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Permit CITY OF TIGARD ELECTRICAL PERMIT II ill I COMMUNITY DEVELOPMENT Permit#: ELC2019-00653 Date Issued: 10/01/2019 T I C;A R ID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110BA08600 Jurisdiction: Tigard Site address: 14260 SW 116TH TER Project: Schumock Subdivision: EVERGREEN SPRINGS Lot: 11 Project Description: Adding(1)branch circuit. Contractor: OWNER Owner: SCHUMOCK, RANDY C RANDY SCHUMOCK 14260 SW 116TH TER 14260 SW 116 TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 503-781-9409 PHONE. FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 10/01/2019 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 10/01/2019 $6.74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 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 ell • er a••licable law. All work will be done in accordance with a•• -d plans. This ,-rmit will ex•ire if work is not started within 180 days of issuance, or if w'--k is •uspended for m the 180 days. ATTENTION: Oreg.—— requi you o follow -- rules adopted by the Oregon Utility No ion,/Cent-/ ose / =`s are set. in OAR 952-001-0010 through 0;o:•-101-•: 0. You m, 'stain ••y of the rules or direct questions to OUNC by callin 03. . 3 Issued B / Permittee Signature: I By: ,/°"'er. 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 FOR OFFICE I SE OyI.v Received A�1.tf///�l�� T 7 City of Tigard / Date/B �� III�� 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Date/B : �'' Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: Juris: ® See Page 2 for T I G A R D inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW 0 New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. 0 1-and 2-familydwelling0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural 0Commercial/industrial amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: ( (7 /� �jJ ❑Addition of new motor load of system. M(` 4?i V/O— /(6±6 / o- 100HP or more. ❑ City/State/ZIP:'yyy op__ ❑Six or more residential units. occupancy. � � ��� ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: '/7! / , `1/. 0 Hazardous locations. 0 Supply voltage for more than , �/� ©ir�l�Bd� �,�V�! P I,i ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: (( 77491 qt „,,,,,,w,,,,_ FEE SCHEDULE l Description I Qty. I Each I Total * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 (l Aro cove /� o Lf vr,i /( (with above sq.ft.) �J V / —( �� /(�� / LQ CIT l Limited energy,multi-family 75.00 2 C` �C�( I residential(with above sq.ft.) t PROPER OWNERRenewable Energy ❑ See Page 2 0 TENANT Services or feeders installation,alteration,and/or relocation Name: I\�r i S6 -- /�tAV�6Y -_- 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:(SOS) *�w i _--9 L/'cq Over 1,000 amps or volts 552.26 2 l ` Temporary services or feeders installation,alteration,and/or Email: relocation i 'l Owner installation:This i tallat'in is eing rade on prop- #'that I own which is not 200 amps or less 59.36 1 intended for sale,le1\t/e}AA1�f��t` r n e e, Si? + •I ' 7,449,670,an. 01. 201 amps to 400 amps 125.08 2 Owner signature: " , Date: G� 401 amps to 599 amps 168.54 2 0 APPLICANT 0 CONTACT PE•SON Branch circuits—new,alteration,or extension,per panel A. circuits Business name: ,�],,4 r1/1 �(/' above serservice or feeder fee, CJ v 1 w� 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without service or feeder fee,first Address: branch circuit 1 56.18 2 City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: SC/he?-4 _ Cd- CCl.S' K Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: / A ,?-7; Sign or outline lighting 67.84 2 t/�/� Signal circuit(s)or limited-energy Address: panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Investigation(1 hr min) 90.00/hr Email: industrial plant(1 hr min) 78.18/hr inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(1 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: 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:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. I Each I Total I * Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: n Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) n Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('h hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 per l aubtotaEnteron Page 1): �' * Number of inspections allowed pepermit. (SEE OAR 918-309-0000) Check Type of Work Involved: Ti Audio and Stereo Systems Ti Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation Ti Fire Alarm Installation n HVAC n Instrumentation Ti Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical Ti Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling n Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017