Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00112
Date Issued: 02/25/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S110BA07500
Jurisdiction: Tigard
Site address: 14257 SW MCFARLAND BLVD
Project: CARSTENS Subdivision: SHADOW HILLS NO. 2 Lot: 60
Project Description: (3) branch circuits for office remodel.
Contractor: CLASSIC ELECTRIC LLC Owner: CARSTENS, HENRY A & LESLEY A
P.O. BOX 1335 12457 SW MCFARLAND BLVD
SHERWOOD, OR 97140 TIGARD, OR 97224
PHONE: 503 - 259 -0459 PHONE:
FAX: 503 - 345 -0912
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 02/25/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/25/2011 $8.52
Type of Use: SF Electrical
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 through52-001-0090. You • - • • - +• • p- t - rules • direct questions to OUNC by calling 5 2.1987 or 1.800.332.2344,,
Issued By: y�L 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' 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.
Feb 24 11 00:40p 503 - 345 -0912 p.1
Electrical Permit Application i i4,......� P . " t FOR 01111 I 1 SI. ()NI.)
City of Ti and Rceeived
111 r g FEB 2 5 2011 Ra : G> r�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503 DatelB : Other Permit
I 16 A K I) Inspection Line: 503.639.4175 Dare Ready/By 41 See Page 2 for
Internet: www.tigard or.gov Notified/Method: MI Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit sets of plans �vaitems checked below):
❑ New construction ® Addition /alteration/replacement
❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family 0 Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ". "1 -3 ",
Job no.: Job site address: 14257 SW McFarland Blvd 100HPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: Tigard, OR ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I ot• I Fe, 1 Total I • ,
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. N. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. 11.)
Limited energy, multi- family
Office remodel residential (with above sq - ft.) 75'00
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 1 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) F ax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, 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: Date: A. Fee for branch circuits with
® APPLICANT I ® CONTACT PERSON above service or feeder fee, 7 40 2
each branch circuit
Business name: Classic Electric, LLC 8. Fee for branch circuits without
service or feeder fee, first 1 56. l8 56.18 2
Contact name: Thomas Adams branch circuit
Each add'l branch circuit 2 7.42 14.84 2
Address: PO Box 1335 Miscellaneous (service or feeder not included)
City/State/ZIP: Sherwood, OR 97140 Each manufactured or modular 67.84 2
dwelling, service and /or feeder
Phone: (503) 259 -0459 I Fax: : (503) 345-0912 Reconnect only 67.84 2
E- mail: (homers @classicelectrienw,com
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR
Signal circuits) or limited- energy
Business name: Classic Electric, LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: PO Box 1335 Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: Sherwood, OR 97140 Investigation (1 hr min) 66.25/ 25/ hr '
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 259 - 0459 Fax: (503) 345 - 0912 Inspections for which no fee is 90 00/ hr
t specifically listed (.: hr min)
CCB Lic.: 181851 51/04 Electrical Lic.:AC414 /� l Suprv. Lie.: 53395 14i/)3 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: /to,„.., i tin /// Subtotal: 7l 02
id et,-- review (25% of permit fee): -
Print name: Thomas G. Adamy Date: 2/24/11 State surcharge (12% of permit fee): 8.52
Authorized signahire: " /- / Iw TOTAL PERMIT FEE: 79.54
�! /�� This permit application expires if a permit is not obtained within 180
Print name: Thomas G. Afdams I Date: 2/24/11 days after it has been accepted as complete.
e Number of inspections allowed per permit.
1 : 1 auIdingtPermro1El.C- Per,mtApp.doe 07/01/10 44a- 4615T(t I /05 /COM/WEa