Permit ELECTRICAL PERMIT
CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00676
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/29/2009
Parcel: 1S134BD02000
Jurisdiction: Tigard
Site address: 11795 SW SCHOLLWOOD CT
Subdivision: ENGLEWOOD NO. 2 Lot: 108
Project: Brown
Project Description: Add /alter (3) branch circuits for kitchen remodel.
Owner: FEES
BROWN, KEN & JODY Quantity Description Date Amount
11795 SW SCHOLLWOOD CT
TIGARD, OR 97223 3 crt Branch Circuits 12/29/2009 $71.02
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 12/29/2009 $8.52
Electrical
Contractor:
PARKIN ELECTRIC INC
14001 FIR STREET
OREGON CITY, OR 97045
PHONE: 503 - 657 -4958
FAX: 503- 557 -1059
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ` V t X c .... A A}f Permittee Signature:
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' Q ^ ^ � ��1,✓'1 Date:
LICENSE NO. �'xY APP
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.
12/29/2009 TUE 11: 30 FAX RECEIVED X002/002
Electrical Permit Application DEC 2 9 200' • FOR OFFICE USE ONLY
City of Tigard m Pcnnit No.: '(
13125 SW Hall Blvd.. Ti trd, OR 97223 CITY OF TIG ` ' ! > ° 61., O
Er
g' Pla t Rcriccv _ ^-�� 'c o� ;
Phone: 503.639.4171 Fax: So3.59a.19 DIVISI c /I3Y: Other Permit. p TG
TIGARD hupcction Line: 503.639.4175 Dale Ready/Ilyi r, ia' El Sec Page 2 for
Internet: w■w.tigard or.gov Notified /Method: C 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 fcedcr 400 amps or more ❑ Building over thtec stories.
❑ Demolition ❑ Other: where the available fault currem ❑ Marinas and boatyards.
CA'T'EGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Cou - use agricultural
® 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other insiallatio,s. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Addition o system. target separately derived systcn,.
El Aion o(ncw motor loot! of ❑ "A' "L" "I 2" "! 1"
Job no.: 09-23687 Job site address: 11795 SW Schollwood Ct 10011P ° 7n0ia occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /Stale /ZIP: Tigard, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts :nominal.
Suite /bldg. /apt. no.: , Project name: Ken Brown ❑ service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qtr'. 1 Inc. 1 'Ibtrd
New residential single- or mutti•fantily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. 0. or less 168.54 4
Tax map /parcel no.: Ea. add'] 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
3 Cks for Kitchen Remodel Limited energy, multi - family 67.84 2
residential (with abort sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER , • • ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Ken Brown 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 11795 SW Scliollwood Ct Over 1,000 amps or volts 552.26 2
City /Slate /ZIP: Tigard Temporary services or feeders installation, alteration, and/or
relocation
Phone: (971)219 - 6601 Fax: ( ) 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 125.08 2
intended for sale, Icasc, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Dale:
A. Pee for branch circuits with
❑ APPLICANT - ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits —
�__..._ without scrvicc or feeder fcc, I 56.18 56.18 2
Contact name: first branch circuit
Address: Each add'I branch circuit 2 7.42 14.84 2
— Miscellaneous (service or feeder not included)
City /State /Z1P: Each manufactured or modular 67.84 2
dwelling, service and /or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E -mail: Pump or in•igation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
1usiness name: Parkin Electric, Inc. Signal circuit(s) or limited-
energy panel, alteration, or
Address: 14001 Fir Street extension. Describe: Page 2 2
•
City /Stale /ZIP: Oregon City, OR 97045 Each additional inspection over allowable in any of the above
— — — Per inspection 66.25
Phone: (503) 657 -4958 Fax: (503) 557 -1059 Investigation per hour (1 hr min) 66.25
CC:B Lic.: 35151 Electrical Lic.• 4 -4 , Suprv. Lic.: 4241 -S Industrial plant per hour 78.18
ELECTRICAL PERIvII'I' FEES
Suprv. Electrician signature, required: '' i -- Subtotal: 71.02
•
I r Print name: David B Parkin Date: 1�� Plan review (2596 of permit fee):
State surcharge (12% of permit fee): 8.53
-_
Authorized signature: TOTAL PERMI'I'FEE: f,Yt
This permit application expires if a permit is not obtained within 180
Print triune: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit. 79.01-
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