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Permit 71 - CITY OF TIGARD ELECTRICAL PERMIT ! '- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00311 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/08/2011 Parcel: 25111 CD03300 Jurisdiction: Tigard Site address: 9625 SW BRENTWOOD PL Project: ROTH Subdivision: SUMMERFIELD NO.9 Lot: 522 Project Description: (2) branch circuits for bathroom remodel. Contractor: RK ELECTRIC INC Owner: ROTH, BARBARA 24495 NW OAK DR 9625 SW BRENTWOOD PL HILLSBORO, OR 97124 TIGARD, OR 97224 PHONE: 503 - 640 -1344 PHONE: FAX: 503 - 356 -0513 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 06/08/2011 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 06/08/2011 $7.63 Type of Use: SF Electrical Class of Work: ALT Type of Const: • Occupancy Grp: Total $71.23 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 ado. -. by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR • -� 1 -0090. You ma btai . • • of the r• es or direct • uestions to OUNC by calling 50 2.1987 or 1.800.332.2344. • Issued By: - ,� ! t Permittee Signature: . d • . iisi/ 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. Jun 07 2011 4:25PM HP LASERJET FAX 5033560513 p.1 . . • Electrical, Permit Application i -': 1 f f roIi ()l t'l, "I.; 1,1WW.- (►1 I., y C ty of Tigard JUN 7 2011 Rsaeived b 13 2S SW F $I T 1 and OR 97223 Dated) ; ,e Afl : �/ ��� _iL : g Flea Review ` I Pam 503,718,2439 Fax' 503.5 Rl'1960 r n RR Othet Fmmit, I _ C 1 OF t IGA l U Dat r ,1.240 :ii ett:At { t> ]ns•actionLine: 503.639.4179 BUILDING t�! Pp'r�ts''ef [ PatoReadylBy; paae In. met www,tigand•or.gov �UILD1 G LJI V IS1OIt� l�otIf odlyethd; Buppleme 2 tnformntion ❑ New constru' Lion ® Addition /alteration /replacement Meow chock all that apply (submit 2 Bete of plant wliterns checked below): 12 Service or feeder 400 empi or mom Q Building over three tootles, ❑ Demolition ❑ Other' where the available fault current ❑ Marinas and is, '..v.,—..: • .. ....: _ .r: ... ` f r y t : , i: C s- ' Q ' ' : . '' ' �.�''" ' I':,.; exceed& os ps at s 14,000 volts or ❑ Floating oia -use "' ` ' ,egg to Ground, or exceeds 14,000 El Commercial /industria Accessory building © C buildings, ogricultural ® 1- and 2 -fam• y dwelling y 8 stops fbr all other inatallatlonr. buildings, ❑ Mu lti- family ❑ Master builder ❑ Other: ❑ Firs pump. ❑ lnatallation of 7 s i(V A or ?:'i" , ',fui' =ii` ,:5 "ii Emer sys I 8C cr s .,':' .'.,.-. . ,,.; FO R10. , 1 ° s?, i'.• ;,i • B separately derived system . .., -. .,,,... ';,... „.,, _.....,.,. motor load of _ .,._. .,...,, .. ..,,,.. ,.�:, ?.,....,;�,�.:•• El Addition ❑„A„ "E", '' I -2", "1-3" Job no.; 3436 Job site address: 962.5 SW Brentwood Place l001SF or name ao aupancy, [ISM or more residential units ❑ Recreational vehicle parka. City /State /ZIP: I Igard, OR 97224 ❑Haalth•edtofaoilitiea. ❑ Supply voltage f'ot' mom than ❑ HUM dous locations. 600 volts. nominal, Suite/bldg, /apt. 0,; Project name: Barbara Roth ❑ Sor via , / or feeder 600 amp& or mon, • .10g.'!:.::,' „•; kit.: iii .. -,.� 1 Cross street/dire•tions to job site: : i,, ' 'Mitt':' ';'!` ' De.c,iptlou Utr, Fee. s emi I - New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no,: 1,000sq. ft, or less 168.54 4 Es, add'I 500 sq, ft or portion 33.92 1 Tax map /parcel o,; . Limited ,, . .. .. , .....,,:_:,:.,., 5 .:.,.,:_.:. 5.00 .......... 'dui � ; .. ^ ,.,,..._..,. ,,,,,: .,:,..:.�:::�: - r;.c:. ., % ,...,:::y..'S.. .� �m�s�F ;'1?►dU „ ..:�; ., .: , ,, (with above � sq, ft.) . Limited energy, multi- femIly 75.00 2 (1 )new bath sir uit and rework (1) lighting elreult residential (with above sq. ft.) Services or feeders Installation, alteration, and /or relocation 2 00 amps or less 100.70 2 t .,.. . ,: .1ia=.:.:r: till '::::::' <''.1 r , i_ , ,_�.:'u`t%u .:: � -.::.� a REI2 ,� "iC1i�t'IV]�Ri;:. - ...� ` `' '` amps am .:... ...: .�•. „ ,,. ..,....,...:,,.....:::_...,, ,;::;,.,....,,......;,, ,�•. -: s'�' +�� 201 ams to 400 amps 133.56 Noma: 401 amps to 600 strips 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 7 City/State/ZIP: Temporary services or feeders Installation, alteration, and /or relocation Phone; ( ) I Fax: ( ) 200 amps or less 5936 I Owner Installati • n: This installation is being made on property that I own which is not 201 snipe to 400 amps 125.08 2 2 intended fbr sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 strips 166,54 Branch circuits— new, alteration, or extension, per panel Owner signature: Date: A, For for branch circuits with ,:: r, ',.;ry�:i :' '': �=_` i' r.: t Q above service er feeder fee ... .:.:::::::: �: ...:,... L Jpr,;;xaar` -..{ ��r'`Pl 7.42 . . . ° .,,. " each breac a irouit 2 Business name: 13, Fee fbr branch circuits without service or feeder fee. first 1 56,1 fl 56 3 Contact name: branch circuit Address: B ach add'l branch circuit 1 7.42 7.42 2 Miscellaneous (service or feeder not included City /State /Z1P Each manufactured or modular dwelling, service and /or feeder 67.84 2 . Phone: ( ) Fax: : ( ) Reconnect only 67.64 2 E -mail: Pump or inigatton circle 67,84 2 � ,, ,- , +,� . tL • `' :er, _ °'d' � vv lighting 67.84 p _. _ � Sign o r outline u Business name: Electric, :;. 141Tt's 4 < '''• , r' ' : ':: _., w.;'+s; '.' Ica uro c -' ^� ^� " , '• c ��' • �� ` � " 3 1g I ult(s)or energy etric, Inc. panel, alteration, or extension. age 2 1 2 Each additional Inspection Over allowable In any of the above Address; 24495 W Oak Drive Additional Inspection (1 hr min) 66.25) hr City /State/ZIP: illsboro, OR 97124 Investigation (1 hr min) 66.23) hr Industrial plant (1 hr min) 78.18/ hr Phone: (503)'640,' 344 Fa,i. (503) 3564513 Inspections for which no fee is - specifically listed ( hr min 90.00/17 CCB Lic,: 9427 ( Electrical Lie.: 34 - 3750 Sum, Liz.: 4724 -5 : tf.,.,-+ :A.. ,t , :1 ; ; ':I,Et Suprv. Eleetrieia signature, required(;/3.2 Subtotal; $63.60 Plan review (25% of permit fee) Print name: on L. Kurtz ate; 6/7/11 State surcharge (12% of permit fee); $7,63 . Authorized signa fi �/• .# "-- TOTAL PERMIT FEE: $71.23 /�ws -/` This p ermit application expires de permit is not obtained within tap Print name: Ron L. Kurtz Date; 6/7/11 days after it has been accepted as complete. • Number of inspections showed per permit. I;1HulidlnaTernita LC - mitApp.doc 07/01/10 140.4615T {11I0$'COMIwHe