Permit - .. ELECTRICAL PERMIT
N . ti OF TIGARD
PERMIT #: ELC2007 -00034
COMMUNITY DEVELOPMENT DATE ISSUED: 1/16/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 AB -03100
SITE ADDRESS: 14135 SW 93RD AVE ZONING: R -4.5
SUBDIVISION: ELROSE TERRACE LOT : 027 JURISDICTION: TIG
Project Description: (2) branch circuits for bath remodel. Job No. E -975
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
CHARLES SCHWARZ S &A ELECTRIC, INC.
14135 SW 93RD AVE PO BOX 218
TIGARD, OR 97223 BORING, OR 97009
Phone: Contact #: PRI 503 -658 -5368
FAX 503 - 658 -7257
FEES
Description Date Amount Reg #: ELE 3 -520C
[ELPRMT] ELC Permit 1/16/2007 $53.50 LIC 148014
[TAX] 8% State Surcharge 1/16/2007 $4.28 SUP 4833S
Total $57.78 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those rules -are` s t- orth in AR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246(699 or 1.80 2 4 '
C
, .tiL4r P ermittee Si na ture: ~ l
/
Issued g t_. L" o ' / 64_ (V- -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
, �
SIGNATURE OF SUPR. ELEC'N: , - i yig , -re "'" DATE:
LICENSE NO:
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.
I - -Electrical Permit Application
l't k oFric UNE•ONLY
City of Tigard Received
eceiv
13125 SW Hall Blvd„ Tigard, OR 97 El%1Filk Re ✓ : % /� .U7 • s� Permit No.. i,�e s7.r676o3
!'hone: 503.639.4171 Fax; 503.$98.19 Q , a u - Plan Review
} Inspection Line; 503,639.417,5 6 i n {` DafdBv: other Permit:
In sp Inspection
ww ne; 503,639.41 �t ...7.!,!,11- �•• Dutc Aar B j _••_
JA 1 i 20 1 Noiiii ,vMct h Qd; it H See Peat 2 for
t Supplemental
t
ln
0-:r..: >' ?z' 3t.� � y Al t i lisv ' FCyw' y; " u:
- ^- �'- ��'�k:5z1$<rh:' n.in: r .l,.,. y . � 5 ��� Iii'_ le ,�� s , , :o,....
❑ New COnstruCEion ... , §. 0-r n r r i .. � ; > ^'•+ _ r�. ��a:., ��rw?..
:i.at��ri¢t`';A _ _
.,. REVIEW.,..,,;
�4S,c dt ion /at 'nt;s[[ t`p a( t Please check all that apply:
y dW9IIIR
D Demolition
that .., . ; `' µ : i ��= �r�1«��� ❑Service over 225 ninon, comm'I i❑Nazardous location
;,;. a s t .:y� ❑Service over 320 am
' ;t D iv irk A> i'li,(:A ' cSO t" " V911. *.10 Vl i`..,' r;� fi ':I; ; '�-�r;tji':k y i':�7.,�;,, g $A. t, amps - rating ❑�lUlldn *over 10
t. .. � t" �R.".... �T 1, F. Ni, �' JkA,..' ti�5,: r' Y, r�4`'::+ e) t, i ,)' Of 1 -Ar1(I Z- l� 4 V i[IUTC nCW re��' QO n[lgl�
_ IT 1- and 2- fancily dwelling ❑ C%ommereial/industrial
[] Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - fancily • ❑ Master builder
['Building over three (] Other: S stories ❑Feeders, 400 amps or more
, ....... ........ OEAT7UN over
;:.1<OB `$ T) fE';,11yF¢)1tJ�j(Q�y;A1U ;;`s`'; c:: ` i';ht ['Occupant load 99 persons ❑Manufaclurcd structures or
no.: E 9�� I °, „. . ;';i .'� "s:`; ❑Irg plain RV park
Job site address; ly ( S� 9 3 r • ❑Health -care facility ❑other: _
Submit 2 sets of plans with any of the above,
City/State/ZIP: � _
Suite/bld The above arc not applicable to tam
$- /apt. no.; p P or
my sense uctiun service.
ro cct name: l i2Z "F°•;; :FETE ..SCgED
Cross street/directions to
job - — _ Dreriptioe Qo,I Mn- Total ]ob Site: New residential single- or multi- family dwelling unit
Includes attached garage,
Subdivision: 1,000 sq. ft. or less 145.15 q
Lot no.: • Ea. add'I 500 sq, ft. or portion 33.40 I
Tax map/parcel no -. -
Limited energy, residential
75.00 2
-
DE3CR1PTi0 O ; ,; , ;,,,::• Limited energy, non - residents
N' 1 *64i0 :• .;,.:,',�: 0-J 75.00 � V Each manufactured or modular
� ��� r ,� �T 1--- dwcllin , service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less . ; 0. PROPER ,t�z,�; ' � i ;,+ h t $0,30 2
. W WNE 'q.W�')k : ::, 9,0. . t ;'4t1"1tat :' �1�c.�i 01
n �. h },: i.. .. _.i. -M •�..:n�r. �',� 5"h� ::Y,ii: :y. <:+: 2 amps to 400 amis
,. ,••••::!:::
,
ccc^^^"��� !` 106,85 Z
Name: \ \fit t�� 401 amps to 600 amps 160,60 2
X 601 amps to 1,000 amps 240 60 2
Address; _ Over 1,000 amps or volts 454,65
z �
CilylStatc/G1P: Reconnect only 66.85 2
Phone: ( Temporary services or feeders installation, alteration, and/or
Fax; ( ) rclocatton
Owner installan: ti o . ibis installation is being ro
p p e
eing made on Z00 amps or loss ti6 8S 1
intended for sale, lease, rent, or exchange, property that I own which is not 201 amps to 400 amps
, ac cording to ORS 447, 449, 670, and 701. 100.30 2
Owner signature; 401 amps to 600 amps 133.75 2
Date:
B
APPL.><C " "i :` <.1 .»t, ranca cir cuits — new, alter a tion n
AN1'. r ,,; or extension per panel
ta r? r,yi +:; {q S❑i °CONTACT PERSON'S;;, ;?tart`.;; A. Fee for branch circuits with + P P
Business name: • ..
-. service or feeder fee, each
branch circuit 6.65
Contact [liuue: — " "'- B. Fee for branch circuits
Address:
without service or feeder fcc,
first branch circuit 46.85 � z
Ci ty /StzteJZ1P . Each add'I hrenrh circuit 1 G.GS I I p � • Ikliscellancous (,service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle
53.40 2
E-mail:
Sign or outline lighting 53,40 2
> i " ; ' „ 'CONT1tAG'aR K, . �s ' r •t ; ;'I Signal eircuit(s) or limited- - •
. ;• O .4 >°w, ,. ¢� . 4 ..t i :,... Y'(
� :i ;� energy p I
Business ramie: ' -' - `'' :” .�, %.' panel, alteration, n, Of
ne ' h.._ • y extension. Describe:
Page 2 2
Address: rib ' ` • - 2 • Ea additional inspection over allowable in any of the above
City /Statc/21.P Per inspection 62,50 ���
I :,rr 5
1'hP : r F 2_200 investigation per hour (t hr min) 62,50
iO .
P ) / 25-7 _Industrial plant per hour 73.75
CCB Lic.: ! El Lic,; ^ >i , >`l,'t .':::
4 S�o� Suprv. Lic.: ,EI EGTItYCAL PERMIT FEES*
Electrician signature, r subwtal 53 S � j
Suprv.
equircd�
�-- ��f.. _ Plan review (25% of permit fee)
Print name: State surcharge (s% of permit
it fee)
�, ► Dart : / S
day, o
Authorized sigma n TOTAL PERMIT FEE '�
nth permtt,tpplication e:plre pe ro[it is not obtained within 1Rtc
Print name: ) G c H 1 , � ffer it has been accepted es complete
•` �� CH. N' ft�� r ��`� ' Hoe methodology act by Tn- counIy ulniciing Industry Service Board
iAkii kliap ycrmitAtiLGPMnitapp.do } 2/03
•• Number of inspections r permit
440-4615TO ao2�coirvwEB
pc p snit allowed.
T °I eSE :ZT LO 9T uer