Permit CITY OF TIGARD ELECTRICAL PERMIT
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- COMMUNITY DEVELOPMENT Permit #: ELC2012 -00582
• . w 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/04/2012
TIGAR Parcel: 25111 DC12600
Jurisdiction: Tigard
Site address: 15950 SW OAK MEADOW LN
Project: RAUSCHKOLB Subdivision: SUMMERFIELD NO.11 Lot: 622
Project Description: (3) branch circuits for kitchen remodel
Contractor: SQUIRES ELECTRIC Owner: RAUSCHKOLB, FRANCES ROSELEE
1001 SE DIVISION STREET #1 1805 NE 226TH AVE
PORTLAND, OR 97202 FAIRVIEW, OR 97024
PHONE: 503 - 252 -1609 PHONE:
FAX: 503 - 253 -5831
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 10/04/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/04/2012 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 0 952 -0 - 090. 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: Permittee Signature: a � 191
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.
10/03/2012 15:22 5032535831 RECEEV' 1 ELECTRIC #2001 P.001 /002
Electrical Permit Application FOR OFFICE USE ONLY
OCT 0 3 20 ' e ten'. eived to y / Z 4-;,111
II
_ . City of Tigard P ermi l No - C ��r.2p / � �o ���
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" 13125 SW Hall B1vd., Tigard, OR 97223 CITY ( �'
V ` �'i. 1 iZevrCw
' Phone: 503.718.2439 Fax: 503.598,1 960 " y�� I Other Permit: r
TIGARD Inspection Line: 503.639.4175 � r LH�l early /tly; _' p p,�ezfor
Internet: www,tigard- or.gov Notifed/Meduxl: if Suppteroenut Information
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❑ New construction ® Addition /alteration/replacementl Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more 0 F,duilding over three stories.
- :- .: ;:,, ,.4 ; _ where the available fault current ❑ Marinas and boatyards.
t... l,.,. gOO,Ig = 6;° ;,x; "k;; sat 150 volts or Floating buildings.
.�., -,. _.,�,:,•....,..,....'.:v:. „. ,�--•` ���,�, . ' � j.. . , �s:a: ?:.. .- . exceeds 1 0,000 amps ❑ g Imo a.
less to ground, or exceeds 14,000 ❑ Commercial -use apiculture]
® 1- and 2- family dwelling ❑ commercial/industrial ❑ Accessory building amps for all Other installations. buildings.
❑ Multi - family ❑ Master builder 0 Other: ❑ Fire Pomp. ❑ Installation of75 KVA or
st: x. z-, -1 f : - , ,x nr - :.+' ,v { _, ❑ Entcr s larger separately derived s
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'2 �. }_� �j�} k r 0 rr' ,t....:-:. :.. ",:r ;L;... .` ".: ': r ^t t:D yt[Cin.
�., � * . r ,;,� .e�' -- ..li : .:i$4:4;, El Add of new motor load of . .. • "1-5",
Job no.; lob site address: 15950 Southwest Oak Meadow Ln 1001-EP or more. Re r
12 Six or more residential units. El Reelce.oion eatienal vehicle parks.
City /State/ZIP: Tigard, OR 97224 I ❑ Health - care facilities.
0 Supply voltage for more than
Harrrdow locations. 600 volts nominal.
Suite/bldg. /apt. no.: ' Project name: ❑ Service or feeder 600 amps or mote.
I ;}.- 4- 7, 31:.e.. :: _•t -•-='+ k ;'§1 Y. �' 41::- , :tv } ,i :. 1 15 :..,: : :;:...
Cross street/directions to job site: thaeription I Qt Fcc 7vtal ....i.
New residential single - or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.; 1.000 sq. ft. or less 168.54 4
Tae map /parcel no.;
Ea. add'l 500 sq. ft. or portion 33.92 1
7 "� w ,,":_y.�ff ,ry VY(S ' Limited energy, residential
~: '.5; x., ., p Kp`: �` :,�rv� ,3,.:;, with above ft.)
75.00 2
Limited energy, multi - family
3 altered circuits for kitchen remodel I residential (with above sq. ft.) 75.00 2
•"" Services or feeders installation, alterat and/or relocation
200 amps or less 100.70 12
D " t r I a ' ..... ; 1 v u ' amps to 400 amps 133.56 2
Name: 401 amps to 600 amps I 200.34 2
601 amps to 1,000 amps 4., 301.04 2
Address: I Over 1,000 amps or volts 552.26 2 1
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) I 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property tHat I own which is not 401 599 s 2 j
-
intended for sale, lease, rent, or exchange, according to ORS 447, 149, 670, and 701. to amps 168.54 Branch circuits - new, alteration, or extension, per panel
Owner signature:
!pate: A. Fee for branch circuits with t 1
,,, ...
_`' =` {3#�..;J„�- �"?1�1f'; .x� '�:a ?�,',�;�`� �� �:'. :�`�, each branch circuit
-r above service Or fe eder fee,
..,.........,a i a� r.,.; . % '�': ;x� „'.i si'g:�'rllc _ : >.`- 'air '', ?.: ,. »i...k'•., 7.42 2
- Lei +s+vt
Business name: SQUIRES ELECTRIC, INC. B. Fee for branch circuits wilhOuL
service or feeder fee, first I 5 56.18 ,,
Contact name: BILL ELLIS I branch circuit 6.18 -
1 Each add'I branch circuit 2 ( 7.42 I 14.84 2
Address: 1001 SE DIVISION ST. #1 1 Miscellaneous (service or feeder not included)
City/State /:GIP: PORTLAND, OR 97202 1 Bach manufactured or modular 67.84 2
• - dwelling, sernce and/or fecdcr 2
Phone: (503) 252 - 1609 Fax: : (503) 253 - 5831 Reconnect only - 67.84 2
Pump or irrigation circle 67.84 2
E - mail: BILL@SQU I R ES ELECTRIC.COM
- ,,,,,,,,,, } _... ;;; -,,. 1 ..,,�r,, _ _ Sigttoroutlincligltting
'':1':riFi,1F:fv4 4.:;k:ii :•:i }'•( �!_:;,i ':' =%�isk . ,: -.t,: _;.�;t}
:. ,., 67.84 2
'.. ".�_�..;.�.. ,.:... �..;1tic �C'':.•Mow.�' -,: .Q m:..]..�^..:1�A: -.. ..ti_= .'.#r`:i:. n a;.
'- -•'�'�'"�•� � ,.;;cK".. °•" Si circuit(s) orlimitedtncr�y .
Business name: SQUIRES ELECTRIC, INC. I panel alteration, or extension. Page 2 2
Mach additional inspection over allowable in any of the above i
Address: 1001 SE DIVISION ST. #1 Additional inspeceton (1 hr min) L 66.25/hr
City /State/ZIP: PORTLAND, OR 97202 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr l
Phone: (503) 252 - 1609 A., (503) 253 1 inspections for which no f'ce is t i
specifically listed (Y: hr 90.00/ hr
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CCB Lic.: 135085 _ Electrical L , Aftke Supry Lic.: 48825 ", r sr ft: [;'r�i Ce p f. *14;EEy : : - :'.::.:' _ .
Suprv. Electrician signature, req. iced: WA I Subtotal: 71.02
a ir
Fran review (25% of permit fee):
Print name: JOSEPH SQUIRES / l Dat : 10/03/12 State surcharge (12% of permit fee): 8.52
Authorized signature: TOTAL PERMIT FEE: 79.54 Adak 1 This permit application expires if a permit is not obtained within 180
/r i days after it has been accepted as c om fete.
Print name: JOSEPH SQ IRE'$ Date 10)03/12 p
�( i Number of inspections allowed per perms.
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