMIT
,.%11. u ;, CITY OF TIGARD
:a ; COMMUNITY DEVELOPMENT Permit#: ELC2015-00885•
TIGARD 13125 SW Hall Blvd ,Tigard OR 97223 503 718 2439
Date Issued: 11/02/2015
Parcel: 2S110DD90312
Jurisdiction: Tigard
Site address: 10940 SW MEADOWBROOK DR 31
Project: Salzer Subdivision:SUMMERFIELD BROOKSIDE CONDO Lot: 31
Project Description: New service
Contractor. NORMANDIN ELECTRIC Owner: SALZER, RAMONA G
51086 NW CLAPSHAW HILL RD 10940 SW MEADOWBROOK DR#31
FOREST GROVE, OR 97116 TIGARD, OR 97224
PHONE 503-357-5380 PHONE
FAX 503-357-4878
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 11/02/2015 $100 70
Specifics: amps or less
1 ea 12%State Surcharge- 11/02/2015 $12 08
Type of Use: MF Electrical
Class of Work: ALT
Type of Const-
Occupancy Grp:
Total $112 78
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 160 days of issuance, or if work is suspended for more the 180
days NTION Ore." law requires you to follow the rules adopted by the Oregon Utility Notificat•- Center Those rules are set forth in OAR
952-0 1-0010 through OAR 952-.0 r r:0 .0 may obtain a copy of the rules or direct questions to OUNC .•calla • 1 -wik967 or 1 800 3 2 2344 _
Iss d By / JA i Permittee Signet. . �/ t' .ii 0 -l(L_� _
/ 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 1
SIGNATURE OF SUPR.ELEC' �% .I+`I°s�`�,r • - Date: 1� ///.�
LICENSE NO. c' S-43—
S
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 - ■ FOR OFFICE 1 S1;ONLY
Q
Received VEMI Permit if: 5(-(/80S
City of Tigard Date/B : a G��l
it 13125 SW Hall Blvd.;Tigard,OR 97223 Ian Review ,
` Phone: 503.718.2439 Fax: 503.598.1960 f r.n/B Related Permit 4-
` Inspection Line: 503.639.4175 co N4 Ready Date/By: Juns PI See Page 2 for
T1 GA It. TYPE- Notified/Method: Supplemental Information
Internet: www.tigard or.gov Q�cke
OF WORK .‘(-\\I ' ? PLAN REVIEW .
❑New construction ®Addition/alteration/replac�'t3fent c GP'[�°A, Please check all that apply(submit 2 sets of plans w/items checked)
,-/g G` 0°``''\S`O\`a ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: �`G �V where the available fault current ❑Marinas and boatyards.
CATEGORY OF_'CONSTRU w 4 t 11.. exceeds 10,000 amps at 150 volts or ❑Floating buildings.
2(1-and 2-family dwelling ❑Commercial/industria. • Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
/P74,0 / /rC OI e7 1- ❑Addition of ore motor load of system.
Job#: I Job site address:
[, 100HP or more ❑"A","E","1-2","1-3",
❑Six or more residential units guy`'
City/State/ZIP: i t et lf� (#-30) Dr ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bld /a t.#: I Project name: ❑Hazardous locations ❑Supply voltage for more than
$• p j 600 volts nominal
❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: •Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft or portion 33.92 1
AK) ' f DESCRIPTION OF WORK Limited energy,residential 75 00 2
4LiCt -
Limited ,m lt energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑' PERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: r!77# , ".lL 7 200 amps or less I 100.70 Mb.f 7,?
Address: 201 amps to 400 amps 133 56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps . 301.04 2
Phone:( ) Fax:( ) Over 1.000 amps or volts 552,26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT • I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension, ter panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 7 42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: - Reconnect only 67.84 2
CONTRACT I R Pump or irrigation circle 67.84 2
Business name:, i `.'ev? -,, ' Sign or outline lighting 67 84 2
,�'y / Signal circuit(s)or limited-energy ❑ Page 2 2
Address: (�12 �M 1 Ie ;,� panel,alteration,or extension.
City/State/ZIP:
Each additional inspection over allowable in any of the above
�J Jr J OA �! Additional inspection Q hr min) 66.25/hr
Phone:( - t� � J� Fax:( J l ./1S7r Investigation(1 hr min) 90.00/hr
Email:• r-�-- r , Industrial plant(1 hr min) 78.181 hr
/47 iy f ��t / y Inspections for which no fee is 90.00/hr
CCB Lie.: /O 0 U-I Electrical Lic ( ' Suprv.Lic.1 5 specifically listed(LA hr min)
ELECTRICAL PERMIT.FEES
Suprv.Electrician signature,required: Subtotal:
_ -_.y
ArW / ❑Plan Review Required(25%of permit fee):
Print name .` Date: _
�� �'�` State surcharge(12%of permit fee): _ 1Z. r4--
Authorised signature: TOTAL PERMIT FEE: 83 5-1,--
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit
I\Building\Permits\ELC PermitApp_ELR_ERE doc Rev 06/172015 4401615T(1 I/05/COM/WEB
ipl;,! .'• CITY OF TIGARD RECEIPT
' , tt 13125 SW Hall Blvd,Tigard OR 97223
µ 503 639 4171
TiGARD
Receipt Number: 400418 - 11/02/2015
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2015-00885 12%State Surcharge-Electrical 100-0000-24001 $12 08
ELC2015-00885 Services or Feeders-200 amps or less 220-0000-43103 $100 70
Total: $112.78
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 10488 DADAMSKI 11/02/2015 $112 78
Payor Normandin Electric Inc
Total Payments: $112 78
Balance Due: $0 00
Page 1 of 1
I
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10940 SW MEADOWBROOK DR 31, TIGARD,
OR, 97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00885
Jeff Grove
Violation Summary:
Inspector Contractor