Permit CITY OF TIGARD ELECTRICAL PERMIT
'7 ' -- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00344
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/22/2011
Parcel: 2S103CD07100
Jurisdiction: Tigard
Site address: 13890 SW 118TH CT
Project: Grover Subdivision: CREEKSIDE PARK Lot: 2
Project Description: (6) branch circuits for kitchen remodel.
Contractor: CLASSIC ELECTRIC LLC Owner: GROVER, JERRY AND JUDY M
P.O. BOX 1335 13890 SW 118TH CT
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503 - 259 -0459 PHONE:
FAX: 503 - 345 -0912
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 06/22/2011 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/22/2011 $11.19
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
Required Items and Reports (Conditions)
This permit - -2 bject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don- n accordance wi 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. •TTENTION: Oregon I. , r:.uire- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00+ -0010 thr.ugh OAR 952 r 1 -t� 0. o may obtain a copy of the rules or direct questions to OUNC by call', I .232.1987 or 1.800.332.2344.
Issue. c �L` � r `� Permittee Signatu .i i C ���
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' i/ �J Date:
• f
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.
■
Jun 21 11 07:52p 503 - 345 -0912 p.1
Electrical Permit Application RECEIVED FOR Oil 1C E 1 SL; ONLY
e / permit No.:
City of Tigard Rec DateB ived : _ Exe,06/� /,.- j
• 13125 SW Hall Blvd., Tigard, OR 97223 I 2 Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960) U N .' �+ 2 O 1 Date/By:
Inspection Line: 503.639.4175 Date Ready/By: runs, la See Page 2 for
.TIGARD
Internet: www.tigard -or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF igagik,DINCi DIVISION PLAN REVIEW
Please check all that apply (submit ?sets of plans w /items checked below):
❑ New construction ® Addition /alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ 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
® 1- 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ","1 2", "1 - 3 ",
IOOHP or more. occupancy.
Job no.: Job site address: 13890 SW 118 Court o Six or more residential units. ❑ Recreational vehicle parks.
Ci /State/ZIP: Ti ard, OR 97223
❑ Hazardous locations.
❑ Health -care facilities. ❑ Supply voltage for more than
ty g 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Deleriptioa i Qtr. I Vee. 1 Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq, ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq, ft.)
Limited energy, multi - family 75.00 2
Kitchen remodel residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 snips 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT i ® CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Classic Electric, LLC B. Fee for branch circuits without
service or feeder fee, first I 56.18 56.18 2
Contact name: Thomas Adams
• branch circuit
Each add'I branch circuit 5 7.42 37.10 2
Address: PO Box 1335 Miscellaneous (service or feeder not included)
City/State/ZIP: Sherwood, OR 97140 Each manufactured or modular 67.84 2
dwelli 67.84 2
h dweng, service and/or feeder
Phone: (503) 259 - 0459 Fax: : (503) 345 - 0912 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: thomas @classicelectricnw.com
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Classic Electric, LLC panel, alteration, or extension. _ Page 2 2
Each additional inspection over allowable in any of the above
Address: PO Box 1335 Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Sherwood, OR 97140 Investigation (1 hr min) 66.2SI hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 259 -0459 Fax: (503) 345 - 0912 inspections for which no fee is 90 hr
specifically listed (Y2 hr min)
CCB Lie.: 181851 Electrical L2 Lic.: 53395 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 93.2$
Plan review (25% of permit fee):
Print name: Thomas G. Adams (a__ Date: 6/21 /1 I State surch (12% of permit fee): 1 L 19
Authorized signature: Av._ , TOTAL PERMIT FEE: 104.47
This per mit application expires if a permit is not obtained within 180' -
Print name: Thomas G. Adams Date: 6/21/11 • days after it has been accepted as complete. + � , .�j
• Number of inspections allowed per permit.