Permit (43) CITY OF TIGARD ELECTRICAL PERMIT
11111
COMMUNITY DEVELOPMENT Permit#: ELC2017-00716
Date Issued: 09/28/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S135AD01101
Jurisdiction: Tigard
Site address: 8845 SW SPRUCE ST
Project: FREEMAN Subdivision: ASHBROOK FARM Lot: 21
Project Description: Upgrade(1)200 amp panel
Contractor: SHOCKER ELECTRIC LLC Owner: FREEMAN,ZACHARY S
2834 CHAMPIONSHIP DR SIMMERS, SARA C
WOODBURN, OR 97071 8845 SW SPRUCE ST
TIGARD, OR 97223
PHONE: 503-758-8088 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/28/2017 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 09/28/2017 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 throug GAR 9 =,1-00•0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 o 332.2344.
Issued 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' 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.
;y_
"^k"G9# �C� It Application
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.,.�•v....,:^s�•e.,regard,ot(97223 ..
k• Pho.e: 503.7182439 Fax: 503.591.1960 . .�„ ReeinedPmsnar:
In/etaionLine: 503.639.4175 a i 16m sf DrdOr seas
Internet: wwrw. C,',I I y .
TYPE OF wo K' PLAN REVIEW
❑New construction MAdditian/altera(ian/replaceneat re Medi
«n timet apply
(same 1 era.of par whims arcked)
p
• ❑Demolition ❑Other: where Me avrhWs frisk mires 0 Menem and bastards
CATEGORY OF CO' 1WJCI70N eaceeds*0.000 saps at 130 wilts e 0 Florins Mildews
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building a.s to pounda exceeds is coo p coerea.*ine ssrscedmral
0 amps for all other raaaleams bs ldeys
-. -4:11i-fammMoto builds
�' 0 Other: I I 17 For PrP ❑heslslalnos of 130 KVA or
s srrE INFORMA nON AND`LOCATION g ,U C I I 0 E y riw• `►se fop iaJ derived
Jen dress: %4J Sly , 13Addpsnodore load of riser
___... � _ 100F�«sere 0-A-.-s".-1-2".-*-3-.
C*ty/Sa nfZIP --� _ �f , fl . 0 Ser«•c ee,eedom ems °LY1P"e'
I 1 Jq7 - liesllh we Leedom 0 Reaeshoasl vehicle perks
Suite bldgJapt_0: Project name: 0lLmedoes loomor e 0 supply voltage for snore than
0 Service or feeder 600 nape or more 600 volts sosrl
Cross street/directions to job site: FEE SCHEDULE
Dae ranee I ay. I leas I reel I •
New nddesW slalle-or malt dwelling unit.
Subdivision: Lot I: Wades atisehod Rasstfe.
Tax nap/paroel 0: 1,000 sq/l orlon' 168.54 4
•
Ea.Will 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK gated mealy,residential
^ _^ (with above an.R) ]Sion 2
e�CJC� �` ► •` s '
Limited energy,multi-family
- _ 73.00 2
residential(with above sq.ft.) -
o PROPERTY own= I o TENANT Reaewabie Emery 0 See Pate 2
Services or feeders lastalbtlen,alleradan,miller relocate.
Name: 200amps«leas ' 100.70 /09,71 2
Address: 201 amps to400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/Stale/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax( ) Over 1,000 amps as volts 552.26 2
- Temporary services or feeders iWaRadom alteration.and/or
Email: rdo<atio.
Owner installation:This installation is being made on propaty that I own which is not 200 amps co les 5936 1
intended for sic,lease,raft,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.011 2
w
Oner signatu e: Date: 401 amps to 599 noire a 168.34 e n 2
EI APPLICANT 1 o CONTACT PERSON Beane'dredb—saw,aNeratie.,or esteade.,per panel
A-Foe far bran&circuits with
Business tee: above service or feeder fee, 7.42 2
each breech circuit
C^•!sct:SLS: , R.Fee for bench circuits without
service at feeder fee,feat 56.1 8 2
Addyosa: branch circuit
Each add9 batch corn 7.42 2
. MacMorran(servlee or feeder ant Indadest---_ ______ _
.Plane:( ) Fax::( ) Each mas6eared«modular 6714 2
Email: dwellag,swine asdf«feeder
R..- —t only 67.14 2
COITI tAcrmR Pimp or irciptiaa nude 67.84 2
Bt name j�j(Qr &Jed�-ci c. r<LC Sian or outline lightly 67.84 2
Sipat eimuil(s)or limieedeeray
Address: ata 3N Chat ionski e Pr mod,altnsatim,or c.m:o. Cl See rages I 2
^City/State/ZIP: r s clb V f l) to r 47707 ! Each.dditlwst impend=over.a.rnble hs a ay 011ie above
Additional inspection(1 hr tea) I [ 66.:x`!hr
Phone:( j• ) !SY"C!09S Fax:( / ' ) love 4m(1 be ma) 90 oily hr
Email: PAW 0• e - - ;c&I•0:4111 betostrial Pie obrm71.IS!lir
bspacti es far which no fees r
t OCB Lica: . I I I Electrical Lic.: I lag 1 Swim Lie.: CO7gde�`
S el°°chad(xIna ) 9000rt
ELECTRICAL PERMIT
FEES
Suprv.Electrician signature,requitaL Subtotal: WO-70
o FIs Review Required(25%(drank fee): J/}
Print :-'�'bej-k lc ��1 E7 j
Side serchtaye(12%ofre t fie): 1 „pi "1
Authorized signature: TOTAL PERMIT FEE-74 1 t ,
This permit ap?irtien endures rot prairie ur aobl iwem
name-
wills t
IPrint me- I nm 1 lova seer It has w rwegssd as ssasras
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City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8845 SW SPRUCE ST, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2017-00716
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor