Permit ti= CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00199
.4 A.i4, DEVELOPMENT SERVICES DATE ISSUED: 4/20/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S13500-10300
SITE ADDRESS: 11673 SW NACIRA PL
SUBDIVISION: NACIRA PARK ZONING: R-4.5 ,
BLOCK: LOT : 003 JURISDICTION: TIG
Project Description: Alteration of (2) branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
KEITH RUST ELECTRIC TECH INC
11673 SW NACIRA PL 2352 SE TANAGER CIRCLE
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: 503 - 380 -9173 Phone: 503 - 640 -4773
Reg #: ELE 34 -638C
SUP 4912S
FEES LIC 155230
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/20/2004 $53.50
[TAX] 8% State Surcharge 4/20/2004 $4.28 Rough -
Elect'I Final
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
2466699 C____ 00 -33 -.344.
Issued .. 1 ; ,� y P ermit S ignature: ��zL s , /
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 INST LLATION ONLY
SIGNATURE OF SUPR. ELEC'N: / e8 -`—�' DATE:
LICENSE NO: 0-/ot 5
Call 639 -4175 by 7:OOpm for an inspection the next business day
FROM Elf RIC TECH FAX NO. :5036401970 Apr. 16 2004 06:43AM P1
EIa.fri Permit A • it �, �:•,�
City of Tigard RE, Received i ,,
13125 SW Hall Blvd, Tigard, OR 97223 Ike ' li� � _ _ ���i ° D-
Plan Review
Phone: 503.639.4171 Par. 50359191960 6 200 { r � fc» .: ,
btspevtion Line_ 503.639.4175 A K _ J i . Date
Ready/By: >t>ea:
RI See Page 2tor
Internet: www.a.tigartior.us I G AR D Notified/Adv./semi: twppta neatai Information
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r New construction ` C " Addition/altciation/ Addition/alteration/replacement Please check an that apply:
0 Demolition ❑ Other 1]scrvicc over 225 amps. coaan'l ❑Hazardous location
«Yd � � . , w o • �,o , q , d b ['service over 320 amps -:aging QBw'ldng over 10,000 sq. ii.
�,. 10' � , y . 16 tit . Z :y S. � l . vn a < Z• :.' ' ? , ',+^+
....+.x .., �� �� . .�oa�ac - vFrf . �i'"M .» .,. "�� W ��c,`'`...v' o£ 1- end 2- fatniry dwellings 4 or mare new scajd�tial
G 1 - and 2- family dwelling ❑ Commercial/industrial 0 Accessory building ['system over 600 volts nominal units in one structure
❑ Multi -family 13 Master builder 0 outer
over three statics ['Feeders, 400 amps or more
' M"'” ,.:y 4 s"t a�yy� :.7. , p �q�jl�oad� a DM`m
i, .:,K,: coo - ,,',2,...., , , J J,p ,. G Q , i A, kd 4 a .i Tt vssAigh mg phi E park
,, , � Ql:1calHta� ��ty ❑other:
Job no_: Job site address: / , /_�f �j, t ��� % v � `�/ of plans with any ofthe above.
City /State/ZIP: K i 4 L 194 . s 9` • -V . l The above ate not applicable to temporary construction service.
g /apk Lam "\ ktJt -S - " ` ` 4Ferk .,:. , ° M �•
Suitelbld '
no.: Project name: M ,H, ,,
t sty Oran rent
Cross street/directions to job site: New residential single- or multi- family dwelling use.
- Includes attached garage,
1,000 sq. it or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. R. or portion 33.40 1
1p/ Limited energy, residential 75.00 2
maparcel no.:
'''.74 - aw (arorw�' sv , Limited energy, non-residential 75,00 2
°. , , , l httan, r� ,,,*`...a. ..`Si'i ( 1 d4,.. � ; o p:44.;aw u. - oleow '•.
:' a sMn
, :t : o<, � ." Each aramnfadtaod or modular
dwelling, service and/or feeder 90.90 1 _ 2
Services or feeders won, alteration, and/or • relocation
-
200 amps or less 80.30 2
ro yeti : G.i 1, -Y� ktr4I'r1Y*- ' ' r; F ^ 2 ` ...ems � .4 sir' Ron wl er S to 400 amps 106.85 2
'a e tit , ,:A=sntrV. air k3 �,uN 401 amps to 600 turps
160.60 2
Name: ij ∎?(1 601 amps to 1,000 amps 240.60 2
Address: ( t 6 75 Alczt V n, 2e over 1.000 amps or volts 454.65 2
City/State/HP: G Reconnect only 6685 2
City/State/HP:
1-"Z / {jp ) 1 7 dt2,3 _ Temporary services or feeders :bt ors, alteration. and/or
Phone: r . 40 Pam ) t • ( ) 200 aegis or less 66.85 1
Oonver installation: This in.tallation 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 701.
401 auras to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
4 7" 1. p q Yep R4, Puy s .b+,- x q a }�•1,,,, A brA
Fes far nCh oicuits with
••'.• , � v/.^¢ T�. ZI' 1' xll. JbLn .5'n:;•P�t➢affiNV #F�fAa. •.• . < �.FU �.'+
service or feeder fee, each 6.65 2
Business name: branch circa
Contact name: a Pee for branch circuits ,,�
without service or each breach circuit
feeder fen, 46.85 lS 2
Address: Each midi bandit circuit j 6.65 6 J 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Asap ar irrigation circle 53.40 2
Phone: ( ) I : ( ) Sign or outline lighting 53.40 2
E-mail: Signal t(s)aliniited-
y 1FpE M�tl �yy eaavA3,: • ,} ;. ,a '
C{•^hi.;'.<.y� w4m i ,. W ,1,TOray4'y P anel, i ! ' 1 ff�� % < Mad.01T��Q , i�i�+��k ' �V �:)�v •: S'I'.�,�.CI�:.Tt�lv�(�IN�+i yf..Ri3:::t�3:2',.i�4:i.'ACg• 1.: ✓�7�'����� c .4,1 , TOT. ��� �'°" � altaatim, ' '
extension. Describe: Page 2 2
Business name: Electric Ines
Address 2352 SE Tanager Cu: Eat additional inspection over allowable in , c of the above
Per inspection • 62 50
City /State/ZIP: Hillsboro, OR 97123 Investigation per hour (1 armin) I 62.50
Phone: (971) 5613381 I Fax: (503) 640 -1970 Indt>m'ial plant per hour 73.75
CCB Lie.: 155230 I Electrical Lie.: 34-638C I Suprv. Lc.: 4912S
Subtotal . 53 std
Suprv. Electrician signature, reluirediO ,! 4 Pisa review (25s6 ofpc7unit fie)
f State surcharge (8%ofpermitfee)
Print ttazne: �1 /d//; i _ . . / • ,- Date: _ b
TOTAL lA PERMIT FEE
Authorized signatur : '. � / �_ / • This permit appl cation empires it a permit is not obtained within 180
days after it has been accepted as complete
Print name: 5 , / Date: is / • Pee methodology ter by Tri-Canty Building Industry Service Bentd
as Number of inspections per pemdt showed