Permit CITY OF TIGARD ELECTRICAL PERMIT
►'� r: COMMUNITY DEVELOPMENT Permit # ELC2011 -00595
TI GARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued 10/25/2011
Parcel 1 S 125DD03000
Jurisdiction Tigard
Site address 6805 SW VENTURA DR
Project Schock Subdivision WASHINGTON SQUARE ESTATES Lot 21
Project Description (2) branch circuits for kitchen remodel
Contractor ANDERSONS INTEGRITY ELECTRIC Owner SCHOCK, CARL F & MICHELLE K
18435 SW PACIFIC HWY 6805 SW VENTURA DR
STE D TIGARD, OR 97223
TUALATIN, OR 97062
PHONE 503 -245 -1396
HONE 503 - 691 -6709
FAX 503- 263 -8862
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 10/25/2011 $63 60
Specifics. Service or Feeder
1 ea 12% State Surcharge - 10/2512011 $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 issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and at 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 throu 952 -001 -0090 You u . .. • .. .f the • •erect questions to OUNC by calling 503 232 1987 or 1 800 332 2344
1
Issued 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
Electrical Permit Application OP FOR OFFICE. USE.ON IN R eceived _
City of Tigard l A Date/B ) Q r r), Permit No - /_ - s+ts
1 , • 13125 SW Hall Blvd , Tigard, OR 01` Plan Renew
' Phone 503 718 2439 Fax 503 5 60 q y Date/By Other Permit / M " - c - ..„9 . 0 - c - ..„9 . 0 / / --eb16 s—
TIGARD Inspection Line 503 639 4175 i0 Date Ready /By tans ® See Page 2 for
Internet w S§ ww tigard -or goy ' O �K 1P C.W Nontied/Medmd rrre . Supplemental Information
TYPE OF WORKi(* NGV V PLAN REVIEW
rl ement
�
Please check all that apply (submit 2 sets of plans w /items checked below)
❑ New construction VI Addition /altcratio
❑ 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 %olts or ['Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
- 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 denved system
❑ Addition of new motor load of ❑`A ",`E ", °I - ", `9 - 3"
/ p- or__ 1001IP or more occupancy
Job no Job site address
`O (1t5s �w� �/t21 ❑ Six or more residential units ❑ Recreational vehicle parks
�, 0 u S p 77 0 Health-care s 0 Supply for than
City /State /ZIP �
fV , 7 -- we -c- I'� ft / / Z Z- �f ❑ Hazardous locations 600 volts is nominal
n
Suite /bldg /apt no Project name 57", a 1 r�"1 - ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to Job site 2 2. N r' £ Ve z czh ct 0 Descripimn I on I Fee I Total I •
New residential single -or multi - family dwelling unit
Includes attached garage.
Subdivision l Lot no 1,000 sq ft or less 168 54 4
111 Ea add'1500 sq ft or portion 3392 1
Tax map /parcel no Limited energy, residential
DESCRIPTION OF WORK (with above sq tt) 7500 2
) }� ,, [ Limited energy, multi-family 7500 2
/ � 04 Gtr / i ll f o r 14 it kW pe ate-i residential (with above sq ft)
1 Services or feeders installation, alteration, and /or relocation
200 amps or less 100 70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133 56 2
Name , // 401 amps to 600 amps 200 34 2
� i 1 1--- C/1 �//x 601 amps to 1 000 amps 301 04 2
Address to 7b 5-7., v /L L -_ Over 1,000 amps or volts 552 26 2
City /State /ZIP
77j- Temporary services or feeders installation, alteration, and /or
d.../7 ,g, f 2. 72 3 relocation
Phone CYO ) Fax ( ) 200 amps or less 59 36 1
3 aJ /3 Q 201 amps to 400 amps 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
above service or feeder fee
]/ APPLICANT I ❑CONTACT PERSON each branch circuit 742 2
Business name /� _41,, - ram ez4 t o 6,, 75 I�
Q B Fee for branch circuits without
`S n � service or feeder tee, first tr
Contact name branch circuit , 5618 � (O 2
,c �� /alt OJ'f_
Each add'I branch circuit / 7 42 7. it). 2
Address / / 70 5:9 ,,, d/( I'� a / // _4 Miscellaneous (service or Reder not included)
City /State /Z,IP /' (/ Each manufactured or modular 6784 2
�' / i 0,, Each
service and/or feeder
Phone (#b ) t i ' c j 7 t/6 r3 Fax ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E - mail
Signor outline lighting 67 84 2
CONTRACTOR Signal circmt(s) or limited- energy
Business name ,I //, panel, alteration, or extension Page 2 2
tit" �� - a ,... L S& L Each additional inspection over allowable in any of the above
Address ■ / � L '1.-\ Additional inspection (I hr mm) 6625/hr
� __,,/''..'' 1 itst S2 -2(03- ca b6-Z, Investigation (I hr min) 6625/hr
City/ State /ZIP
/r-C �A /I
W�N 7 4 /1v Industrial plant (I hr min) 7818/hr
Phone (y0,) ate 67 7 Fax ( ) 7 3q _3(33 , Inspections for which no fee is 90 00/ hr
I . _ specifically listed (i4 hr min)
CCB Lie q i Ll I // c {{ ,lectncal Lie `! �" � ''l Q •Supry Lie 1 S ELECTRICAL PERMIT FEES
Supry Electrician sigrl�ak?ire,fEquvcdU IN, 1011 o Subtotal ( 3 _
'• AJ Plan review (25% of permit fee)
Print name pz ft /Z va / _
J i Qyt e- _ Date
t 60 State surcharge (12% of permit fee) c7 _ -
:.h .Z o / J
TO 1'AI PERMIT FEE 7 ,
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 of inspections allowed per permit
I Viuiiding\Permits\ELC-PermnApp doc 07/01/10 440 -4615T(I I /OS /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n B • urglar Alarm
n G • arage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n C • lock Systems
n D • ata Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n L andscape Irrigation Control*
n Medical
❑ Nutse Calls
n O • utdoor Landscape Lighting*
n P • rotective Signaling
❑ Other
Total number of commercial systems
*No licenses are required. Licenses are required
for all other installations
I
0Bwlding 1Pernn¢/LLC- Perm0App doe 07/01/10