Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
Permit#: ELC2020-00636
T[GARL) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/17/2020
Parcel: 2S104CD01600
Jurisdiction: Tigard
Site address: 13995 SW MISTLETOE DR
Project: Schmidt Subdivision: HILLSHIRE ESTATES Lot: 16
Project Description: (10)branch circuits for kitchen and powder bathroom remodel.
Contractor: BUCKAROO ELECTRIC Owner: SCHMIDT,TIMOTHY&KAREN
31601 S WRIGHT RD 203 S POPLAR AVE
MOLALLA, OR 97038 BREA, CA 92821
PHONE:
PHONE: 503-880-6326
FAX: 503-829-5207
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo/Purchase 12/17/2020 $122.96
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/17/2020 $14.76
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-00:1 You,u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � •vr1. (,),_--_ Permittee Signature: 714/ VI"--/ e.- OA)
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' 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 RECEI\'ED FOR OFFICE USE ONLY
Receivtd I
City of Tigard Date/By:
i/n f 20 '00 t#E t-G 20 Zt7-00 4,3(40
IIIU 13125 SW Hall Blvd,Tigard,OR 97223 DEC 2020
Plan Review Related Permit#:
s Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
f
TIGARU TYPE OF WORK '�qRr7 ReNoadyDvietho IZ/' V 71 Tans' I ® See Page l Inc
.:., Internet: www.ti and-or. ov � �CITY OF . , NotiFedlMathod: � �v Supplemental Information
Inspection Line: 503.639.4175
'>� g g T,U.SI�N
0141 L- !c4-2C-iJ PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION ..... exceeds 10,000 amps at 150 volts or 0 Floating buildings.
-0-4-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
,yt 0 Addition of new motor load of system
/
Job#: I Job site address: ., 4,,in t. //,.,/ ( ..f')( 1oo14,or more. ❑•A,• ,•E•• •'I_2,•,"1_a,•
City/State/ZIP: { ' / 11 0 Six or more residential units. occupancy.
f )c/�. L� '/) {/ l ,�� :,7 ❑Health-care facilities. ❑Recreational vehicle parks.
Strite/bldg./apt.#: ` Project nam/ems 0 Hazardous locations. 0 Supply voltage for more than
/t ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: f l; I I Pt 11 t- j'`5 1- FEE SCRk IULE
Description I Qtr. I Each I Total I •
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'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75_00 2
<1 c 1 i / (with above sq.ft.)
Ire it)f.-Ln.{ Limited energy,multi-family
residential(with above sq.ft.) 75:00 2
0 PROPERTY OWNER 0 TENANT Renewable Energy ❑ See Page 2
,f Services or feeders installation,alteration,and/or relocation
Name: S C.,)4.M} 1 b T Ti I"1 c 1 `r kal-dZ 200 amps or less 100.70 2
1 201 amps to 400 amps 133.56 2
Address: 2-0 3 S P e P 1-sq44- er 0F�
401 amps to 600 amps 200.34 2
City/State/ZIP: 17� - --, C 4-' q',-7-/ 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
0 APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per 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 blanch circuits without
service or feeder fee,first. 56IS ( � i 2
Address: branch circuit t
City/State/ZIP: Each add'l branch circuit '1 7.42 (r` s .7i 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation cycle 67.84 2
Business name ,reel Fit.• ,/ /�_.,�.(,..- • Sign or outline lighting 67.84 2
$ �+ Signal circuits)or limited-energy ❑ See Page 2 2
Address: .'!�,4'I J 1 /f p /t 41 panel,alteration,or extension.
Ci /State/ZIP: / `' t 7�y -� gi
• Each additional Inspection over allowable in any of the above
�' J1`/, l�el, C� ` Additional inspection(1 hr min) 66.25/hr
Phone:( g e3t go- .2)26 Fax:( ) Investigation(1 hrmin) 90.00/lir
/ / . Industrial plant(1 brmin) 7&18/hr
Email:/1//G ist I eo e /et: p i c., ( q 7k lc.#,l. c emA Inspections for which no fee is 90.01U hr
CCB Lie.: cif `-'; Electrical Lie.: 2)t '/ / ' Su rv.Lie.: t .---e ' specifically listed('h hr min)
�,. 7 L y �; �'/ p /, ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _ >.� / _ __ Subtotal: 1,2;;I.,I C
Print name:L p 76 / �f1&( f,941 Date:4,2,-/6 -, ;?J,. :1 0 Plan Review Required(25%of permit fee): (•(.71,;
f° State surcharge(12/a of permit fee):
Authorized signature: TOTAL PERMIT FEE: ,i 't ? }
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. q 7
l:lBaildiosTerounsiELC_PennitApp_ELR_ERE.doc Rev 06/17/2015 440-46157(11/05/COMIWEB