Permit CITY OF TIGARD ELECTRICAL PERMIT
} COMMUNITY DEVELOPMENT Permit #: ELC2011 -00616
TIGARD_ 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 11!03/2011
Parcel: 1 S 133DD 13800
Jurisdiction: Tigard
Site address: 11952 SW 127TH PL
Project: SCHMITT Subdivision:'ILLAGE AT SUMMER LAKE PARK NO Lot: 175
Project Description: (2) branch circuits for bathroom remodel
Contractor: MULTIPHASE ELECTRIC Owner: SCHMITT, LORI KAY
20701 S. MONPANO OVERLOOK DR. 11952 SW 127TH PL
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE 503 - 631 -4649 PHONE:
FAX: 503 - 631 -4659
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/03/2011 $63 60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/03/2011 $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 issu-• -- = 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 - •rdance with ap•roved 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 ATT' TION Oregon la eq re ou to follow the rules adopted by the Oregon Utility No - ion Center. Those rules are set forth in OAR
952 -001 -r 110 thr ugh OAR 952 a • -009 may obtain a co•y of the rules or direct questions to OUNC • 1987 or 1 800 33.._ •
Issue' By: 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' ` , l .;r 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.
Electrical Permit Applicatioll CEIVED FOR OFFICE' USE ONLY • n
T Received Permit No.: /try // 049 /S'
. City of 1 igar( Re e;vy: // °z 1� et
® 13125 SW Hall Blvd„ Tigard, OR 97223" D u 0 2 2011 Plan Review Other Permit. p� h �t I ®�
R Phone: 503.718,2439 Fax: 503.598.19 Date By.
Date Ready /By. ns 121 See Paw 2 for
TEGAIti? Inspection Line • 503.639.4175 I) Supplemental Information
Internet: vvww.tigard -0r.gov CITY TIGARD No �"
TYPE OF BiallpiNti DIVISION PLAN REVIEW
P sec ck all at apply' (s e 2 . ,ets of plans \t: items el tec ked be lot t 1'
1:3 lvew construction Addition/alteration/replacement ,� 0 So o• ceder 400 amps or mom ❑ Building over throe stones.
❑ Demolition ❑ Other: where the ayailablc fault current ❑ Mannas 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 0 Commercial /industrial ❑ Accessory building amps for all other ins ions. buildings. ,
El Multi family ❑ Master builder ❑ Other: 0 Fire pump. O Installation o. 75 KVA or
larger se c 1
❑Emergency system b '� ' y derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new molar load of "A ", "E" "I• ", `l -3 ",
100HPocmore
Job no.: Job site address: I SW 127 Place 1 i q . ❑ Six or more residential units IN Recrea . i 'chicle parks.
❑ Health-care facdaie ❑ Supph volta:e ore than
City/State/ZIP: Tigard, Oregon Z ��" ❑ Hazardous locations. 600 is no final.
El Service or feeder 600 amps or mom- . � —
Suite/bldg./apt. no.: Project name: Schmidt FEE SCHEit . `
Cross street/directions to job site: Description I Qtr 1°ter ,
New residential single- or multi - family dw g, unit.
Includes attached garage.
Lot no.: ` ,000 sq. ft. or less - -�
[ 4
Subdivision: Ea add'l 500 sq. ft. or portion / 64' .3 92 - 1
Tax map/parcel no.: Lunrted e nergy. residental 75 00 2
DESCRIPTION OF WORK (with above sq. fr.) •
Limited energy, multi- tamll) 75.00 2
Bathroom remodel residential (with above sq. ti.)
Services or feeders installation, alter. 'on. and /or relocation
200 amps or less 100.70
TENANT 201 amps to 400 amps 133 56 X
❑ PROPERTY OWNER 2 00.34 2
401 amps to 600 amps
Name: 601 amps to 1,000 amps 301 04 2
Over 1,000 amps ar volts 552 26 2 •
Address:
Temporary services or feeder.t installation, alteration, and/or
City/State /ZIP: relocation
200 amps or less 59_36 1
Phone: ( ) Fax: ( ) 125.08 2
201 amps to 400 amps i
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps s` 1 68.54 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670. and 701. Branch circuits— new. ahra or extension. per panel
Owner signature: Date: A Fee for branch circuits 1 dli ,
1 T PERSON above service or feeder ee, 7.42 2
® APPLIC.�IVT ® CONTAC each branch circuit
B Fee for branch circuits v /Fhonr -
Business name: Multiphase Electric, LLC service or feeder fee, first 1 56 18 56 18 2
branch circuit
Contact name: Dave Cackle \,.Each add'1 branch circuit k l 7 42 7.42 2
Address: 20701 S. Monpano Overlook Drive - Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
City/State/ZIP: Oregon City, OR 97045 dwelling service and/or feeder
Reconnect only 67.84 2
Phone: (503) 631649 Fax:: (503-) 631 -4659
Pump or irrigation circle 67,84 2
E -mail: multiphase @ccwebster.net Sign or outline hghUng 67.84 2
CONTRACTOR Signal ctrcuitls) or limited - energy 2
panel, alteration, orextension. Page 2
Business name: Multiphase Electric, LLC Each additional inspection over allowable in any of the above
Address: 20701 S. Monpano Overlook Dr. Additional inspection (1 hr min) 66.25/ hr
1-
Investigation (1 hr min) 66 25/ hr
City/State /ZIP: Oregon City, OR 97045 Industrial plant (l hr mm) 78 18/ hr
Phone: (503) 631 Fax: (503) 631 - 4659 Inspections for which no fee r5 9000 /hr
specifically listed (%: hr mm)
CCB Lic.: 162827 r t 113 Electrical Lie.: 5122 t, It4v. Lie.: C5 1 I (Of. ELECTRICAL PERMIT FEES
C�j e� fv � Subtotal. 63.60
Suprv. Electrician signature, required: U� 1i , — Plan review (25% of permit Fee):
Print name: David Gackle - 1 Date: 10/04/11 State surcharge (12% ofpermit fee): 7.63
TOTAL PERMIT FEE: 71.23
Authorized signature: T his permit application expires if a Hermit is not obtained within Islh
days after it has been accepted ns complete.
Print name: David Cackle I Date: 10/4111 • Number of inspections allowed per permit.
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