Permit p CITY OF TIGARD ELECTRICAL PERMIT
111 2 . COMMUNITY DEVELOPMENT Permit #: ELC2012 -00672
T EGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/28/2012
Parcel: 2S 111 BA00805
Jurisdiction: Tigard
Site address: 14130 SW 100TH AVE
Project: Randall Subdivision: TIGARDVILLE HEIGHTS Lot: 25
Project Description: (5) branch circuits for home upgrades
Contractor: CLASSIC ELECTRIC LLC Owner: RANDALL, MARIA L
PO BOX 1335 14130 SW 100TH AVE
SHERWOOD, OR 97140 TIGARD, OR 97224
PHONE: 503 - 259 -0459 PHONE:
FAX: 503 - 345 -0912
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 11/28/2012 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/28/2012 $10.30
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 through OAR •5 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344.
Issued By: `./a� � �_ _ 4 Permittee Signature: Off` APet (e4 r (o J
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.
Classic Electric, LLC 503 - 345 -0912 p.1
Electrical Permit Applicati CEW FOR OFFICE 1 :SE ONLY
City of Tigard �� �+ 11 Received Perm irNn. -�b?
132 g g Zo�2 DateB : L a-k a— ra
v 13125 SW Hall Blvd., Tigard, OR 97223 AAl1 q Plan Review
Phone: 503.718.2439 Fax: 503.598.1960`t ` DateB : Other Permit:
TEGARD Inspection Line: 503.639 DateReady/13y. el See Page 2 for
Internet: www.tigard or.gov CITY OfTt s" Notified/Method: �M Supplemental fnformatioa
TYPE OF NBIO DING DIVIS PLAN REVIEW
❑ 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 0 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
/i1 1- and 2- family dwelling 0 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family Q 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"
Job no.: lob site address: 14130 SW 100 Avenue 1001IP or mere. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parka.
City /State/ZIP: Tigard, OR 97224 ❑ Heaithcue Facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal_
Suite/bldg. /apt. no.: Project name: ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description • I Qty. I Lee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less I 168.54 4
Ea. add'I 500 sq. R. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft)
Limited energy, multi - family 75.00 2 I
Home upgrades residential (with above sq. ft.) -
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
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: ( ) l Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.03 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, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits— new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with '
above service or feeder fee, 7.42 2
❑ APPLICANT I 2 CONTACT PERSON each branch circuit
Business name: Classic Electric, LLC B. Fee for branch circuits without
service or fader fee, first 1 56.18 56.18 2
Contact name: Thomas Adams branch circuit
Each add'l branch circuit 4 7.42 29.68 2 •
Address: PO Boa 1335 Miscellaneous (service or feeder not included) •
Each manufactured or modular 67.84 2
City /State/ZIP: Sherwood, OR 97140 dwelling, service and/or feeder
Phone: (503) 259 - 0459 Fax: : (503) 345 - 0912 Reconnect only 67.84 . 2
2
Pump or tmgaoon circle
E -mail: thomas@classicelectricnw.com Sign oroudine lighting 67.84 2
-
CONTRACTOR Signal circuit(s) or limited - energy •
Business name: Classic Electric, LLC panel altemlion or extension. Page 2 _ 2-
Each additional inspection over allowable in any of the above
Address: PO Box 1335 Additional inspection (1 hr min) ' 66251 hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Sherwood, OR 97140 Industrial plant (1 lirmin) 78.18 /hr
Phone: (503) 259 Fax: (503) 345 - 0912 Inspections for which no fee is 90 hr
specifically listed (4 hr min)
CCB Lie.: 181851 Electrical Lie.' C414 I Suprv. Lic.: 5339S E LECTRICAL PERMIT FEES
�7 / // I� Subtotal: 85.86
Suprv. Electrician signature, required: Ito. .4 `iAi Plan review %ofpermit fee):
Print name: `��-A e,, l �t Date: 11/27/12 State surcharge (12% of permit fee): 1030
I [o" i' 'S�` 'Ym? TOTAL PERMIT FEE: 96.16
Authorized signature: re - ." (, er
• K"" This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ``� y - h s G . M2.rs1 S Date: 11/27/12 • t ismber of inspections allowed per permit.
I:',Budding1PamitS0 LC- PamitApp.doc 07/01/10 440- 4615T(11/05/COM/WEB