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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00653 131 25 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2011 I1 G A'RL� Parcel: 2S103BB03500 Jurisdiction: Tigard Site address: 12193 SW 125TH AVE Project: Brown Subdivision: BROOKWAY Lot: 35 Project Description: Panel change and (2) branch circuits for heater and lighting. Contractor: RK ELECTRIC INC Owner: BROWN, MELODY FRANCES 24495 NW OAK DR 12193 SW 125TH HILLSBORO, OR 97124 TIGARD, OR 97223 PHONE: 503 - 640 -1344 PHONE: FAX: 503 - 356 -0513 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 11/18/2011 $100.70 Specifics: amps or less 2 crt Branch Circuits w /Purchase 11/18/2011 $14.84 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 11/18/2011 $13.86 Electrical Type of Const: Occupancy Grp: Total $129.40 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 OA -0r -6190. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ^ / Issued By: r `� / Permittee Signature: /^/ l / L —jC� 70 " v 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 —SURR. -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. Nov 18 2011 10:35RM HP LRSERJET FAX 5033560513 p.1 • EIectrical Per Application w� 11.4)141 01- I it l' WO.: urgi v City of Tigard 1?..- 61\11 V Datel ; w Ef , = �f L _ , — / (�t! v S -armtt •n.: • 13125 SW Hall Blvd„ Tigard, OR 97223 Review t I . " Fhone: 503. 718.2439 Fax: 503.598,1960 r 011 Date/Hy� a ' ther Permit, i i ( A • t'. inspection Line: 503.639.4175 1' : . DA! Rendy/Dyi 0 lurl� El See Page 2 for Internet: www,tigard- nr.gov TiC �4�ified/Method / /� Supplemental Information .. . ,. .�.,{r'1: ri :n'..n':,:• ...,. r :f:, P.�6jY 'i:j .:br '. 'i;0 lilt" :. 171 ! tl,i 4 �/ ii �, F , }(r.� � {I ,„ .,i - Y „ (`� ai ., t , I .. A# r,. \, i 1 l ll ' ', ,. ❑ New Construction ( .. Add it'ion/alterationOliVkcement Please check all that apply (cubmlt Z sets anions w /katne chocked batc.v) DI Service or fonder 400 amps or more C) Bu over three stories. ❑ Demolition ❑ Other: where the available fault currant ❑ Marinas and boatyards. \� � y .�� ,y � \ �,...�, .l, tr \:,r � `` ep: \ � t7 �, r�r. r , ���,p,��� I „. , exceeds 10,000 amps at 110 volts or ❑ Floating buildings. '' .'9 't � l <3<''i;'1l + '" a + "! �': � Nr' 1 'i� t '" 5 (o c'o'g. +>�'` '� .''!�:•,Me.,,....t.,,. .:,.�..:�:. ��. ......,,. .It.,Y,.,i!,L, +,n�,.lylxl.. {i'. d,.w.lyY;.h...., lase to ground, or exceeds 14,000 ❑Commercial -use agricultural sl I- and 2- tinily dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations, buildings. ❑ Multi- family ❑ Master builder ❑ Other Q Fire pump. ❑ Installation 01 75 KVA or y r. ; a yA;gy;.g ❑ Emergency syttom. larger separately derived system. alb' r 6 i'in ' ice.„ i, d; ,, t •'�� �?,fi +c�+; x +�1 '1�a+11:'*�`� m � �� .,. .. . I .. Y c, . :M � . ❑ Addition of new motor load of ©"a „g„ "1.2',..1.3r, Job no.: 5 7 Job site address: i �, 673 :::).A. 1 .H lone 1/L�. Six or more residential unite. ❑ Recreational vehicle parks. City /State /ZIP: - � , b' g'-7. ❑ Health -once t ❑ Supply voltage for more than Q Harerdoas locations. 600 vets nomiuel. Suite /bldg. /apt. no.: Project name: /I l oct, r) o J�( /- v ❑ Service or feeder 600 amps or mom. p� Y treet/dirtxtions to job site: Y l 1; : 4 "-r:':"i }igi; ',. RITLOta=e+.g "yfiYj�;•;k! Cross S J 5 Deserintlas I Qty, FeS, 1 Total l New residential single- or mul family dwelling unit. includes attached garage. 1,000 sq, A. or lees 165,54 [ 4 Subdivision: Lot no.: ga. ndd't 500 eq. ft. or portion 33,92 1 Tax map /parcel no., _b y�yy{r� Limited energy, residential 75A0 2 " f''' .� /f.ji�'ti + IiN� ,1O,r',\':::*00',ii',j:,,'q ^, i. "r. :::[ : 'i ,• � (with above sq. it ). rr Limited energy, multi - family �L , residential b (with above s R.) 75 00 2 "P(Am Par r G(( " CA .LAA ' `� .f - res Services Or f (with a ove indtillIntion, alteration, and /or relocation +�^ 2110 amps or loss O0,7 /c)a - 7D 2 ..,:,.,. t1. 4�r x`l h > � + rain: '.ii. .f 201 amps to 400 em 33, �'' '4': " .;., ? 'F. ilI!!#i i;,: vh p amps 1 56 2 Name: 401 amps to 600 amps 200.34 601 amps to 1,000 amps 301.04 2 Address: Over 1.000 amps or volts 552.26 Temporary services or feeders Installation, alteration, a nd /Or City /State /ZIP; relocation _ Phone: () Fax: ( ) 200 amps or less 19,36 I 201 snips to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 2 intended For sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168,54 13ranch circuits - new, alteration, or extension, per panel Owner signature; Date: A. Pee for branch circuits with f above service or feeder fee, I� / [] . li , .. .V� i; I P i.O '� ? $5: 11. as' each branch circuit d+ 7.42 i�F, � 2 Business name: 13. Pet for branch circuits without . , service or feeder fee, first 56.18 2 Contact name: branch circuit - Each add'1 branch circuit 7.42 2 Address: Miscellaneous (service or feeder not Included) City /State /Z1P: Each rnonutacturcd or modular dwelling, service and/or feeder 67,84 2 Phone: ( ) Fax; : ( ) Reoonneet only, 57.84 2 Pump or irrigation circle 67.84 2 E -mail: _ . Signor outline lighting 67,84 2 ' + :t0 o el ii'' S` '. . ,,,- Si ci or li :,: : ..:. ..........�,,, rcu mRedd -anal ey Business name: RK Electric, Inc. panel, alteration, or extension. , Page2 2 Each additional inspection over allowable in any of the above Address: 24495 NW Oak Drive Additional inspection (1 hr min) 66.25/ hr City /State/ZIP: Hillsboro, OR 97124 Investigation (1 hr min) 66.25/ hr Industrial plant (1 lir min) 78.18 / hr Phone: (503) 640.1344 Fax: (503) 356.0513 Inspections fbr which no fie is 90.00/ ht specifically listed ('/�t hr min CCB Lic.: 94275 Electrical Lic.: 34.3750 Suprv. Lie.; 4724 -5 �; .,,g- 1 ;'' f;•:'%ri!:'' Jet -- " i 11 ' .ES; , Suprv. Electrician signature, required: - . Subtotal: ii 1- Plan review (25% of permit fee): Print name: Ron L. Kurtz 111 Dote: 1 ( ,-.-1 tf f ( State surcharge (12% of permit fee); /,3, 5 TOTAL PERMIT FEE: 9,2(40 Authorized signature: i oK I ' / J _ { This permit application expires if a permit is not obta ined within ISO - Print name: Ron L. Kurtz �- ` / { Date: ^ / l.) - 1 I dapestiona a ys after a llo we p nee n acperCemplit. d as C e P mplole. I Number of ine I:\Swlain44Pennity \ ELc-'I' 1nitAll0.d0C 07/31/10 440- 4e157(I I /05 /COM:WEB