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Permit l ,, CITY OF TIGARD ELECTRICAL PERMIT .- ' ': COMMUNITY DEVELOPMENT Permit #: ELC2011 00347 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/23/2011 Parcel: 25111 DC12800 Jurisdiction: Tigard Site address: 15955 SW OAK MEADOW LN Project: Wilson Subdivision: SUMMERFIELD NO.11 Lot: 624 Project Description: (1) branch circuit for kitchen range. Contractor: RK ELECTRIC INC Owner: WILSON, RUTH ANN 24495 NW OAK DR 15955 SW OAK MEADOW LN HILLSBORO, OR 97124 TIGARD, OR 97224 PHONE: 503 - 640 -1344 PHONE: FAX: 503 - 356 -0513 _ FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 06/23/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 06/23/2011 $6.74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 Required Items and Reports (Conditions) This per ' is issued sublto the r-, ations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be d in accordance with app -d pla. s. .is permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 da . ATTENTION: Oregon la . require . to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 9 - 001 -0010 thr . OAR 952 1 01 009 . .y obtain a copy of the rules or direct questions to OUNC , . n. 503.232.1987 or 1.800.332.23• .. . / ii Issued By: l., a Permittee S nature: !� • l 4a 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' pt Q ibli-(irtrio—At.-- 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 23 2011 12:03PM HP LRSERJET FAX 5033560513 p.1 Electrical ermit .4.pplica ECEIVED I cllz (0.1:4 ,'lsl; ( • Ci of Tigard N 2 ru�eiYa r Parrott Na 131 3 SW Hall Blvd., Tigard, OR 972 2011 Date /H : t� ae-- a�p/� -. 60- ll : al l Ph e: 503.718,2439 Fax: 503.5 960 Plan Revi Other AolmiL • 1.1 (i ins -c L ine: 503.639.4175 t� Y pp �p� D al e Read /Ii AIi 15 p� TIGARD y Y: '' See Paget for Internet: www,ligard- or.gov BUILDIN NO[i fled /Method: Sup plementel Inform erica) '.r:' , 7' i '. „i'i , 'r' ,..1 -, .., ',•7• �.,vy�, '�'r4'� i �. }: • u �� ,�.1�, i,.;+171'.���1N_ �}��(�r�1'�7 • [� A�•.E'n� ail .lY . d.� � .'„ , t A: .;,:, h�. ... il�i, , '' �.'. \ !^':F'•:�f;�ir. ^�, �R' . © New construction Addition /alteration/replacement 1 PlcarA check all that apply (submit a rata of plans whims chocked below): ❑ Service or feeder 400 amps or more ❑ Building evtr three ttcrioy, ❑ Demolition ❑ Other: ;: r ; where die Available teak currant ❑ Mannar and boatyards. , 4 y ry�, ( 5 :' y'',u :; ' 4, '.;j exceeds ,000 A a 150 volts or ❑ nt in is •, ' 'i : • .AG;c: .•.,• .• i r . y ,,' ,4 r,r�Ph � a'IM1rlf�.;; li� !',r�h , . , rt�k ; p et 6lr4alld , ricultural L,,.. less excee to Sroun oro xc 14000 ❑ C ercial -use ag 41. and 2-family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. 0 Multi - family Q Master builder , Other: ['Fire pump. ❑ Installat of 75 KVA or A' ;iBl!r yy,,, r..y� i�• , i.. a, , {` • ,_, k , . , d a,l: .�.�� •. q l ;,r ;:.,: .n ,, r ., Emergency ryrtem• larger a ,',�!r#;10.a'>!!�f;,: r ,,.� u o ., C..$ i,1! ..' �{I Se 5”, .' kly derived system. 0 •�' ifT I .:r : It::;,;` „'':. ❑Addltlon of now motor load of �� l 6 q tom, r ti )Ji . 100HP or more, pea anc Job no.: ✓ Job site address �.// I d V�r ����" p r � � f in Six or more residential units. ❑ R eerordioeal vehicle parks. City /State/ZIP; f l r • t-/J ?•-'t'T _ ❑ Health-care facilities. 0 Supply vu for more than l ❑ 1'fazudcus location, 600 volts nominal. Suite /bl dg,(ept, nc : Project name:'� f y . 1� T ❑ Serviceor feeder600ampsormore, Cross street /directianstojob site: ■'!; ∎ Z. 6 ' .:+�•, ∎# °$ d " = ` . . ' ' Daicrlpdon I Qty. I /tr. 1 Tcta! I New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision; f Lot no,. 1,000sq• ft. or less 166.54 4 — Tax map /parcel no.: Ea. add' 1 500 se', ft. or portion 33.92 1 1 ,, Limited energy, residential ;i,% ,r' l` O .i 011 '; 6l a'' 1' `'' � (with above as ft) 75,00 2 Limited mited energy, multi - family 7500 2 � ' 1 r' emit_ (with above sq. It.) Services or feeders Installation, alteration, and /or relocation 200 amps or less 100.70 2 r, d di re :P,;4:•ti, c; ? i Y , r:.4 t !'.a: 1' :. ” Ii''' ° IIJI,'? , :.h ' I .. , ,:,• ;r 61d" :. n y , :Q tti*o • :t I A, ,•, ,r i I 201 amps to 4 00 amps 13356 _ > 1, (. , ,}; a.vltd _' LC t is ;, I 3,56 2 Name; 401 amps to 600 amps 290,34 2 601 amps to 1,000 amps 301,04 _ 2 Address: Over 1,000 amps or volts 552.26 2 Cityltital, /71D. "' Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) ) Fax: ( ) 200 amps or less 59.36 I Owner installation: This installation is being made on property that I own which is not 201 am to 400 amps 1 2 intended for sale, ease, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 599 amps 168.5 2 Owner signature: Date; Branch circuits - new, alteration, or extension, per panel Fee tt} Ww ;,� lz�:,,'i �p "�� i - k'. . ' Iti i � n Pe r branch circuits with ,''> ' ''b. ;l; 1,2 . r ' "., ; Ekt;;4 "t above service or feeder fee, 2 „ each branch circuit 7.42 Business name: a. Fan far branch circuits without service or feeder fee, first 2 Contact name: • branch circuit . each odd' I branch circuit 7.42 2 Address: Miaeellancoue acrvlceorfeedernot City /State /ZIP; Each manuflietured or modular 67,64 2 dwelling, service and /ortbeder l Phone: ( ) I Fax: : ( ) Reconncctonly 67.84 2 -- Pump or irrigation circle E-mail, ' P 67 04 _ ';; ... , t' s, "t ,iu 1. ii,� e ^Il'; `ai „t.. , { +' y , r Sign or outline lighting 67 B4 2 :: _; ` :d '!N' 1;; "bio;,r:`;!;',i,y.n c;b.r ¢" 1','riid. : ;:: > ; ';e _ 1'I •;I ? ?y ia;” 1G:,;: Signal clrouit(a) or limited energy Business name: RX Electric, Inc, panel, alteration, or extension. , Page 2 2 Each additional Inspection 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 investigation (I hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr • Phone; (503) 640.1344 Fax: (503) 356,0513 inspections for which no fee Is 90.00/ hr CCB Lic, 94275 Electrical Lie.: 34-375C s• ecifleall: listed 14hr C Supra', Lie.: 4724-S : k,1�,; �; rah:': s Cz..?.;..�` '5. Suprv. Electrician signature, required: Subtotal; 1E• �, r t 14 in Plan review (25% of permit fee): Print name: Ron L. Kurtz Date: (°I � / (/ State surcharge (12% of permit fee): tp , 7 Authorized signatt re: TOTAL PERMIT FEE; ' •• • • This permit application expires if a permit is not obtained within 180 Print name: Ron L. Kurtz 447, I Date: ' clays after it has been accepted as complete, r f �' Number of inspections allowed per permit, r I \ 3uildii Pon.iltApp.doc 07/01/10 490 46157(II /DN00M/WEB