Permit „ CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00081
Date Issued: 01 /31 /2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1 /31 / D600701
Jurisdiction: Tigard
Site address: 7275 SW VARNS ST
Project: Rusk Subdivision: ROLLING HILLS Lot: 1
Project Description: (1) water service, (1) water heater replacement (1) water piping
Contractor: POWER ELECTRIC INC. Owner: RUSK, RAYMOND R & PATRICIA J
PO BOX 14692 7275 SW VARNS ST
PORTLAND, OR 97293 TIGARD, OR 97223
PHONE: 503 - 786 -6930 PHONE: 503 - 684 -9722
FAX: 503 - 786 -5462
FEES
Quantity Description Date Amount
1 ea Reconnect Only 01/31/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 01/31/2013 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 / ,” •52- 00�,;r�. D Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: 4 Permittee Signature: / T /
117 / ee9 - O/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 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.
01/31/2013 03:56 FAX 5037865462 POWER ELECTRIC INC 0002
Electrical Permit Application RECEIVE rot: Orrlc.E USE ONLY'
City of Tigard n�eiaed / tv1� Permit No.:t ' /3 ,pp0F/
i • 13125 SW Hull Blvd., Tigard, OR 97223 JAN 31 2013 plop Rev; • L)Jap /3 —D
t; Phone: 503.718.2439 Fax; 5033 .598,1960 1)ntel@v; Other Perm ot
T1 G A R D Inspection Line: 503.639.4175 CITY OF TIG ' ' II Dat Rudy/By: Awls: If, 0 See Page 2 for
Internet: www.tigard-or.gov •tified/Method: CO Supplemental laformadon
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❑ New construction NI • ddition/alteration/replaccrncnt Please check all that apply (submit sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 •' or: where the available Pauli current (1 Marinas and boatyards.
S. • '4.: : " i L i . " V A ' excee 10,000 amps 150 volts or ❑ Floating buildings.
Cii t O '•••- - : CO IY ti i, ;.) a : ''" '''' • " r' P g e�.
'�"' � ' ' " -�' ;',..:i••••': •' "�' � i �" � i i ' � legs to ground, or exceeds 14,000 ❑Commercial -u.¢e agricultural
nd 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations, buildings.
C] Multi- family ❑ Master builder ❑ Other: ❑ Firc pump. ❑ Installation of 75 KVA or
',' ,a; ° Emergency system. larger separately derived system.
JOi3;;:SiTE; 0: eA'tidp� :
-• ...:? - .. IO . ..... :. ���' ,. • .. .. ❑ Addition of new motor load of 12"A", ' ' ", - 1-3",
Job no.� 33 Job site address ' 514 IIwMPurmore, occupancy.
F t�w/S I( ❑ Six or more residential units. Cl Recreational vehicle parks.
City /State /Z1P; . i , C7'2,12.2 ❑ Health -care facilities, ❑ Supply voltage for more than
O
' Hazardous locations 600 volts nominal,
- Suite/bldg. /apt. no.: Project name; "4 .. i:•'i.� ❑Service or feeder 600 amps nor Q moo 1 r � e � . ayCp/� i
.. - -, • . . lei.: - :.1. �. >ttotac. ' '. `. _ •..' ':
Dedpdon I Rte•
Cross street/directions to job site: I � per _ ,. i _ Te ral'f� '
. • � .. •: �
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. R. or portion 33.92 I
Tax map /parcel no.: -
Limited energy, residential
r.;a ,r r ;:r .' + ,. d ,., .. tr._. with cs ,fc 7500 2
::r: zva:;�..::,: ,:.,•..c.,�
:;: E GRIP•_I'[ON••:•OF.,• �•�: �. .:�:r •:;,, ;r „ i`a
_,. a.:c Limited energy, multi- family
6.0 'Tr Ale W residential (with above sq, ft,) 75,00 2
r 1 v �� / Services or feeders Installation, alteration, and /or relocation
�
r t �� f ff amps or Iias 100.70 2
r `r( C i 200 �.,, r. r 'Y' . :: :- r,:.:. 2 01 amps to 400 amps 33,56 2
- ;.::'. ;°(-, r, �! aPROPERTY ',n�i�NE , 1t'�.:...? ,' �., , : ,a, :
401 amps to 600 amps 200,34 2
Name: _ - 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 55226 2
Temporary services or feeders installation, alteration, and/or
City /State/ZIP; relocation
Phone: ( ) Fax: ( ) 200 amps or less 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 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 carps to 599 amps 160 2
Branch circuits- new, alteration, or extension, er panel
Owner signature: Date: A. Fee for brunch circuits with '
r : above service or feeder !be
'+C';r . - .i`1►QI',U]�f....I.; a 42 2
=` eae n branch c i rcu it
Business name; B. Fee for branch circuits without
service or feeder fee, firs
56 16 2
Contact name: - branch circuit
Each add', branch circuit 7.42 2
Address: Miscellaneous (service or feeder not include
City /State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Reconnect only 67.84 2
Phone: ( ) I Fax: ( ) 7
Pump or irrigation circle 67.84 - 2
E - mail:
Sign or outline lighting 67.84 2
_ ,�:: :s - . u.
.:r. 'ii .CONTRAAC)fOR:..i . ::. ' ? : ; i ' 1 :- .'ic:.' a'•: Signal circuit(s)or
- ,,...:: :;r _ ., : :•... .....: „ ;.., - . ....... . .....,,. . . . '..;h:, . .�. limitetl energy
panel, alteration, or extension. Page 2 2
Business name: R� Each additional inspection over allowable in any of the abov
Address:
V / 5C7- Additional inspection (I hr min) 66,25/ hr
x tv � lnvcatigation (I hr min) 66,25/ hr
City/State/ZIP: U� {JOB Industrial plant (I hr min) 78,18/ hr
•
Phone: ( ) nC� T , 61 3tp Fax: ( ) ) r 4#7, Inspections for which no fee is
r tF s.e,cificall listed h hr min 90.00/ hr
CB Lie.: •■ - Electrical Lic.. , CC Suprv, Lie„ + �� , .t illfl'
R.
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• � � � +�� Subtotal: S• uprv, Electricht l7_nAtu ', = ed:. - � fC Plan review (25% of permit fee):
Print name: _ 1 / y Date:/_.-34-0 State surcharge (12% of permit tee); s /y V
'` TOTAL PERMIT FEB: 5 _
Authorized signature: 2) 1v', 1 7 ' f5 This permit application expires if a permit is not o wilt)
days after it has been accepted as complete.
Print name: Dom: • Number of inspections allowed per permit.
1: lauildinalPermitsEL C.PermitApp.doc 07/01 /10 440.4 lST(II/OS/COM/WSB