Permit 71 ,� CITY OF TIGARD ELECTRICAL PERMIT
2,: COMMUNITY DEVELOPMENT Permit #: ELC2011 -00443
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/04/2011
Parcel: 2S109ACO2400
Jurisdiction: Tigard
Site address: 13125 SW BULL MOUNTAIN RD
Project: Knudeson Subdivision: Lot:
Project Description: (2) branch circuits for bathroom remodel.
Contractor: CLASSIC ELECTRIC LLC Owner: KNUDESON, KIM & REBECCA
P.O. BOX 1335 13125 SW BULL MOUNTAIN RD
SHERWOOD, OR 97140 TIGARD, OR 97224
PHONE: 503 - 259 -0459 PHONE:
FAX: 503 - 345 -0912
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 08/04/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/04/2011 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTEN . •re.:• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 r through OAR 95 r' / 591 You may obtain a copy of the rules or direct questions to OUNC by calling • r3.232T1 ° :7 or 1.800.332. 344.
Issued c : / / / Permittee Signat 4 . ,4%1
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' ft � Date:
el ff. ith LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
AUG. 4.2011 9:38AM N0. 3490 P. 1
Electi i rermit Application q A' E .FOR x
City ¢ ° n u� Eicw ig� - , r ' SW Hall Blvd., Tigard, OR 7 2 � fi %\ •
II '' •. Phone: 503,718.2439 Fax: 03s59$ -1960 L Date/By: Other Permit:
Inspection Linc: 503,639.4175 ` t SS ' Date Ready/By: AIME tot See Page 2 tar
f1Cr1L►t l) p �' Noti to M h o ,
Supplemental tnfcrmatien
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. ..,.. ............... „ „ .�� ....,.,.,� ... i ? °ii'iii;:'i:i;•i�ii'i��' „� amps or ...:..:.,,.,.: :::,:�::,:,
D New "� ' / / Please check all that apply (submit 1 sets of plans whtems checked be low)'
0 Service or feeder 400 a mare ❑ Building over three atorios,
DeMOlitiOn. ■ • '''Z'• where the available fault current ❑ Marina and boatyards.
a p e exceeds 10,000 amps at 150 volts or CI Floating buildings.
F2 1- and 2-fatnily dwelling less so ground, or exceeds M 000 ❑ Commercial -use agricultural
■ Commerciallindustrial r Accessory building amps for all other installations, buildings.
CI Nitliti-family builder Other: ❑ Fir pump, ❑ In ' srallanon of 7$ KVA Cr
■ ❑ Emergency system. larger separately derived system.
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Job • no : Job site address 13125
SW Bull Mountain Itd
10 01'Ip or more. occupancy. a
- - ❑ Six or more residential units. ❑ Recreational vehicle parka.
City /State/ZIP: Tigard, OR 97224 El Health-care facilities. CI Supply voltage for more than
1:1 Hazardous Iacationa. 600 volts nominal.
t. no. Project name: Suite/bldg./apt. ❑ Service or feeder 600 amps or more.
;,,:� ,,, . >;, s'< :
Cross stieet/dircctions to job silo: nercri.nou r
New residential single- or multi-family dwelling unit
Includes attached enrage.
Subdivision:
Lot no.: 1 eq. ft, or less 168.54 4
Ea. add'l 500 sq, ft, or portion 33.92 1
Tax map/parcel no.: Limited energy, residential 75.00 2
, <s:i:.. , ; , . .5 i% ::;: ;,:;..!, ,� .,,t y,, (with above sq. ft
Bathroom remodel ;' :::. Limited energy, tuulti- Enmity
_ residential (with above sq. it,) 75.00 2
Services or feeders installation and /or relocation
• 200 amps or less 100.70 2
+:s
t:ri i 133.56 2'i
:fiil
';� 2U1 am ate 400 am pa P
P
401 amps to 600 amps 20034 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or voila 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 39.36 1 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 singe to 599 amps 168s4 2
intended for side, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration or cxtenslon, per panel
Owner signature; Date: - - A. Pee for branch circuits with :, -
2 .r., ::,,:, :,,., .. .:,...:..,,:a: :..:•:r:r- erf
. 4.;, ,:k;:<:; is iii : above service or fccd ee 7 42
:<
,., each br Giro I
Business name: Classic Electric, LLC B, F ee for l rane1a cireuita without
eervite Or feeder fee, first 1 56.18 56,18 2
Contact name: Thomas Adams _ branch circuit
Each add'l branch circuit 1 7.42 7.42 2”
Address: PO Box 1335 Miscellaneous (service or feeder not included)
Each manufactured or modular
67.84 2
City /State/ZIP: Sherwood, OR 97140 dwelling, service and /or feeder
Phone: (503) 259 -0459 l (503) 345 -0912 R econnect o nly 67.84 2
Pump or irrigation circle 67.84 2
email: thomas t(belassicelectricnw.¢om a ,,,,,,, si or outline lighting 67.84 2
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::<., >$` Vii:: >� ° %ii: <: . .,.... 't . �rter
Business name: Classic Electtic, .n�ri:< :tii ' �'' �, �` ....... � � � � a�.,r , :,!. <i Si 1 circar 4 or
limited
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C, 1,.):,C panbl, alteration, or extension. 2 2
Each additional ibraption over allowable in any of the above
Address: PO Box 1335 Additional inspection (1 hr min) 66.25) hr
Investigation (1 hr min) 66.25/ hr
City /State/ZIP: Sherwood, OR 97140 Industrial plant (1lirmin) 79.18/ hr
Phone: (503) 259 -0459 Fax (503) 345 -0912 • Inspections for which no fee is 90.00 / hr
a . eeifrcall listed 1 4a hr min)
ojiz 533 " :F<'' >,P.�' S:<;; " %'ri">i
CCB Lie.: 18185I Electrical LiG.: C414 Supry G.: . Subtot 63 60
Suprv. Electrician signature, required: i i;l ' Plan review (25% of permit fee);
Print name: Thomas G. Adams Date: 8/4/11 State surcharge (12% of permit fee): 7.63
TOTAL PERMIT FEE: 71.23
Authorized signature: l Th is permit application expires ire permit la not obtained within 180
days after It hos been accepted as complete.
Print name: Thomas G. Adams Date: 8/4/11 a Number of inspections allowed per permit,
IA tjuiklhnll 'ermits1ELC•PermiLApp.doe 07/01/10 440- 4615S(11r05/CORA/PJ10