Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2021 00330
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/17/2021
T f i;A R.O g Parcel: 1S133DC14100
Jurisdiction: Tigard
Site address: 13134 SW SHORE DR
Project: Wachsmuch Subdivision: ARI GREEN Lot: 32
Project Description: Installing new electrical outlet boxes for kitchen remodel
Contractor: OWNER Owner: WACHSMUTH,ANDREW J&
ANNE-MARIE
13134 SW SHORE DR
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo/Purchase 06/16/2021 $100.70
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/16/2021 $12.08
Type of Use: SF 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 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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Holly Va flt/(De4 We fe Permittee Signature: O vvApplUcati,an
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.
r oil`.lid h frM/tEJ F-5/27/2
Elec i Permit Ap plication A 720
1.' W ' )1 1'1. , 1 ,1 1 Ai
Ci131ty Sw Tigardll M
Tigard,OR 972a�ITY OF TIGARD d // '�01/ limit#:fit Cz1�2/-t,?�33d
Plan Review Rem Permit#:
Phone: 503.7182439 Faoc 503.598DING DIVISION` Date/By: re ®tleer+sezear
Inspection line: 503.639.4175 Ready Date/By:
Internet www.tigerd-or.gav Notified/Method: I Supplemental Information
t`t ;. .ee.','�-tii/r4 'Mail . ', a• ,r.r,a,t'', .,.,«a.,'`.'a`'et i1;, ,,,r..a_'.,vtiM. ; ..o NSm -rrI: MS2L.,,,w...:.. .... : t 4;,::
❑New construction n 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 0 Other: where the available fault current 0 Marinas and boatyards.
;Att'�K�(( rt 404 ' exceeds 10,000 amps at 150 volts or ❑Floating buildings.
i 1 1-and 2-family dwelling 0 Comnlercialindushial 0 Accessory building rose to g<on a<exceeds 14,000 ❑Commercial-use agricultural
❑Multi-family 0 Master builder 0 Other amps for all other installations. buildings.
❑Fire pump. 0 Installation of 150 KVA or
+ f rtt}` 1-I -j ,,• .: '''°'I"'! : Emergency system larger separately derived
o Job#: Job site address: (d(S ei b r)VC. ❑ or .Addition of new motor bad of
13134 S ❑" ,"1-2","1-3",
C /state/zip: -r „i q ^ ❑Sue or more residential units. o�uPancy
❑
m' I g „it 1 °f� ❑Healthcare facilities. Recreational vehicle parks
Suite/bldg./apt.#: I Project name: ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volt nominal.
Cross street/directions to job site: , ..
laaaeaMWa me. Sack Toot
New resideagIai tingle-or tsdtt-faetily dwelling udt.
Subdivision: 1 Lot#: Includes attached
Tax map/parcel#: 1,000 sq.It or lees 168.54 4
,� { ,#�v; ;,wax r* *'*,� Fi add'1500 sq.8.or portion 3392 1
1 s �w 0g1 4,g4+ c. c a.:11r-.' 'hu Limited energy,residential
INS\ -\ \t� ,_ (with above sq.R) 75.00 2
�0. '(V��N/ -Q�c { (/� O #o�(QSLimited energy,multi-family
l. . 1 C '(\ `C Q-"M!D 6-Qk residential(with above aq.IL) 75.00 2
. .i Renewable Enemy Cl See Page 2
e'V� ..r 1 t. C•: a•;,..,. ,.. `4:. Service or feeders installation,alter,wadlor relocation
Name: A , Y e W k A f\1(\Q—flA a f t Q.. a C S'(V\ a 200 amps or leas 100.70 2
Address: 1313\- S W 5\Cif \)Y\\J 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 1 , (rd / U ck\aa'') 601 amps to 1,000 amps 301.04 2
Phone:(51) ) 21 1 010 1 Fax:( ) Over 1,000 amps or volts _ _ 552.26 2
Temporary services or feeders installation,alteration,arwUor
Email: 0. c e\1-1 0.44 _ 0\h+nQrnai ie-� J v10A\40.C OYV-N .ration
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 1
intended for sale,l - t' o r' _'e,according to ORS 447,449,670,and 701- 201 amps to 400 amps 125.08 2
Owner signatur ] Sl2 401 mmpa to 599 amps �b�.��.,,,, extension,per
2
.}ig s'rt ors+, ^; r * l.S. .r Branch circuits—new,alteration,or extension, panel
A Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch arenits without �r
Address: sbranah mraa feeder fee,Sntt ' 56.18 S7•i 0 2
it
City/State/ZIP: Each add'l branch circuit 6 7.42 'I l.S 2i 2
Miscellaneous(service or feeder not included)
Phone:( ) 1 Fax: :( ) Each manufactured or modular
dwelling,service and/or,feeder 67.84 2
Finail Reconnect only67.84 2
w " hiL , FXjt 4fi r rktwsiii avm „ . a Pomp ar irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal arroutt(s)or o limited rgy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Eachadditional inspection over allowable in any of the above
Additional inspection(1 br min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
F.tnail: Indianolaplant(1 hr min) 78.18/br
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Supv.Lic.: hated Limn
k ;;° >*,.x -", '. `C - • •, }rt , ` , 3
Suprv.Electriciansignature,required: Subtotal: /
00,-7 i
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE
Authorized signature:
Property Owner Statement RECEIVED
Regarding Construction Responsibilities i t 7 202
Oregon Law requires residential construction permit applicants who are not licensed with ttrTY OF TIGARD
Construction Contractors Board to sign the following statement before a building permit ciiv)IING DIVISION
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I _ I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Andrew Wachsmuth
Print Name of Permit Applicant
May 27,2021
Signatu f Permit Applicant Date
Permit#:
Address: i%
rtu�rrrE
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Issued by: Date: E4
This Copy for Permit Offices