Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00187
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/12/2011
Parcel: 2S102CC04300
Jurisdiction: Tigard
Site address: 13655 SW STEVEN CT
Project: SCHEIDERICH Subdivision: Lot: 0
Project Description: (3) branch circuits for kitchen remodel.
Contractor: OWNER Owner: SCHEIDERICH, WILLIAM J
13655 SW STEVEN CT
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 04/12/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/12/2011 $8.52
Type of Use: SF Electrical
Class of Work: ACS
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 i ccordan - 'th approved •lans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TENTION: Oregon -w -quir =- •u to follow the rules adopted by the Oregon Utility Notification Center, Those rules are set forth in OAR
952 -00 -0010 through OAR 952 -• . 0090 • u nay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or ( 1.800.3 344.
Iss ed By: k. t e /I Permittee Signature: /' ( `r 80 � �-
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not int • • - d for sale, lease or rent.
OWNER'S SIGNATURE • !� aliEr 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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
eeem a Permit No ' 7
. _ i �tiC� . e9t/
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1 II Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit
T { G A R D Inspection Line: 503.639.4175 Date Ready/By: Julio: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
i
TYPE OF W O, ' PLAN REVIEW
A na, .. ... ._.. _...
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CAT ,CORY OF CONSTRICTION 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 snips for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE 1 \FORNI.UION AM) LOC:ATIO� ❑ Emergency system. larger separately derived system.
�
4.;,,,,,,.,..--:,;'1,--..a.',:' '❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 13655 SW Steven Court lool3Pormore. o�upancJ•
❑ 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: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Cul de sac off Cresmer Drive, Cresmer Description Qty. Fee. Total *
New residential single- or multi- family dwelling unit.
connects to Ash to the east and to Garrett to the north. Includes attached garage.
Subdivision: Berea Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: 2SIO2CC04300
Limited energy, residential 75.00 2
1ESCRIPTION Q „v1 ORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
Kitchen remodel - update existing lighting and outlets only residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
2 01 snips to 400 amps 133.56 2
®P {20PEK "1'1' OWN �, t� � « i'4 ���..�' p
Name: William Scheiderich 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 13655 SW Steven Court Over 1,000 amps or volts 552.26 2
City /State /ZIP: Tigard OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)5262215 Fax: (503)3504033 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, ore hagge, according to ORS 447, 449, 670, and 701.
� A Branch circuits – new, alteration, or extension, per panel
V
Owner signature: Date: C{ • I a ' 1 t _ A. Fee for branch circuits with
above service or feeder fee,
® A PPE IC.A \T 0 ('ONI'ACF PERSON each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first / 56.18 2
Contact name: Owner - see above branch circuit
Each add'I branch circuit A 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR
Signal circuit(s) or limited- energy
Business name: panel, alteration, or extension. Page 2 2
066 Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (/ hr min) 90.00/ hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES ,„--
Suprv. Electrician signature, required: Subtotal: 0 '
Plan review (25% of permit fee): `—
Print name: Date: State surcharge (12% of permit fee): g,5 1
TOTAL PERMIT FEE: 79 .51f
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number o inspections allowed per permit.
1:\Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(11/05 /COM/WEB