Permit CITY OF TIGARD ELECTRICAL PERMIT
1 a COMMUNITY DEVELOPMENT Permit #: ELC2009 -00393
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/03/2009
Parcel: 1 S 136AD07100
Jurisdiction: Tigard
Site address: 6976 SW PINE ST
Subdivision: Lot: 0
Project: Schoch
Project Description: (1) branch circuit for a /c.
Owner: FEES
SCHOCH, MICHAEL & Quantity Description Date Amount
SCHOCH, PENNY, 462 SW VALERIA VIEW DR
#201 1 crt Branch Circuits 08/03/2009 $46.85
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/03/2009 $5.62
Electrical
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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. A " TIO - eon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 0010 through OAR • • -001 -• Or. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue. :y: . LL vL , PermitteeSignature: 1r
OWNER INSTALLATION ONLY
The installation is being made on property I i not intended for sale, lease or rent.
OWNER'S SIGNATURE x ./ I Date: q( r/
b
1 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 3 roIi oFF1ci.: usi: (1 \1.1
City of Tigard - . Et-C-47°-41 — C513 Reese Permit No:: '
13125 SW Hill Blvd., Tigard, OR 97223,
'Plan Review
II Phone: 503.639.4171 Fax: 503.598.1960 Date/B : • Other Permit:
TI G A R D Inspection Line: 503.639.4175 ' Date Ready /By: kris See : El S Page 2 fo
Internet: www.tigatd or.gov Notified/Method: Supplemental Information
. ' TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit is 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. .
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
. IS 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. . larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", ,
Job no.: 09 - 101 l Job site address: 6976 SW Pine St 100HP 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: Air Conditioner ❑ Service or. feeder 600 amps or more. .
FEE SCHEDULE
Cross street/directions to job site: Flag Lot - Between 68th and 71st avenues naseriottoa I .Qtr. I Fee. I Total I •
off of 99 /SW Pacific Highway New residential single- or multi - family dwelling unit.
g y Includes attached garage.
Subdivision: 1993 -075 • Lot no.: 2 1,000 sq. f. or less 145.15 . 4
• Tax map /parcel no.: R2034012 Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.) •
Electrical for Air Conditioner Limited energy, multi- family 75.00 2
. residential (with above sq. ft.)
' Services or feeders installationalteration, and/or relocation
J 200 amps or less 80.30 ' 2
® PROPERTY OWNER I ❑ 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, according to ORS 447, 449, 670, and 7 1. 401 amps to 599 amps . ' - 133.75 2
S Branch circuits — new, alteration, or extension, per panel -
Owner signature: y.,...—........„0„..2
• Date: D
A. Fee for branch circuits with
® APPLICANT I ® CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: ' B. Fee for branch circuits
Contact name: Same As Above without service or feeder fee, 1 46.85 46.85 2
. first branch circuit
Address: Each'add'I branch circuit , 6.65 2
• Miscellaneous (service or feeder not included) '
City/State/ZIP: . Each manufactured or modular .
dwelling, service and/or feeder ' 90.90 2
Phone: ( ) Fax:: ( ) Reconnect only . . 66:85 2
• E -mail: mischoch @hotmail.com ' Primp or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40, ' 2
Business name: N/A 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 • Phone: ( ) I Fax: ( ) Per inspection : 62.50 • .
Investigation per hour (1 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: . 46.85
Print name: Date: Plan review (25% of permit fee):
• State surcharge (12% of permit fee): 5.62
Authorized signature: TOTAL PERMIT FEE:. 52.47
• This permit application expires if a permit is not obtained within 180
Print name: • 1 Date: days after it has been accepted as complete:
- • Number of inspections allowed per permit -
I :\ Building \ Permits \ELC= PermitApp.doc 05/23/06 440- 4615T(I1 /05 /COM/WEB
1