Permit CITY OF TIGARD ELECTRICAL PERMIT
.1
I COMMUNITY DEVELOPMENT Permit #: ELC2009 -00488
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/17/2009
TIGARD 9 Parcel: 1 S136AD07100
Jurisdiction: Tigard
Site address: 6976 SW PINE ST
Subdivision: Lot: 0
Project: Schoch
Project Description: (2) branch circuits for electrical upgrade.
Owner: FEES
SCHOCH, MICHAEL & PE..0%• y Quantity Description Date Amount
R
#2e 1 t0 q� 4 �� ,� r 2 crt Branch Circuits 09/17/2009 $53.50
wo /Purchase Service or
PHONE: Ti (DF}2D 02 q 7» 3 Feeder
1 ea 12% State Surcharge - 09/17/2009 $6.42
50 3 - 3 0 5 — 3 $ $O
Electrical
Contractor:
OWNER
•
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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. ATT • • : Oregon requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 *010 through OAR 952 -0. • '0. • u may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issu • By: Permittee Signature: V P
OWNER INSTALLATION ONLY
The installation is being made on property I own which is of inte ded sale, lease or rent.
OWNER'S SIGNATURE Date: ‘. .142L6 7 2____
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' 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.
. Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard
1312
Received
�7 6 n Permit No.: eq �V ti
°
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• 21 ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
El New construction ® Addition /alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: 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
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ 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 ", "l -2 ", "I -3 ",
Job no.: 09 - 102 Job site address: 6976 SW Pine St IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard /OR/97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Kitchen Wire Upgrade ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Flag Lot - Between 68th and 71st avenues Description I Qtr. I Fee. I Total I •
off of 99 /SW Pacific Highway New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1993 -075 Lot no.: 2 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: R2034012 Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
1) Replace Aluminum Wire w/ Copper Wire from Circuit Box to Receptacle residential (with above sq. ft.)
2) Install New Circuit Breaker, Wiring, and Receptacle Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Michael and Penny Schoch 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 6976 SW Pine St Over 1,000 amps or volts 454.65 2
City/State /ZIP: Tigard /OR/97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (530)305 -5580 Fax: (503)292 -9846 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, a cordin : to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
signature: '�. 4V I • Branch circuits - new, alteration, or extension, per panel
Owner si g �►
.A � ... ___,L Date: ° j Ii1
A. Fee for branch circuits with
® • PPLICANT • I ® CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: Same As Above witho service or feeder fee 1 46.85 46 2
first branch circuit
Address: Each add'I branch circuit 1 6.65 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
Phone: dwelling, service and/or feeder
( ) Fax: ( ) Reconnect only 66.85 2
E -mail: mischoch @hotmail.com Pump or irrigation circle 53.40 2
'
CONTRACTOR Sign or outline lighting 53.40 2
l
Business name: N/A /_�"_ k) e- Signal circuit(s) or limited -
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: N/A Electrical Lic.: N/A Suprv. Lic.: N/A Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 53.50
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): 6.42
Authorized signature: TOTAL PERMIT FEE: 59.92
Print name: I This permit application expires if a permit is not obtained within 180
Date: dove after it hay been arrented an cnmnlete.