Permit ,1.
CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00304
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/22/2009
Parcel: 1 S133DD10500
Jurisdiction: Tigard
Site address: 11894 SW 125TH CT
Subdivision: VILLAGE AT SUMMER LAKE PARK 4 Lot: 142
Project: Rueck
Project Description: Install (1) 200 amp service, and (5) branch circuits.
Owner: FEES
RUECK, GREG D & DORSEY J Quantity Description Date Amount
11894 SW 125TH CT 1 ea Services or Feeders - 200 06/22/2009 $80.30
TIGARD, OR 97223 amps or less
PHONE: 1 ea 12% State Surcharge - 06/22/2009 $9.64
Electrical
5 crt Branch Circuits w /Purchase 06/22/2009 $33.25
Contractor: Service or Feeder
OREGON ELECTRIC CONSTRUCTION INC 0 ea 12% State Surcharge - 06/22/2009 $3.99
1010 SE 11TH AVE Electrical
PORTLAND, OR 97124
PHONE: 503 - 234 -9900
FAX: 503- 535 -2763
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $127.18
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
l
Issued By: t et L I � { , Permittee Signature: < 111 1 JJJ J" L,' r ( C)1l
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
JUN-17.09 12:57 FROM - OREGON ELECTRIC MARECEIVED 5032349900 T P.002/002 F -864
Electrical Permit Application 1 oR Orel('E I_ ,;r: 0.1.1
City of Tigard JUN 17 2009 R te$ Perm : E ` ��1♦! ... op
I II a phone: 503.639.4171 Fax: 503.598.1960 13125 SW Hall Blvd., Tigard, O 97223 CITY OF TIGAR 1 J other Permit:
r , AID Inspection Line: 503.639.4175 BUILDING DIVISI I ate Reaa /ay: NMI F Svc Pn>:e Z for
Internet: www•tigardor.gov Notified/Method: Supplemental Information
• TYPE. OF WORK . • PLAN. REVIEW
El New construction ® Addition/alteration/replacement
Please check all that apply (submit 2 sets of plans wlimms checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current El Marinas and boatyards-
' CATEGORY OF 'CONSTRUCTION • exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- less to ground, or exceeds 14,000 El Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial El Accessory building amps for all other installations. buildings.
El Multi- family ❑ Master builder ❑ Other: 17 Fire pump. CI Installation of 75 KVA or
. ❑ Emergency system- larger separately derived xyxtem.
JOB SITE INFORMATION AND LOCATION ❑ Addition orncw motor load of ❑ "A" - E" "1-2", "1.3 ",
Job no.: 73859 Job site address: 11894 SW 125''' CT 100111' or mote. 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: DORSEY RUECK ❑ Service or feeder 600 amps or more.
FEE SCDULE
Cross street/directions to job site: Descri Qty. Fee Total -
"-.—.-- New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: — 1,000 sq. ft. or less 145,15 4
Tax map/parcel no.: Ea add'! 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. it.) -
P
• ' i s ' 1 / t r Li d ntial energy,
(with obi o ve aq y ) 75.00 - 2
' ' ;1; ' •' ' \ K� � • 1 'y A 1 rnsirntial (tlr abve s . R
Services or feeders installation, alteration, and /or relocation
1 , r',� \C ` Li) ? O , , i 0 (> c 'i().t� C C. 200 amps or less I 1 80.30 2
❑ PROPERTY OWNER .I . • ❑ TENANT • 201 amps to 400 amps 106.85 2
Name: 401 amp t o 600 amps 160 2
- . 601 amps to 1,000 amps 240.60 2
' Address: Over 1,000 amps or volts 454.65 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 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 701. 401 amps to 599 :imps X 133.75 2
Clymer si inure Date: Branch circuits - new, alteration, or extension, per panel
1'>n A, Foe for branch circuits with
❑ APPLICANT • . ' • ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: 8. F for branch circuits
without service or feeder fee, 46.85 2
Contact name: _ first branch circuit
I Address: Each add'. branch circuit 6.65 2
1 -- Miscellaneous (service or feeder not included)
City/ State/ZIP: Each manufactured or modular 90.90 12
dwelling, service and/or fcedcr
Phone: ( ) I Fax: ( ) Reconnect only 2
E-mail: Pump or irrigation circle 53.40 2
• CONTRACTOR • Sign or outline lighting 5340 2
Business name: OREGON ELECTRIC GROUP Signal circuit(s) or limited-
energy panel, alteration, or
Address: 1010 SE 11 AVE extension. Describe: Page 2 2
City /State/ZIP: PORTLAND OR 97214 Each additional inspection over allowable in any of the above
Phone: (503) 234 - 9900 I Fax; (5035) 535 -2763 Inv esti gation ms gat i o n 62,50
nv per hour (1 hr min) 62.50
CCB Lie.: 203 I Electrical Lic.: 26 -95C ! Suprv. Lie.: 4549S Industrial pmt per hour 73.75
• . ELECTRICAL PERMIT FEES .
'
Suprv- Electrician signature, rec � �
Subtotal: -- 66r85"
Print name: RICHARD MCELLIOTT Date; 6 - 17 - 09
Plan review (25 of permit fee);
Authorized signature: I CState surcharge (l2% of permit fro): -tt •0£
� ��'�; TOTAL PERMIT FEE; al.8.7-
Print name: RICHARD MCELL1OTT Date: 6 -17 -09 This permit appileadon expires if a permit is not obtained within 150
days after it has been accepted us complete.
• Number efinspectiors snowed per permit_ ( f , 9 � r -
J
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N :me of supervising electrician: h l C{!1 Q Yal, - M G I) i 0ii- Date of request: ( / 171 V00
Supervising electrician's license number: L5LC1 S Date installation was completed: 1 I
E ;ctrical permit no.: _ If a temporary perrnir is posted at the job site please include a copy of it with this form.
Al':-!V M ,1 to M:M•, tED REOYIN ETRI AEY.,c0W►1T fNEOF,.II T #, �, �''
�'s�ELE. r' �• RAFT ,. � i1�AT10�1 : "`�t�� *;'�r'��'+�'�'�� �,1•,gri$'ts��
Name of electrical contractor: 01 ■ an ei 1(1 OV License no_: cl. to - R5
Business address: 10 0 S' f� ; State: :r,_ zip: c31. �
City: Q . --
Pine: ,3 - z-1 - 'IgO a Fax:SA3 3 /00 ( E - mail: c E . I adSore e Ie i-i e - oil
,. : n A'FI. .d Mr �x ' .4: �` b' -.• n � ��
�, ;i�;ik�a�.as�'+,.�a���}f���� �',: ��'t n : '1�'�E�s��:;��.,, rt R a' } l1Sl['�Ol1AERPRI'1+]FORIIII` � ONI��•�l -d ��' �, " A.�t���'�?��,.�' , „_ �;t�o,��s� htt-
C ustomer's name: 1rS �' ..g MCC K w .
Customer's address: f i g eV 5 Gk.) 1 2 5 111 C+
City: a r S t a t e : Dg ZIP: 2 7 Q S
P .ddress o installation if different than customer's address:
City: State: ZIP:
, -r N •, i n 4 NFORMA31011 J 05- ! 5g10�+° '- ", :;i' /4 : g,` i'i i kak"
x4�d��gr t�- rM {; ���ii,'.t,9�;�t,'±�._ ���ii; =�, NS'PEGT•Ih1 5(`+.,'AUT•FIORI.TY:;:1 `` tom' °
authority having jurisdiction to inspect ( - .1 fl trd _ Phone: 5)3 -(../3 1 •7 r
Address: 131 Q 5 5fr -Hai{ Fl ‘......1
S tate: () ZIP: 37 2 3
city: t /, �(`..
7. � T �r { r. a¢ ' hr ;'!!RE 1 r . ORMA�ll10g1 4VrW17 r! �- IV0 "r:u 2Q
_ . -�;.� �R ..� • _ . - .'- ��3: � ,:•: ; �CEI• IN�G' �`El_l= t��7,�RIG .U711:.[Tlf�' :1N F. •� �;• "..._ .•�, : t�,'s l�ll• �:,
W 'A3 5-f Y-15 C)
Z;fame of electric utility receiving request: �{� � �(r1 �frQ �. ,�� Phone
6a3
fa{ 1,3 666006 State: LA
car car , i , an e e: 7� ZIP: q7` .0 LA
1 , :_3 �'�C•TKN'w i I " �-SI' ..•. 0 ,,, it it i.. �.:' ��"•.A ;,.+�,''" . :,5: w y::?_'; I ti• N„ i . i, ;: ^w.:1., ?.r s,',:
�����; ��� :�,�- r�.7F�+F�; ;,;�a�,,. "r;a�;� �,,:": v�, ns, ��,,'�`�s�•..,,.at�of�l-= AS'.ON `FOR�^.REQUEST'�..:�;,� '.r �i � t• r�:;;" •'1~r,.�?:- :.n:..
L. Restoring electrical service at was interrupted or disconnected because of eithr r a:
❑ Service change or Uncontrollable event, such as fire, Mod, or severe weather;
or
liI. Electrical service at a remotp location needs to be:
❑ Initialized Restored _
`: w`' :r'itt;':r' =r:. cryi ;i 4-4 F :, x;� ETE'ONr_INS'fR " ' ?',?Ia ^" = µE�� "' :, ,
• COIVtf?L S� °-AND> )GNAr'IJI�I`.; ='k _ . � 9,
l;iupervising electrician Electrical contractor
Note: After sending this form to the electric utility Note: By close of business on the first business day following
named above, you must send a copy of this form to: energizing of a completed installation in response to the above
(1) the electrical contractor, (2) the customer, and request, you musr. (1) noii:y the authority having jurisdiction
(3) the inspecting authority. that the installation has baen energized, and (2) request that the
'P 3 - 7 r 4 authority inspect the coin feted installation.
upervising electrician's signature A Electric utility
Note: Please consider notifying the inspecting authority
7 ?i ell a rcl r ` 0611, b identified in this request when an installation is energized
[� r N5 r1.n q� before inspection.
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.Ci-19-2009 06:08AM FROM- T-873 P.002/002 F-489
Electrical Permit Appjici_tt_ton" IIIITICE USE ONLY
City of Tigard Received PmbiltN° :. n c 2 .tit) 10 11
1113Iva., T
13125 SW ard. OR 07223
113ig
, p Phone: 503.639,4171 Ems: 503,538060
IN =al .
Plan Review
DadB . " . -
Other remiie
Inspection Line 503.639.4175 onto ft yr*. - PI. see rpm? z for
Internet www.tiprd-or.gov Notifediblethoce suppiceaccum lrmation
- . .
'''''''' ' "' ' '''. ''''iiiM''jittiiir*irl.f,•••,:■)ZW:,;:;.),:.,. ,,-,:i...
443 §,.tLi/T.471:.:i.O .." , ..-:: , ..A,::' - . ..Z., . ..." ? .6;An. 't :.- 'A •i
'Ll New construction El Additionfalterationfreplacernefit - mom omit ce urn appigMimitlacw or wfir-rn ch=
CI Service or ft- td:w 400 op ar men Cl Building over throe alOrioo.
0 DctOOlitiOn. El Other umete the av Odds fault curium El Masinna mid boatyards.
Floating baliallaga.
• .'Pzzi.:.:',_! rii::i.5 ..--it•ft.. ._....;:.1.i:7.---1,r.-`?"..4.F--1,tekvF).•?•,:•;:.:4:. ics. cc roue i at weeds 14.000 IZI Commercial-use aricoltursi
El
1- and 2-Eimily dwelling ID CommercIa/finclustrial U Accessory building m kw. sli Aber installation°. buildings.
LI Muhl-family 1:1 Master balder Ei Other I:1 'rum rimy- Eltiondiatico u175 KVA or
El Emereency o yrtech iargar acesranny derived aysicm.
'eo ylje*iii5--k7.1tr.1444•141,0114•;;:
. y.. - :•: . t.....:•./: ...:::.;;^-%...:.•,, i' ,..,... ::- : :; . . . .. - f- :. ....-1 - - 4 '',. ( ?Pk , ,,r?' c"■,.. e-- •
HOW or Mac. occupancy.
.1073R;; . itc addrcss: 11894 SW 125 CT 0 sk u,i. mon :c.idasatial oaks. 0 Peorondonal vehicle parka.
. _
City/Slate/ZIP: TIGARD OSt 97723 Li etaalth-carc )1iitifil inStipplyvoltap for more than
_____ _ 0 lima:vim locatimui. KM von nominal.
Suite/bIdgJapt. nO.: I Project name: DORSEY RUECK LI Sari= or 0 et:er 600 amps OT111 OM
- .--- " 1 :;. -2 435 1 !::: 1 1f.1W.g0.0-01f1 - :EIA■:', 4 , ,,, ,...,f:krIg i ;;: -. i$/ , i , i ,,,,,, :
„. .
Cross Stroevaireclions to job site: DUCt10011 Irrall 11111UMMI Told • _
• . NewresIdenilmi single- or muld-Yamily dwell* mill.
• Includes atm eled garage.
Subdivision: I Lot no.: 1,000 eq. ft_ cr: cm
110111:13)71■111011
-- - Adel 300 sq. ft or portion 33.40
Tax map/parcel no.: Limitccl eneri:y, re:ideate' 75.00
-.,.,..:. K., ..1 ,....-r■..:: %.■'..:44_:).ttit.:'! hA'ritf g.....: • ,..
..", ;1. t. A ,ili a Pr; 4r-l.t.e• ' ,•'', ., -, 45k-ble:KLETISM • PUI " •:"` ,-A.•;:i;S. - ... - 3"7 , 4$ 1 "'e- V.% ‘,.. (with above sell_ .
Limited alert 5 nnalti-farnay 11111:1
REFA1R1VLETER RASE DA 75.00
TV VERIZON resiamdall taiti above a.. ft.
—
Ser•icas or f mdcra innallation, alteration, altefor tolocadon
200 amp? or 1E:s 80.30 2
i gi . ,V, ' ' ' f_ '' .; iZ.Y70.-k0** ', ,, k..*-1 , • 1. . 1 ?: 2 " 1 : . ' 201 arinas ic 6 oinPs 106_85 Z
Name: 401 amp: to 140 amps .1111 160.60
• 601 amps to : ,G00 gems Ill 240.60 MI
Addre m ss: O 1,000 a n;35 or volts 454,65
City/State/ZIP: Temporary , *N'IfiCCS or feeders instailatiod) AiitirAtiOn, =Wm
• - _ relocation ,_.
Pbo= ( ) 1 Yak: ( ) 200 amps or .,c7s. 6645 _
Owner installation: This installation is being made On property that 1 own which is not 201 amps to ■I(10 awe. )00,30 2
inrcndcd for sal; lamer, rent, or exchange. ttworcling to ORS 447, 449. 610, and 701. 401 amps to fi 9 maps 133.75 2
Branch circuit c -sew. alteration. orextenNion. per panel _
7-- -. Owner signanuo; Dille: A_ Fee for broach circuits with
-
' i:i'l.11e .' °Ixa * ° °r r fc°, 6.65 2
4r-1s branch circuit
Business name: S. Fee for bc ;nth circuits
without se re lee or feeticar fee,
Contact name: 4615 2
first Imam h •tircuit
., - —
• Address! Each. addl brmiclt circuit 6.65 2
- tukconunou is (noeviee or feeder not included)
aty/StattatP: Eitel manuft gratai or modular 900 2
__ thaeliifig. fict di= multor feeder
Phone: ( ) ----F1:7)--- Reconnect ma!' I 56.85 66.85 2
P.,-maill Pump or /Aril ation circle Mill 55 .1111111111
?.'efe-•;.'-7.k.;.?:' im,,.....,;ii sign or outline lighting XIII 53 WIRIER
o
Business name: OREGON ELECTRIC GROUP Signal circui(r) or limited-
cum peed, :Ileration. or
Address: 1010 SE 11 AVE onion. Drib= Page 2 2
City/Shaft:MP: PORTLARD OR, 9721
Each additijenatinspcction °Yee allowable is a' Of clic Above
Per inspeetio n 62,so
Phone: (503) Z34 Mx S-2763
Invostigatior_prt hour (I le mho 62.50
MB Lic.: 203 Electrical LSc.: 26.95C Suprv_ Lit! 4$49S Industrial Film per bout 73.75
I • r
Suprv_ Electrician signature, 03gratrS)c Ilk c... 0) .. &mow, 66.85
Print name: RICHARD MCELLIOTT Datu: 6-17-09 - ?kin review (s% of p ermit fee);
5.al e surcharge (12% of permit foe)! 8,02
Autbori2ed signature: ItlittNiMititi '9.. vi % .C- to _ - .. - -
TOTAL PERMIT P2: PE:. E 74117
Print tlaffle! RICHARD MCELLIOIT Date: 6-17-09 mu pus* rrPalotidno m o w ir o perndtlit not Obtlided,ithin WI)
dors ales hes bow, accepted at campktc.
• Numbmornviroolinnit ode.rad per permit.
butaidineramIntELC.IrcrraliApamc o9234,.....,...7" 40.051 six i 11051COMAIMB
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