Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2013-00045
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503 718.2439 Date Issued: 01/22/2013
Parcel: 1S135CA01902
Jurisdiction: Tigard
Site address: 9600 SW NORTH DAKOTA ST
Project: Kociemba Subdivision:HERS ADDITION TO GREENBURG HE Lot: 1
Project Description: (1)200 amps or less and(2)branch circuits recovery from fire damage Service connection with 2 construction
circuits
Contractor: L&K ELECTRIC Owner: KOCIEMBA, DIANE E
10122 SE SHADY LN PO BOX 231021
DAMASCUS, OR 97089 TIGARD, OR 97223
PHONE: 971-506-8351 PHONE
FAX: 503-663-0343
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 01/22/2013 $100 70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 01/22/2013 $14 84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 01/22/2013 $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•i R •52-001-''90. You m-y obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800.332 2344
o�� APPS( /� ;? <
Issued By: 4. L I _� r Permittee Signature: (�H�' Lt��
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 503.639.4176 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-17-2013 08 :47 PM L&K ELECTRIC 5036630343 P. 01
Electrical Permit Application RECEI City of Tigard ( / 3 PerttritNo..62,C )01 - (-P43
• 13125 SW Hall Blvd.,Tigard,OR 97223 P Review
B Phone. 503.718.2439 Fax' 503.598.1960 JAN 2 2 2fk 511 Other Permit:
Inspection Line: 503.639.4175 Date Ready/By Jun �_ Er See Page 2 for
Internet: www.tigard-or,gov CITY(F'� txlMlethod: _ l� Supplemental Information
. ,JTDPnINGDIvi .e'PLAN REV W ,, e''{
• TVE OF•PORK Y1
❑New construction 21 Addition/alteration/replacement Please check all that apply(submit j sets of plans writema checked below)
❑Service or feeder 400 amps or more ❑Building over three stories
❑ Demolition Q Other: where the available fault currant ❑Mennen and boatyards
I!" ,�„ �arALtEGORY OF C TRQI�(ON exceeds 10,000 amps at 150 volts or D Floating buildings,
lase to ground,or exceeds 14,000 ❑Commercial-use agricultural
E I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings
❑Multi-family ❑Master builder ❑Other: D Fira pump. ❑Installation of 75 KVA or
r,'Y., v ❑Emergency system larger separately derived system.
„,,, ti:- .a,, JOB SITE 11NFO)1i,MMAT1ON AND LOCATIQ :w`
, ❑Addition of new motor load of
I00HP or more occupancy
Job no.:13-4211 Job site address:9600 SW North Dakota St
. ❑Six or more residential units ❑Recreational vehicle parka
City/State/ZIP:Tigard 97223 ❑Health-Date facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt, no.: Project name: ❑Sarvica or feeder 600 amps or more
,,FEE,:SCI8EDUI".E "'"'
l Cross street/directions to job site: Description _ 14M I Vet, I Tntot I "
I New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no, 1.000 sq ft.or less 168 54 4
fax map/parcel no.: Ea WWI 500 sq ft,Or port on 33.92 r .
Limited energy,residential
.. DES 'PITON Q ,,�I'OIii. �.��,., .„ a. (with above sq ft) 75.(10 2
•,.
Limited energy,multi-family 75.00 2
recovery from fire damage. Service connection with 2 construction circuits. residential(with above sq.ft)
• Services or feeders Installation,alteration,and/or relocation
200 amps or less 1 , 100.70 ' 100.70 12
r
0 PROPfiRTY OWNER 4 .fir.,r .,- 201 amps to 400 amps 133.56 t 2
� 1�. 401 amps to 600 amps 200.34 1 2
Name:
601 amps to 1,000 amps 301.04 1 2
Address: Over 1,000 amps or volts 552 26 2
Temporary services or feeders Installation,alteration,and/or
City/State/ZIP: relocation
Phone:( ) Fax:( ) 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 40:amps to 599 amps 168.54 2 �
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. - i
Branch circuits—new,alteration,or extension, er panel
Owner signature: Date: A Foe for branch circuits with
'''1' '' Q APPLICANT '.T j...• .0 CONTACT"'PERSbN above service or feeder fees 2 ' 7 42 ' 7 42 2
each branch circuit
Business name: B Fee for branch circuits wdhae:
, service or feeder fee,first '
•
Contact name: branch circuit 56.1 B 2
' Each add'I branch circuit 7.42 [2
Address: ' Miscellaneous(service or feeder not Included)
City/State/ZIP: Each mant:fhctured or modular 67 84 2
dwelling,service and/or feeder
-
Phone:( ) Fax: :( ) , Reconnect only 67.84 2
Pump or mgatton circle 67.84 2
E-mail:
ys. ,„ Sign or outline lighting 67.64 2
it CONTRACTOR Signal circuit(s)or limited-energy
Business name:I&K Electric,Inc panel,alteration,or extension. Page 2 _
Each additional Inspection over allowable in any of the above
Address: 10122 SE Shady Lane Additional inspection(1 hr min) 66.25/hr-
City/State/ZIP:Damascus,OR 97089 lnvesngation(I hr mm) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:(971-)506-8351 Fax:(503)663-0343 Inspections for which no fee is 9000/hr
r specifically listed('V,hr min)
CCB Lic.: 157326 Electrical Lic.: 26-1180C Suprv. Lic.: 4975 S .. EIXC"TR CAli;,d+PERMY F! 4' '
Suprv.Electrician signature,required: 1 Subtotal 108.12
Plan review(25%of permit fee).
Print name: Larry Peterson Date: 1/17/2013 State surcharge(12%of permit fee): 12,97 t
TOTAL PERMIT FEE: 121.09
Authorized signature: �- This permit application caplets if a permit is not obtained within 160
Print name: Larry Peter.an Date: 1/17/2013 days hone t has d been accepted at complete.
y Number of inapecuons allowed per permit. ']
f',aw:d,ng'Permrtw'\ELC•Perrn Appdoc 07.0:;10 440.46:ST(I1�05'COMIWBB 1 19 D