Permit q CITY OF TIGARD ELECTRICAL PERMIT
''• = COMMUNITY DEVELOPMENT Permit #: ELC2011 -00332
Date Issued: 06/17/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1 S134CA06600
Jurisdiction: Tigard
Site address: 11950 SW BURLHEIGHTS ST
Project: PFAENDER Subdivision: BURLWOOD NO. 2 Lot: 15
Project Description: (2) branch circuits for kitchen.
Contractor: RK ELECTRIC INC Owner: PFAENDER, DAVID M CHARLEA
24495 NW OAK DR 11950 SW BURLHEIGHTS DR
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503 - 640 -1344 PHONE:
FAX: 503 - 356 -0513
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 06/17/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/17/2011 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 •, 952- 001 -0090. You m. : _•py of e ru r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Al.i. Permittee Signature: ..5.- a.Y�' .0 ''
/' //
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.
Jun 16 2011 12 :55PM HP LASERJET FAX 5033560513 p.1
Electrical l`ermit Aulicntion F(:)1t ( I4 . 1 I,.I: I!SIB, ONl,'•
� � Received '!
1111-- II C' of Tigard ' R Perini- No.' LC 3 ti -- �1?
131.5 SW lull Blvd„ Tigard, OR 97223 Plan Review
f . Phinc; 503.718.2439 Fax: 503598.196 'C Date/Ely: Other Permit!
'l•d 6, .1 !t E?
Ins ectlon Line: 503 , 0 Data Road /13 y y •.. Jur +a: HI See Page 2 for
Int.mgt; www,tigard- or.goy L f Not fleclivlothod; 00 Supplemental Information
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❑ New C0tt91ru ion ®Addition /alteratlon/ropl t 1V - • pietne shack all that apply (submit 1 seta of plan w /items checked below)
, \ , ❑ Service or Rader 400 amps or more CI Building ever three storie
where the available fault current ❑ McInnes and boatyards, s,
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C.. 1 - and 2-fami y dwelling ❑ Commercial /industrial ❑ Accessary building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
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Adding amps for ellother installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ lit tnlletion of 75 KVA or
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Job no.: 3330 Job site address: 11950 SW Burlheights St. 100HP or snorer occupancy.
['Six or more residential Anita. ❑ Recreational vehicle parks,
City /State /ZIP: igard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more Om
_ - - - -• ❑Hazardoss 1poatio45, 600 volts nominal,
Suitc/bidg.lapt. n ..: Project name: Pfaender In en. r imps or mars,
:.A co v scad 600 €
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Cross street/dire • -
tions to job site; , ," ` r .
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- Dererlpil.n Qty, I Fee. Tolnl
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: - I Lot no.: 1,000 sq. ft. or Less 168,54 4
- Ear add'1$00 sqr ft, o portion 33,92 1 •
Tax map /parcel Q • _ . _ --
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Limited energy. multi - family 75,00 2
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(2) circuits for - tchen upgrades resideal (with above sqr fir) _
• - Services or feeders installation, alteration, and /or relocation
_
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. 133,56 2
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401 amps to 600 a mpa 200.34 2
Name; _
601 amps to 1,000 amps 301,04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZiF: Temporary services or feeders Installat1ran, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59,36 I
Owner instellati • n: This installation is being made on property that I own which is not 201 amps to 400 sines _ 125,013 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 544 amps 168,54 2
Branch circuits - new alteration or extension .er it anel
Owner signature: Date; A, FCC for branch circuits with
. a s ere
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r ,. , ,. 7,42 2
ce or feed
each branch circuit
Business name: B, Fee for branch circuits without . service — .. -- service or feeder fin, first 1 56.18 $56,1 S 2
Contact name: branch circuit
- 8eah udd'1 }ranch circuit 1 ... 7.42 $7.42 l 2
Address: _ Miscellaneous (service or feeder not included)
Each manufactured or .nodular
GityfState /ZIP: dwelling, service and/or fbeder 67,84 2
Phone: ( ) 1 Fax:: ( ) Reconnect only ,- 67.84 2
Pump r irrigation circle 67,34 2
E -mail: _„ -
.•.r r •T' . , - - ••••' ° ...r:. -
Sign or outline lighting 67,64
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' � • '� '��''> • 'w• = "'�• "•• '• " i gnal oirauit(s) or lirnitod- energy
Business name: K Electric, Inc. panel, alteration, or extension. - Page 2 2
- Each add inspection over allowable in an +_oo the above
Address: 24495 W Oak Drive Additional inspection (1 hr min) 6625/ hr
City/State /ZIP:. lllaboro, OR 97124 Investigation (1 hr min) 66.25f hr
Industrial plant (1 hr min) 78,18/ hr •
•
Phone: (503) 6401344 I Fax; ( 503 ) 356,0513 Inspections for which no fee is
° ... - s ecitcall listed 'h hr min 90,00! hr
CCB L ic.: 9427 •. Electrical Licr : 34.375 O Suprv. Lic,: 4724 -5 � Ytt
1:;;, '. .,. . .. :rf. , , ° -,..
Suprv, Eleetriciu signature, required; "OFF ,. Subtotal: 563.60
Plan review (25% of permit fee):
Print name: Ron L. Kurtz D ate: 6/16/11 - State surcharge (12% of permit fee): $7,63
Authorized sign: TOTAL PERMIT FEE; $71,23 j
Oh. i .._. This permit application expire* if* permit Is not obtained within 180
Print name; Ron / Date: 6116/11 r days after it has been accepted na complete.
N , of inspecsions allowed per permit,
IABuildinglermltp\ - • rrntIA.pp,d44 0 ?/C1/10 440645l5T(11 /0! /CONI/WEB