Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00048
• 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2012
F f [, A R. n g Parcel: 1 S 134ACO2655
Jurisdiction: Tigard
Site address: 11222 SW COTTONWOOD LN
Project: Yount Subdivision: ENGLEWOOD NO.3 Lot: 221
Project Description: 2 Branch circuits for lights and plugs
Contractor: RK ELECTRIC INC Owner: YOUNT, PHILIP & DONNA LIVING TRU
24495 NW OAK DR 11222 SW COTTONWOOD LN
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 01/27/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/27/2012 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp: R -
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 OAR 95 AR , 952- 001 -0090. 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: AA V Permittee Signature: OA
OWNER INSTALLATION ONLY YY iii
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.
Jan 26 2012 10:18AM HP LRSERJET FAX 5033560513 P.1
1 Electrical Permit Application % y � � - " i'o' of l• l('i; t" ti ON I .Y
Ei i cw ty ti coo 1312SW Hlvd„ Tiard, OR 9 t 6 j 598. 960 w \ other Permit:
Phone; 503.718,2439 Fax: 503. \Q
I tc.AtS) Date/B :
Inspection Line: 503.639,4175 JP �t;�t + ■ fn See Pale 2 for
<.f)
Supplemental Information
Internet: www.tigard�r,gov 0 pp
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,� �^^ �tiriA / rr t w� p ,.. r• A` 1� i/ K t rri 4 i� i,tu ,¢'7 r 1 c �6 4 5i k t ' tr ! ,p r,7 ^' . �1 * i p y i' i
'F6 " 3 , J .: t` ! fi" t f�' Ir k ), I ( • l�Rm�lA i:9i r 'f[ 0 f j ! "` <! f' :+ r,�.x4 S ,.nt..I=I x,1 ` l" a «�l I,.= V i : i
h t.' Ga, ri d. .r a ' n .: ' 4 4t a �
0 New construction NI Addition /alteration/ ° r' e Plaaea check all that apply (sabmit sate of plena wlitams checked below)
❑ 901.403 or finder 400 amps or mote ['Building over three stories.
❑ Demolition ❑ Other: whom the available fault current ❑ Marinas and boatyards.
4 e , y e s o s J Q1' ' ' /; p I , > ".,7 , +r r ' -,,�c,C i i °l exceeds 10,000 amps at t 50 volts or 1:1 Floating buildings.
°t � l lass to ground, or exceeds 14 ^ 000 ❑ Camino: Mal-use agrlouitursl
6 I eInd 2-family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installation. building.
❑ Multi- fhmiiy ❑ Master builder ❑ Other: CI Fire pump. ❑ installation of 75 KVA or
y , ' x t - r' . r l ,t l r � y, t :,,;. '+ ❑ Berergency amen. Newer separately derived ,yet e,71
j +t �4 7 {�'I�21hl ul � o ( /�i' 7 I i , rain 11 f�a > 0.11 ,�� a! �!.,') li ' 1 ` k ' . ❑ Addition of new mow load of ❑ W „ .. -2 „ „
100HP or mare. occupancy.
Job no.: 44 40 7 Job site address: j 1 � , - 3vI 6 /{ V 1 ' ( I VG ,� �,. M. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /Statc/ZIP: -✓ Y/1/r a V— g '7,3J,b ❑ Health -care facilities, ❑ Supply voltage far mere than
❑ Hazardous locations, 600 volts nominal.
Suite/bldg. /apt no.: Project name: 12)11 l C ,i CI re
Servioe or feeder 600 amps or ma,. g�`
C yfj $j i i V''13, j S� {'.1.. Af
Cross street/directions to job site: Poserlpt!9n Qtr. Pea Total -
New residential single- or multl- family dwelling unit.
Includes attached garage. _
Subdivision: i Lot no 1,000 nq. ft, orlesa 168.54 ' 4
Ea. add'] 500 sq. ft. or portion 33512 1
Tax map/parcel no.: _ Limited energy, residential
:c;i t: )i 1 =+' d , l? 13 1 =, ,' t'` d ¢ , ., ,. tij ',r ;' ", Y i 's> ?. to (with above sq, It) 73.00 2
M'i
tit } rd i='fr't Ii ,tiCe ri o A+7 X t�' i t„I W�F'i i+F• k t H ; ; l' , ? , t 1 , ,sir � i
f I imiurd energy, multi- Camily 75.00 2 ■
( ; ( t ! L- ,' 5 frY- //j111.5 I g l p `, r ( C 5 residential (with above sq, R.)
I i�i ✓1 Services or feeders Installatlon,alteratlon, and /or relocation
i 200 amps or less 100,70 2
,Y ir,i'.i,M;7j;,�I. ,r. ,} : , r p . t“ , 'tFl" r, r' ti,e;,�,i ill ''r`.l�'t )ut ;,' I,' 4 ; �r�y,, �. .. . .,� < nl S l'i'' i`at
»� -: "i 201 amps to 400 amps 133, 6 2
ry`,Atfil t .i" i� 0 ail l ii> .G,��y, oki! 'y 3 r�E��I:� 'V MT , f; 1' ∎7, ;�; ' r hr
Name: 401 amps to 600 amps 200.34 2
. _ 601 amps to 1 ,000 amps 301.04 2
Address; Over 1,000 amps or volts 552.26 2
- Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36
II
Owner Installation: This installation is being made on property that I own which is not tot amps to 400 amps 125.08
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Dote: A. Fee for branch circuits with
.a r + + a • ^'r:.'.'da« tip,, L, t" y t �„ r Try Y:. U • , p1,' ,+ �,. +. above service or fender fee,
OM NI i q '' ��iit'r- ,y v i,y;#,!l Ya { 6.M 7.42 2
�cMa�; t; A>,]i sf''S`a+'�'`�fN?vCe,�n //9 � S?�,i l��wl',�b,�A,ir'. •fi* .. / "�.F �j �f4nC v1rl",� each branch circuit `
Business name: B. Fee for branch circuits without
service or fender fee, first I 56 18 5,,,,i3 2
Contact n amt: branch circuit
Each odd'I branch circuit / 7.42 2,5z 2
Address: Miscellaneous (service or feeder not Included)
Ci /$tate/ZIP: Each manufactured or modular 67,84 2
tY dwelling, service and/or feeder
Phone: ( ) Fax; : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67,84 2
E -mail sign or outline lighting 67.84 2
, N a r !',i,. '. fa • v � ta „ + t{q �' � ? r 1y1 , •
, �'�.P��: � „ . ; , tt r i !1!s�s' ab:, � ,. t, 'Y,.�+,. i.:, °'� ��c ..-. ti �, ,,d Si cimuit{a) er limited-energy f
Business name: RK Electric, Inc. panel, elteretlen, or extension. I _ Page 2 I 2
. _ Each additional inspection over allowable in any of Me above
Address; 34495 NW Oak Drive Additional inspection (i hr min) 66.25/hr
City/State/ZIP: Hillsboro, OR 97124 investigation (I hr min) 66,25/hr
— _ - Industrial plant (I hr min) 78,13/ hr
Phone: (503) 640 -1344 Fax: (503) 356 -0513 Inspections 1hr which no fee is ■ 90,00/ hr il
s- eolticall listed lihrmin
CCB Lic.: 94275 I Electrical Lic.: 34-375C i Suprv. Lic.: 4724 -S xiii^+I 1}t 7.1:4%7. ig: C. • .?,T.1,” i .,.. ti ' ' -' `'?2i;: r ':',. , .
Suprv. Electrician signature, required: ' !C %r7 IL( _ Subtotal; W, , (p
Plan review 25% of , ermit fee):
Print name: Ron L. Kurtz Date: / /.' ( State surcharge (12% of permit fee): Wan
y� J + OTALPERMIT.FEE: 74 0 2,3
Authorized signature: (,✓rsd ! This permit applicetlon expires If a permit la not obtained within 180
Date: ate: -� days OUT It ham been accepted as complete
Print name: Ron L. Kurtz
// I . 64// P. Number or inspections allowed per permit,
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