Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00353
` °.. COMMUNITY DEVELOPMENT DATE ISSUED: 6/19/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 111 DC -02500
SITE ADDRESS: 15745 SW ALDERBROOK CIR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.8 LOT : 472 JURISDICTION: TIG
PROJECT: DUROCHER
Project Description: Installing (1) service.
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: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
MARY DUROCHER RK ELECTRIC INC
15745 SW ALDERBROOK CIR 24495 NW OAK DR
TIGARD, OR 97224 HILLSBORO, OR 97124
Phone: Contact #: PRI 503 - 640 - 1344
FAX 503 - 356 -0513
FEES
Description Date Amount Reg #: ELE 34 -375C
[ELPRMT] ELC Permit 6/19/2008 $80.30 LIC 94275
[TAX] 12% State Surchar 6/19/2008 $9.64 SUP 4724S
Total $89.94 REQUIRED ITEMS AND REPORTS
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 O: - 952 - 001 -0100. You ma . stain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
/ t
Issued By: , ��_ / `� /� Permittee Signature: C / at,
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'N: 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.
,. . • s• Jun 19 2009 11:OGAM HP LASERJET 3330 p. 1
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Electrical Permit Applic miliT CEIVED FOR OFFICE USE ON 1' ' .,
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City of Tigard
� i
13125 SW Hall lvd., Tigard, OR 972�,,33, , i 2008 D an Review / ®h(
Received l .__. ^ " , '
' Phone: 503.639.4171 Fax: 503.598j2,6011 1 9 2 008 DateBv: Other Permit:
T: C... h l> Inspection Line: 503.639.4175 Date Ready/By: H See Page 2 for
Internet www.tigard or.gov Notified/Method: A Supplemental information
€art • ai
0Mili ll . , It l�, ° n I s` E iu 1 u m ;,� y� , 57 ' " ' tom
�. .s.- ..t alca�rasbswaaeintm- �I �l:�t�_�4�� � #.lti.l�i ��i�_����ui " � IT �:,��:be - ,�;1'• ", -. I ,.:7` S,L.0 ,.o _ '3 .,,
Please check all that apply (submit sets of plans wincing checked below). New construction m Addit ion /alteration/replacement
❑ Service or feeder 400 ID Demolition ❑ Other: where the available Etult p o
current ❑ Bui over o hr y e stories.
ads ',.'t.:'," t ,@ pnntgtttml�uianitry sntlmet +toll ❑ Marinas and boatyards.
..iX'3 r S S. i , r lid tq : Gib - ' 8 @a'a t9 qtr 1 4= M. exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
i g ❑ ❑ ry.
I a t 1 . � rrga d� t _ tt ,. r n ,a fi,1,1 , ,, less to ground, or exceeds 14,000
gr ❑ Commercial -use agricultural
ID 1- and 2-family dwelling Commercial/industrial Accesso . building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: . Fire pump. ❑ Installation of 75 KVA or
O t o ttr� a as ra tae5 tstac+ n �t:z `+- ,i'rE# M =at. 0 Emergency system. larger separately derived system.
1;1i 'P. �i 1 t : h • iiril ' nhl lladisttnum fallif tie Ik vdvh, I 1 i r PiJ RI11 It ❑ Addition of new rooter load of ❑ .•A ", '•E ", " " 1-3 " ,
Job no.: 813 Job site address: 15745 SW Alderbrook Circle more. c
❑ Six x o or r m more n residential units. ❑ R ecreational vehicle parks.
City/State/ZIP: Tigard OR 97224 ❑ Health facilities. 0 Supply voltage for more than
❑ Hanardovs locations. 600 volts nominal
Suite/bldgJapt. no.: I Project name: / I' 4 f ❑ Service or feeder 600 amps or more
�'` rrY "J te4 ST}
Cross street/directions to job site: ' t `"I r°a,, of li t tt , Fee.
�A t
.° t t i:� �,�L ,.� t,� � #rt? n - I Iwc,;
I D escription 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
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.. Limited energy, residential
t t ,ar , is a trt � e�pp@@�,pEr t��ttr��dT��;,t�p I! tp�� 75.00 2
ar
" i;, -.;i = . : ` , <.- . 5ii ;'1s iz l� zthT Ela " E'I'n4 . 7. a 111/01/1 .111 W (with above sq. tt.)
Limited energy, multi - family
Panel Change residential (with above se. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 1 80.30 $80.30 2
.p i ,- ,, -. "rt4 63 .Y1 % 7.. MI 7 I Ij
, f- aL z�- , e4.4.4(xx , ' i l 01 n ll . Io. '-'' .. w v aNitt i ii ` d is f : 201 amps to 400 amps (06.85 2
Name t /� I 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner
�� signature �p gy�pp,, Date A. Fee for branch circuits with
r lid Ermgl .I Il f' If la ll ¢ _ 'liLrlIklla a$ a " tl :ql i s above service or feeder fee, 6.65 2
each branch circuit
Business name: RK Electric, Inc. B. Fee for branch circuits
Contact name: Robert De La Cruz without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (503 ) 640.1344 Fax: : (503 ) 356.0513 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
,E ik . ,.d : Ain` .`,/ 3ilrvi; 'i;R.v 1 • = I1 Ill,.rI , u Rt .:> € I)' Si or outline lighting 53.40 2
Business name: RK Electric, Inc. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 24495 NW Oak Dr. extension. Describe: Page 2 2
City /State /ZIP: Hillsboro, OR 97124 Each additional Inspection over allowable in an of the above
Per inspection 62.50
Phone: ( 503) 640 -1344 i Fax: (503) 356 - 0513 Investigation per hour (I hr min) 62.50
CCB Lie,: 94275 34 -3750 Suprv. Electrical Lie.: S u rv. Lie.: 4724 -S Industrial plant per how 73.75
i nd " 1 STIERVI ZEMIT :ilk I 3 .1 a l it ,' /111r:1
Suprv. Electrician signature, required(
.,
a deg ,, . _ Subtotal: $80.30
Print name: Ron L. Kurtz Date: 6/19/08 Plan review (25% of permit fee): 0-
State surcharge (12% of permit fee): $9.64
Authorized signature: . ' • l TOTAL PERMIT FEE: $89,94
Thin permit application expires if a permit is not obtained within 180
6 /19/08
Print name: Ron L. Kurtz Date: days after It has been accepted as complete.
* Number of inspections allowed per permit.
1:13uilding?eamitsiELC• P rmitA5p doe 55123)06 140-46 15T(1 I /05 /CcM,wEB
CITY OF TIGARD
BUILDING DIVISION 't° PERMIT #: ELC200&00353
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/19(2008
Phone: (503) 639 -4171 topiliiqi Il'i
Inspection Requests (24 Hrs.): (503) 639 -4175 .r._.111 -__..
INSPECTION WORKSHEET FOR DATE: 6/26/2008 TIME: 7 :00AM PAGE: 14
SITE ADDRESS: 15745 SW ALDERBROOK CIR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.8 LOT #: 472 TYPE OF USE:
PROJECT NAME: DUROCHER
DESCRIPTION: Installing (1) service.
OWNER: DUROCHER, MARY , PHONE #:
CONTRACTOR: RK ELECTRIC INC 1-10 o is , PHONE #: 503-6011344
Inspection Request Scheduled For: Date: 6/26/2008 Pour Time:
Code # Inspection Description / oG . Ifi�# Contact # • . ssage
199 Electrical final 071879 -01 503 -640 -1344 Y
30 rnIIJ ,
Corrections /Comments /Instructions: 'a\ • - 32.( ) S •
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►A PASS PARTIAL APPROVAL ❑ CANCEL ' NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Gm, \ cia, LE Date: 4 tilo 6 Phone #: (503) 718- V