Permit CITY OF TIGARD ELECTRICAL PERMIT
° • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00519
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/05/2012
Parcel: 1S135DB02603
Jurisdiction: Tigard
Site address: 11403 SW 90TH AVE
Project: Hawks Subdivision: TIGARDVILLE PARK Lot: 4
Project Description: (1) 200 amps - replace damaged feeder
Contractor: RK ELECTRIC INC Owner: HAWKS, BRANDON
24495 NW OAK DR 11403 SW 90TH AVE
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 09/05/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 09/05/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 2 001 -00 0. 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: i 12 /i Permittee Signature: 04 4 PP A')
.ri DA,
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.
Sep 05 2012 2:01PM HP LASERJET FAX 5033560513 p.1
Electrical Permit Application �
RE E . I',Ili t >I t, tI:;l'. ()NI .1
City of Tigard S E P 0 5 2012 ( IL2 Permit rte' 1. / s.- vast •
• 13125 SW Hall Blvd,, Tigard, OR 97223 P1® Review
1 Phone: 503.718.2439 Fax: 503.398, 1 DatdB ; Permit
.I.1 c ;1 , 1; i . Inspection Line: 503.639.4175 vI l i � U iein Rmdy/By:
Internet. www,ti or.gov BUILDING DIVMSIG - • Notfled/Metlwd: 112EIEWER.II. ..
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❑ New construction ® Addition /alteration/replacement please chock all that apply (submit1 eats apt= wants chocked below):
❑ Service or feeder 400 amps or more ['Building over three stain.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
s?;; = A-'� = t ,w, �" • -_ _ - =Alt egi : -•z4% ..4 exceeds 10,000 snips to 150 volt, or Q Pleating buildings.
; —a tc =: =gy : :.j - loss to or accede 14.000
ground. ❑ Commaoiel•uso agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ,nips for all other Initellarlons. buildings.
❑ Multi - family ❑ Master builder 0 Other: ❑ Fire pump. ❑ Installation of 75 KVA or
•,i ... r. :ter :i1 —' _ - •r: pr,�: _ - ° •< , .•f , ;:: ; ❑Hmorgeney rryetsm larger cep system.
.• : . :� :;; :- -� -�� �" �' separately rive
�� :, ,.... .._ ., �•tT�,�� 4fi,�' -- to
.... •; ... _ - ...__. : :_ ... .... " �,�� ji ��'+aK; ❑ e of mote ad of ❑"A,. „ 8", °t.2 - . "1.3".
Job no.: 5370 1 Job site address: 11403 SW 90 Ave Six orm rmon. 000uparmy.
❑ Six or more residemial units. ❑ Recreational which' pants.
City /State/ZIP: Tigard, OR 97223 ❑ Heal th•eare reeiutlo,, ❑Supply voltage for morethao
❑ HUN dous locations. 600 volt, nominal.
Suite/bldg. /apt. no.: I Project name: ❑ Service or Feeder 600 � or more
- '�F':. IT : �pv�r!r- t • - ' c-7,9 t � t::. : T old - !••r,:: sin : I 45,1 '..
Cross street /directions to jab sit:: Description i•k FA -4 I at,. I Teo _. -•, to • •
New residential single- or mold -family dwelling unit.
' Includes attached garage,
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. edd'I 50D sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited a residential
.,,,....,.. « -- : , q 75,00 2
rte ......... ....,.. :T > -�. �,: ..
; s *�; z T TS -. -.: — ,4 ". :.r, •.., . a ;� -- - -R =' ` }; .�r =., , ' '�r : : : :sF,1 (with above S. ft,)
Limited energy, multi- fhmily 75.00 2
Replace Damaged Feeder residential (with above K. ft.)
Services or feeders lnatallatton, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2
_ , ,r =gym
.,� :. - �y r - " . i& - Aftkpinomt 201 amps to 400 amps 133,56 2
401 ear to600amps 200,34 2
Name: Lifetime Remodeling - 601 amps to 1,000 amps 301,04 2
Address: Over 1.000 amps or volts , 552.26 2
City /StGltJZIP Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or lees 59,36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 08 z
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 165,54 z
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
:: ti..�- p�a� j —__ _ _:: _; 0 1 : , :V� above service or feeder fee
: _ ^ : ! b T�s.RSOLV ;; :' 7.42 2
,` , :. ,-
9� .= - __._._... r.,.. •,,.• each branch circuit
Business name: RK stria, Inc.
B. Pee for branch circuits without
aervke or feeder fee, first 56.18 2
Contact name: Carol Owens branch circuit
Each add'l branch circuit 7.42 2
Address: 24495 NW Oak Drive Miscellaneous (service or seeder not Included)
Each manufactured or modular
City/State/ZIP: Hillsboro, OR 97124 _ dwelling service and/or feeds 67,84 2
Phone: (503) 640 -1344 1 Fax:: (503) 356 -0513 Reconnect only 67.84 2
Pump or inigation circle 67.84 2
E -mail;
�� __ :._ :u .*,� : , : , ,: w.. , Sign or outline lighdng 67.84 2
Ali. :'.•y:; ; t _ {:- ; °1 1s � M6$ 4:. t:M2.14 :. cara ;O ;: ?gNT :4;4 : i P �: Signal circuit(s) or limited-energy
Business name: RK Electric, Inc. panel, alteration, or extension. Pape 2 2
Each additional inspection over allowable in any of the abov
•
Address: 24495 NW Oak Drive Additional inspection (1 hr min) 66.25/ hr
City / State/ZIP: Hillsboro, OR 97124
Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78,18/ hr
Phone: (503) 640-1344 I Fax: (503) 356 -0513 Inspections for which no fee is 90.00/ hr
specinc alIX listed A br min)
CCB Lic.: 94275 1 Electrical Lic.: 34 -375C I Su Lie.: 4724 -5 ' � : -` :. � •
Suprv, sa . ; :s� = �.:, � ..I • + r l�;- i
Suprv. Electrician signature, required: Subtotal: 100.70
_ _ Plan review (25% of permit fee):
Print name: Ron L. Kurtz ate: 6. I State surcharge (12%ofpurtr,it fee): 12.08
Authorized signature: r - TOTAL PERMIT FEE: 11218
//A TIM permit eppilestion expires ft a permit is not obtained within 180
4444//// Date: 4)1/6/1 days after It has been aaeepted as complete.
Print name: R013 L. Klutz
• Number of inspections allowed per permit
t: lBulldinelPerrrlinut .C- PaedtApp.doo 07/01/10 4404615T(11/05/C0 M/Waa