Permit CITY OF TIGARD ELECTRICAL PERMIT
. .'- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00434
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/03/2011
. Parcel: 2S111CC19200
Jurisdiction: Tigard
Site address: 10335 SW GREENLEAF TER
Project: Kilkenny Subdivision: Lot:
Project Description: (4) branch circuits for kitchen remodel,
Contractor: A & J ELECTRIC Owner: KILKENNY, JULIE R
PO BOX 330 10335 SW GREENLEAF TER
FOREST GROVE, OR 97116 TIGARD, OR 97224
PHONE: 503 - 359 -5891 PHONE:
FAX: 503 - 359 -1981
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 08/03/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/03/2011 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
Required Items and Reports (Conditions)
This permit is issued_subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in a rdance w approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT TION: Oregon -w re uir= you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 10 through OAR 91 001 -Oki u may obtain a co•y of the rules or direct questions to OUNC • • ••::•.• ° 2.1987 or 1.800.33 .2344.
/
Issued • _/ i Permittee Sig •ature: .? i_ s' !irEMP
'
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' � Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Aug 02 11 07:56a Leeann Greason 503 - 359 -1981 p.2
Electrical Permit Application ��‘1/4 C ) . - ' '. R OFFICE USE ONLY
City of Tigard ® \ R eceived
F Re Re . - - / . ��1 Permit No.: E � / % � 3 ,
13125 SW Hall Blvd., Tigard, OR 4.12 3 a �` � Plan view
' r` Phone: 503.639.4171 Fax 503. 8.1'k V .1 ,. Dat /B . Other Permit:
TIGAILD Inspection Line: 503.639.4175 �� „` ° t ; „� ' Pate Readv;By: 111 ris: 0 See Page 2for
Internet: www.tigard- ar_gov Q� '`' Nolifed'Method; Supplemental Information
�� e$A
:1 : on6 ° y! � n tu t > r ;:.. K..a ,44 € a ' b n .l' .. � --,n. . .tom � � t �
❑ New construction ® Additionialteration /rep'1°apaeyment F'lcr I •:ek all that apply (submit 2 set of plans wiitems checked below):
V ' ❑ Sr- or feeder 400 amps or more ❑ Building over three stories
❑ Demolition El Other: V r, , •:: :he available fault current ❑ Marinas and boatyards
• r t . r' H e.,A, i 7� ` ' 4, r 'ms ,� e j : s�a`� 'M,, � ' (i;b. '?I• Is 10,000 amps at 150 volts or ❑ Floating buildings.
•_rowtd, er exceeds 14,000 ❑Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial 0 Accessory building !m all other installations. buildings.
❑ Multi ramify ❑ Master builder ❑ Other: ❑ - I. I ”' SIP ❑ installation of 75 KVA or
* ' - s c i t ,, :'^e ❑ Fir,'tt,ncy system largr separately derived system.
d
. ,, i2 a ; e in t t, r - f '.,3 6 esa � - ` v �:.m of ....or load or
Job no.: Job site address: 10335 SW Greenleaf Terr Par more. occupancy.
❑ ti' ,., more msidcntiat units. ❑ Recreational vehicle parks.
City!State /j1 P: Tigard, OR 97224 ❑ Fie :;•tl.care facilities. ❑ Supply voltage for more than
❑ (s •_rdaus locations. 600 volts nominal.
Suiteibldgiapt. no.: Project name: ❑ n .ice or feeder 600 amps or more.
Cross street/directions to job site: Qty. s«: . ' •
. I'.I iitial single -or multi- family dwelling unit.
In,:,r,.,; attached garage.
Subdivision: Lot no.: I,0l)u iq . R. or less 168.54 4
- . aci
Ead'l 500 sq. ft or portion 33.92 1
Tax map/parcel no
r - n
Limed energy, residential 67.84 2
Lim i°rl energy, multi - family
Kitchen remodel r .;: cntial (with above sq. 4.) 67.84 2
Ser . or feeders installation, alteration, and/or relocation
203 r , ; ts or less 100.70 2
- rt io r. t tit AF 1 . 3`: F w �
;Pa ;t% fK ,:. 201 it.p,1o400amps 133.56 2
Name: 40' , nos to 600 amps 200.34 2
60; •:v:;; c 10 1.000 amps 301.04 2
Address: Ov; ,ni0 amps or volts 552.26 2
City /State /ZIP Ter.. ,Mary services or feeders installation, alteration, and/or
reif, inn
,Phone:( ) Fax: ( ) 20( I .1;,s or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 __ _L.'
10400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701_ 401 :n;, s to 599 amps _ [68.54 2
Dr: +ni. n circuits - new alteration, or extension, per panel
Owner r signature Date: A. r i r branch circuits with
:r rat. , `a. rte :. ` atx �x>,, :a2v ^ t § e; .
- ,.r ; . ..,. - ;� � _ ', ' � a , nx,-3 y!'. _?: . e rv ic e or feeder fee
7.42 2
73.. _' arch circuit
Business name: :.� ._r branch.circuits
Contact name:
v;f' :u! service or feeder Fee, 1 56.18 56
L i l t tranch circuit
Address: Fact, . ::te'I branch circuit 3 7.42 22.26 2
Misc .ltaaeous (service or feeder not included)
City /State/ZIP: Ea.I •...;rn ufaetured or modular
Phone: do.�.ri_ : service and/or feeder ; 67.84 2
( ) Fax :: ( )
ker :. met only 67.84 2
E -mail: _ Punt ;:.tr irrigation circle - 67.84 2
y •; ), „,. e : -; €g ;v1rT 'It e:�y t g c'vt” ,' A :! `_ "•• ( J : .;' r i Sir„ -line lightin 67.84 2
Business name: A &J Electric, Inc fl ea :' I :arcuit(s) o limited -
cnc:;'. �. net alteration, or
Address: PO Box 330 I cx-n -.1. Describe: , Page 2 2
City /State /ZIP: Forest Grove, OR 97116 : : , .dlditional inspection over allowable in any oldie above
of fee):
Phone: (503) 35 etron 66 -25
e /'1 :5891
(503) 359 -1987 e-'er-i
m , iron per hour (: hr min) 6G 25
p�
CC:13 Lie,: 959 Electrical Lie.: 34 Suprv. Lie.: 5055S I 5 Ind tl plant per hour t,8 18
gill'/ l . _, ' .� t.ltT z
Supt-'. Electrician signature, required: j.. ./2"
1 Gtf _, Subtotal: '�%,,, ....
ra
Prinl name: Anthony Wilson 7 Date: 8(2(11 Plan review (25 %ofpcmtit tee):
_ ,-- Slate surcharge (12% ¶41f
(12% ,
Authorized signature: L. TOTAL PERMIT FEES: %`•`\ ''7,.S
Print name: TI — •1nernit application expires if a permit is not obtained within ISO
_ Die days after in has been accepted as complete. titx
I:'•.RuilJinq\3�errnus `.ELC -Ve, mil.k do • ! 1::!•_t, of inspections allowed per permit.
c 10,01550 440 -161 nun .os /COM :WEa