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Permit y q CITY OF TIGARD ELECTRICAL PERMIT 11 I , COMMUNITY DEVELOPMENT Permit #: ELC2011 -00185 T [GA .R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/07/2011 Parcel: 25111 DB09900 Jurisdiction: Tigard Site address: 15495 SW OAKTREE LN Project: McRivette Subdivision: Lot: 0 Project Description: (5) branch circuits for kitchen remodel. Contractor: A & J ELECTRIC Owner: MCRIVETTE PO BOX 330 15495 SW OAKTREE LN FOREST GROVE, OR 97116 TIGARD, OR 97224 PHONE: 503 - 359 -5891 PHONE: FAX: 503 -359 -1981 FEES Quantity Description Date Amount 5 crt Branch Circuits wo /Purchase 04/07/2011 $85.86 Specifics: Service or Feeder 1 ea 12% State Surcharge - 04/07/2011 $10.30 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $96.16 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 C ter. Those ru are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You m obtai • • o "Vlr »_ or •r t questions to OUNC by calling ,. 2 7 or .800.332. 4. Issued By: ,_ Perm[ttee Signature: 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. Apr 07 11 03:36p Leeann Greason 503 -359 -1981 p.1 Electrical Permit A,pplicatio) : __ FOR OFFICE USE ONLY' City of Tigard ‘ ,` x ..* ,1 Received N.___ 13125 SW Hall Blvd., Tigard, R " 3 e ., Nan Review i1/ �' ' ?hone: 503.639.4172 Fax: 569 .598. k961) l Plan Review ' TIC::1RD inSpeeiioh Line: 503.634.41 75 �\ Dare/By: c Re June: nnir. oi. as Internet: wwwtigard-orgov Notified/ Method �_ 13 SecPima 2 f Supplemental for Date R /� ,. �3, . Supplemental Irm M c a� { a " # _ '. ' CI New construction Add)liontalleratictn/ replacement Phase check all that apply (submit 2 sets of plans wlnems checked 'aelow). ❑ Service or amps or mare ❑ Building over ltree:ae :aeries. ❑ Demolition ❑ Other: � ;'_ � c ^ ; w k c s ; y w'an'e the available fault current [ Marinas and boatyards. S .. µ , - 6 ; 1 t 1 Y'e'a 4t - ` ; ; exceeds 1100 amps at ISO vats or ❑ Floating buildings 1 -rind 2- family dwelling ❑ Commercial industrial ❑ Accessory building less to ground, or exceeds 14,000 p Commercial -use agio ltaral ❑ M ultl fami ly 0 Master builder amps for all outs installations. buildings ❑ Other: ❑ Fire pump. ❑ Installation cf ?s 1CVA or t 4 ,«� , R�Ah si :' .ti t n i l a R F pfi # ; LJEma'gency huger ■ � � ° far °" ' � - ;a3 " ❑ Addition of new motor load of Sp sepatatdy derived SyStcni. Job no.: Job site address. � � ❑ - '�.. »�....) - ,. _'' �Syp - -s © �., ` .. 1 x or or more. Recreational City/State/ZIP: ''.---„..43.,,....,5."},i, r� \ ' L7 Six ormcteresidentialunits. ❑ Recreational vehicle parks. v� ❑ dealt - ca facititics. ❑ Supply vo:tugc for Mae than Sllil�bld a t. no.: , - ❑Hacardots locations. 6CO volts nominal. S' F Project name: D Serves or feeder 600 amps or more Cross street directions to job site: r- fir L °' ,i �1 ] y R W' " rte I[ts! Fee. Total 1.2111 New residential single- or multi- family dwelling unit. Includes attached gage. Subdivision; t,0 s - ---- -- + tent nn.: q. fr. or less J I 168:54 14 fax map/parcel el no Ea add'l 500 sq. L orport:on 3332 V ,... - ..:1,1.:: ,. .1,4 , .; <s' t :� Limited energy. residential t a .r 4 ,a.t (with above sq. ft.) 67.84 2 C� t t� � ` Limited energy, multi - family I f c���Z� residential (with the sq. fix) i l 67.84 2 • ,, er amps feeders installation, a � � n, alt iteration, antL'or relocation E s1� .: ' ` a1,.� J 100.70 ] 2 2 ' 201 amps to 400 amps 133.56 2 1��_, \����- -ti�� ��� 401 amps to 600 amps 20034 ' Address: , 601 amps to 1,000 amps 301.04 2 .. ..� - ---N______ O Over 1.000 amps or volts 55226 2 j City /Siitte/ZiP: Temporary services or feeders Inatalladon, alte ration, and/or Phone: ( '� '' relocation Fax: ( ) 200 amps or less Owner installation: 't 401 am 1a his installation is being made on property that I own which is not amps 400 amps - 125 08 2 intended or sale, lease, rent, or exchange, according accordin to ORS 447, 449, 670. and 701. 401 amps to 599 amps 168.54 ? Owner signature: aranch circuits -new, alteration or extensi , on, Ile: per panel �._ rr k ` „, s A. Fee for branch circuits with .,a ' 3 �' !. . fsr 4 above service or feeder fox;, liustne . name: T " " ` 7.A2 2 caul, branch circuit • B. Fee for branch circuits Contact ranter tririrour service or fcedsx fee Address: first branch circuit r \ 56.I8 �� \�I 2 Each add'I branch circuit. 'X- 7.42 r•� 2 City:!Statu'7_1P; Miscellaneous (service or feeder not nieluded) - Phone ( Each manufactured or modular 7 A4 G Fax: ; dwelling, service and/or feeder 2 Email: ( Reconnect only' 67.84 ` - t Pump or irrigation circle 67.84 I 2 Business name: C e - y Sign or outline fighting 67.84 2 - -- ---- ;� �..e � Signet circuit(s) or limited- A ddress: � energy panel, attention, or extension. Describe: Page 2 I 2 'ily/5tart. %'1.1P: S.-‘ S.-‘ C 1 1 ��,, \\ '"�� \\.Cj Each additional fns action over anowuble in any l of the above - !'hone: ( ) CSC _ Per inspection Tax: ( )_Soy`. 66.25 CCB Lie.: a �� �� Inv m ligation per hour(! mint 66-23 Electrical Lic. :" V\ --N Suprv, Lie.: � s Industrial plant Per hour 7 I8 Stiprv. Electrician signature, required: _ '.... Suhtotai. e c ,,� Prim; name: j ■ i } / ai Date :� Plan review 1.25% of permit fee): I Authorized signature; ■ State surcharge (12%ofpermit fee)- TOTAL PGRMIT F6E: \era i Print name: Date: This perm ap p, eatioo expires ire permit is not obtained within 180 r" di.iiusie,rennirr'.F2,C- P 7rn t t days after it has been accepted as csmnlete, 4AP.aoc iomv�4 • Number of inspections allow •d pa perrnil 440.4615Tt1 I139CDMA'EB