Permit CITY OF TIGARD ELECTRICAL PERMIT
n COMMUNITY DEVELOPMENT Permit #: ELC2013 -00376
Date Issued: 07/03/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1S136DB02601
Jurisdiction: Tigard
Site address: 11606 SW PACIFIC HWY 200
Project: Green Light Subdivision: AZOIC TERRACE Lot: 1
Project Description: (3) branch circuits for front of building.
•
Contractor: RK ELECTRIC INC Owner: HWY 99 LLC
24495 NW OAK DR 2655 MARYLHURST DR
HILLSBORO, OR 97124 WEST LINN, OR 97068
PHONE: 503 -640 -1344 PHONE:
FAX: 503 - 356 -0513
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 07/03/2013 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/03/2013 $8.52
Type of Use: COM 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 OAR 952- 1 -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: Permittee Signature: "f G / Kref 7vv
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.
Electrical Permit ApplicatiorRECEI.V r J] 1 oil Ol i'i r. l itif•. only
City f Tigard Received 3 .. - • Panuit No.:
N --- . ty g JUL 2 2013 Date/By. �� � .� 8—tCa0 . 376
13125 SW Hall Blvd., Tigard, OR 97223 Plan, Review
. X Phone: 503.7182439 Fax: 503.598.1p_ Date/By: Other Permit: '
T I Ci A Inspection Line: 503.639 V 1 I 1 �T Date Ready/By: k // 13 See Page 2 for
Internet www.tigard- Or.gov L' ; p Notified/Method: I I l7 Suppl Information
1I.
Mel ':,l }}'T�7M r�,br!IfFF� tr 1 „�,� T.,� r.,`:..'�� 1.. ::. '� rr7il. ?rl�"! r ,.'�1�11t t :,,:ff r - P: tp :1;'7. �1 It '. :�1:t :rr r })".r, {lr tae u,nr n :fit' �I ia♦�ri {'{ay.
r:.• •I'•?l,s .r 1(4,41 #.Y� I r t , rrtr: ✓i. .',l +I .;.t ) 5t. Er �:, ,7 l ✓ry - . - _ 11 ..- t !,,IT /i!f! .iq : f:.l { rt1,r V .f Y,, 7. [ t.i ` . j ?
I �1 Ii �S 7 1. �� . ; rh i g „a.: :r!'�7JIlr., , .e. :li:,:�,1 u.. ,- "_Il . "'r ., il,� �: ,:, ,at`.. .. l �,I :. IJ,�lre,i. r1 ,.,.' �7, 1i ,�L,l.,,r ,:L. } �.., T.. :I�I.R' {,...TFrti� }illr'I �l�nll.e(- .... - r,.�t,.::wt
L,1 ..f ..,}:._h r. u,.,i «Y'fn a ._, n..a '■i L. ::e..:.�. .,. .,:.,o. .,. I
x„ ,.:, J r.
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more . ❑'Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
hl'I+11iFliI rF 1 ',+.1 4 a i a y 1 er t, , a7 �*- `.t rt 4 1 A l ,.._Fr i k amps Floating buildings.
V, 1 N exceeds 10,000 sac 150 oohs or ❑ Floatin build'
4 f k r r t ,.- a , ,,
AS.r r:: S_.. r ?...a ?.x«.ii 4r�r- ..... ' .+.,. , � {tti . �^ _��i. __,a.., ::.r.r?s r,.t t { -Yr ll`�rc!r11 ws< r4' r,�.! ?t..? .,1�,x” less to ground, or exceeds 14,000 0 Commercial -use agricultural
❑ 1 - and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
IC {I::.; T �. L ! t i 4 rf I t c li ly . S F r L1 q r 61 IQ I� t -r ,--, i- i f r � s 1 I e err 51q: 0 Emergency system. larger separately derived system.
1 mea ! .....,... Y, a .:.: a.. i,- x f' , u ,.. , ...... � W,I. 5, - S(� l' L-v tu n ...-. r.. j 1--, Addition of new motor load of • ❑ .. - E„...1 -2", "1-3",
100HP or more. occupancy.
Job no.: 6295 Job site address: 11606 SW Pacific Hwy
❑ six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Healtb -care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal
Suite/bldg./apt. no.: 2? 0 t/ Project name: Green Light ❑ service o r feeder 600 amps or morn
l F l i 1 .f r) a - j ; r A'F- Usz�r r� 7 i , ;r 6 „,
iai.: s.t., 1.1 } te`1 :::.4 , _.,m.m..r..., d•ov.n ..'1':t u1.,m I l,r: 1 � ..t ....a.'G.,x , i . f1, Alit,
Cross street/directions to job site: • Description Qty. Fee, Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
_ Subdivision: I Lot no.: 1,000 sq. ft or lees 168.54 4
Tax map/parcel n0 - Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential •
ci s I r r , t R � r11? S1r f�1r , , �, �i ! pa y a p : r with R 75.00 2
44�r't,l28IrrilNdi!; )1:1. ,!:; 1,. Ili.,.,at -1 u 1:.._.�.., r . 1 ..!t.v..Ailt 'a '.t ,!}r`.J ,lilt.k:?„ r1 ..iq.._�'n.,... €. ( q
Limited energy, multi - family 75.00 2
Added Circuits for Front of Building residential (with above sq. R.)
• Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
m Ir C Y t UI'T1i l7'T !Ir"1 s , r n 1 r f, I' r [f } µ
x ut i 7 ;:, t i . . .
ni ��Il I ., ,. . .1:7 ': ,7 ;r I u IT - r { r l l} t S r IJ F ei 201 amps to 400 amps 133.56 2
fu.: :r „111, ..vt1 �.,,r. _4-,ta :$.1 . ^,.k.:t -n:i.. .1., .l1. ::': :!.r x :1.
ft . . - .;
di { .s � .,i. 1 . : i}. : : ::: 1Z! I ,
Name: Green Light District 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301,04 2
Address: Same as above Over 1,000 amps or volts 552.26 2
City/State/ZIP: /State /ZIP: Temporary services or feeders installation, alte and/or
tY relocation
Phone: (503)624 -0420 Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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: Date: A. Fee for branch circuits with
r � t l e 7t+ i7 � r i' { ..two, , v^ ^ ^T s �'1 ., . }M l }f , ). � rti ti r. i , r F t , R 'N'd;v ,1 r a b o ve service or feeder fee,
„i) ` l !34',1 ' 1 tt: J, E 4 �,tfit l r r 11! hw{011 ;7 A pli .42 2
u 1 ,.;;a § !.17) _I c�l., rr� r . i.. i „a,fb', l.,.�,'.r., t +, - - -. r , t .. !r, �. . .. + _. .v. , .. , ..ii Ef! JH�l ;ta each branch C1rCU1t 7
Business name: RK Electric, Inc. B. Fee for branch circuits without
-.» service or feeder fee, first 1 56.18 56.18 2
Contact name: Carol branch circuit
Each add'/ branch circuit 2 7.42 14.84 2
Address: 24495 NW Oak Dr Miscellaneous (service or feeder not included)
Ci /State /ZIP: Hillsboro OR 97124 Each manufactured or modular 67,84 2
ty dwelling, service and/or Rader
Phone: (503) 649 - 1344 I Fax: : (503) 356 -0513 Reconnect only 67,84 2
Pump or irrigation circle 67.84 2
E info ®rkeleetrle.biz
f �.`+1,i, !,j? ) info@rkelectrie.biz
r r�EriT`T , r ; ir 1 >• I ,r r )i 7� H r...• •t 1 1 , ,• Sign or outline lighting 67.84 2
aSt1!ii3'J�r' . i . y .r „a.9._5` ixkr P i�,t 1 „r .` y�^ ...( -m „_ .:�.., l X ti :•:iar � ,��It \ ,'� ;.1: ;�.t , ,
Signal circuit(s) or limited energy
Business name: RK Electric, Inc. panel, alteration, or extension. Page 2 2
Each additional ismeetion over allowable in any of the above
Address: 24495 NW Oak Drive Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Hillsboro, OR 97124 lnvestigacion (1 hr min) 66151 hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 640 - 1344 I Fax: (503) 356 Inspections for which no fee is 90.00/ hr
s. ciftcall listed 14 hr min
CCB Lic.: 94275 I Electrical Lic - -375C I Suprv. ” t ' f �a+ n `r 1. rr ,1, : ;� '7555 ?: 7`"'�i”` I ' I Et" t )I :i
LiC_' 4724 -5 , ,;... i ....t,i ri„.1 -
Suprv- Electrician signature, required _ Subtotal 71.02
/ � Plan review (25% of permit fee):
• Print name: Ron L. Kurtz Da? 7/2/13 . State surcharge (12% of permit fee): 8.52
/ TOTAL PERMIT FEE: 79.54 X
Authorized signature: tj This permit application expires if a permit Is not obtained within 180
. days after it bas been accepted as complete.
Print name: Ron L. Kurtz Date: 7/2/13 • Number of inspections allowed par permit.
l;\ Building \ermits\ELC- ParmitApp.doe 57 /01 /10 440-4615T01/05/COIW4JEB