Permit Support Document f CITY OF TIGARD .•7 >,r f ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT � Permit#: ELC2019-00686
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2019
Parcel: 2S 109AA00700
Jurisdiction: Tigard
Site address: 14255 SW 125TH AVE
Project: Black Sheep Construction Subdivision: None Lot: None
Project Description: House remodel. 4/17/2020: REPRINT permit to add(1)additional service and(10)additional branch circuits.
Contractor: CLASSIC ELECTRIC LLC Owner: BLACK SHEEP CONSTRUCTION LLC
PO BOX 1335 16340 NE YAMHILL RD
SHERWOOD, OR 97140 YAMHILL, OR 97148
PHONE: 503-259-0459 PHONE:
FAX: 503-345-0912
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/09/2019 $100.70
Specifics: amps or less
20 crt Branch Circuits w/Purchase 10/09/2019 $148.40
Type of Use: SF Service or Feeder
Class of Work: ADD 1 ea 12%State Surcharge- 10/09/2019 $29.89
Electrical
Type of Const: 1 ea Services or Feeders-200 04/17/2020 $100.70
Occupancy Grp: amps or less
10 crt Branch Circuits w/Purchase 04/17/2020 $74.20
Service or Feeder
0 ea 12%State Surcharge- 04/17/2020 $20.99
Electrical
Total $474.88
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 952-00 090. 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: Permittee Signature: 0"/ °2 /C'9 7CJA./
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 E C E!V E FOR OFFICE f'S E ONLY
N1AR el t) Received /./7 City of Tigard Date/By: Permit p
illg • 13125 SW Hall Blvd.,Tigard,OR 97223w Ca�// —OD 6
t I Phone: 503.718.2439 Fax: 5o3.598.i966a1TY OF TIGARD Dattel Review Related Permit%:
Inspection Line: 503.639.4175 BUILDING DIVISION Ready Date/By: Iures: lel See Page 2 for
TIGARD Internet: www.tigard-orgov Notified,Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/iteu,s checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
. ❑Demolition ❑Other: where the available Fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION • exceeds 10,1)00 amps at 150 volts or 0 Floating buildings.
all-and 2-family dwelling 0 Commercialiindustrial 0 Accessory building less to ground,or exceeds 14,010 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
['Addition of new motor load of system.
Job#: Job site address:14255 SW 125th Avenue IOOHP or more. ❑"A "E "1-2 "I-7",
City/State/ZIP: Ti ard, OR 97224 ❑Six or more residential unis. occupancy.
g ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations, ❑Supply voltage for more than
❑Service or feeder 600 amps or mare. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
tte,crintiun I 00. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or Icss 168.54 4
Tax map parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with abovesq.ft.) 75.00 2
Add subpanel and 10 circuits to existing permit#ELC2019-00686 Limited energy,multi-family
residential(with above sq.ft.) 75.00 '_
. Renewable Energy See Page 2
• 0 PROPERTY OWNER 0 TENANT.
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1 100.70 100 7Q 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:( ) Fax:( ) Over 1,000 amps or volts • 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 40O amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
® APPLICANT �'-CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits wig),
above service or feeder fee, 74.20
Business name:Classic Electric, LLC 10 7.42 2
each branch circuit
Contact name: Thomas Adams B.Fee for branch circuits wirheut '
Address: service or feeder fee,first 56.18 2
PO Box 1335 branch circuit _
City/State/ZIP: Sherwood,OR 97140 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503 )259-0459 Fax::(503 )345-0912 Each manufactured or modular 67.84
dwelling,service and/or feeder
Email:thomas@classicelectricnw.com Reconnect only 67.84 2
CONTRACTOR •
Pump or irrigation circle 67.84 2
Business name:Classic Electric, LLC Sign or outline lighting 67.84 2
Signal circuits)or limited-energy 0 See Page 2 2
Address: PO Box 1335 panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:Sherwood,OR 97140
Additional inspection(1 hr min) 66.25/hr
Phone:(503)259-0459 Fax:(503 )345-0912 Investigation(t hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
thomas@classicelectricnw,com inspections for which no fee is
CCB Lie.: 181851 Electrical Lic./ C414 Suprv.Lic.: 5339S
specifically listed('b hr min) 90.00/hr
g ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 'w'u ..-'d t ` Subtotal: 174.90
Print name:Thomas G.Adams Date: 03 30 2020 ❑Plan Review Required(25%of permit fee):
/, f / Stale surcharge(12%of permit fee): 20.99
Authorized signature: v`/t --. ' L• G `e': ' TOTAL PERMIT FEE: 195.89
This permit application expires if a permit is not obtained within 180
Print name:Thomas G. Adams Date: 03-30-2020 days after It has been accepted as complete.
' Number of inspections allowed per permit.
I'.auddirgsPcrmits\ELC PematApp ErR_EREdoc Rev O6/17r2015 440-4615TQ 1/09r0WWEB