Permit , CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00736
COMMUNITY DEVELOPMENT DATE ISSUED: 11/1/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103AC -01900
SrrE ADDRESS: 11230 SW FONNER ST ZONING: R -4 5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: ROGERS
Project Description: Panel change and add (1) branch circuit.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA /SPEC OCC:
Owner: Contractor:
SHERRI ROGERS RK ELECTRIC INC
11230 SW FONNER ST 24495 NW OAK DR
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 503 - 547 -1344 Contact #: PRI 503 - 640 - 1344
FAX 503 - 356 -0513
FEES
Description Date Amount Reg #: ELE 34 - 375C
[ELPRM`f] ELC Permit 10/31/200' $86.95 LIC 94275
[TAXI 8% State Surcharge 10/31/200' $6.96 SUP 4724S
Total $93.91 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Muniapal Code, State of OR Specialty Codes and all other applicable laws
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 - m• o than 180 days ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center
Those ru -s are set fo i. • - 9. - 001 -0010 through OAR 952 -001 -0100. You may obtain copies • hese rules or direct questions to OUNC at
503 246 6699 or 1 800 k;2 23
Issued By: li Permittee Signat , • r °rc_j, ,
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:
$DNTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: � ' � Ler DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
\it
Oct 31 2007 8: 23F1b1 HP LASERJET 3330 p . 2
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Electrical Permit A 1 ' . ' VVEI)
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City of Tigard Daten3y /0 51 ,07 y Perrnit No ' eLdAeo '7- 0 07 3
, ,
13125 SW Hall Blvd., Tigard, OR 97 * ' ri 1 10k. Plan Review
Phone: 503,639.4171 Fax: 503.598.19600C 1 .,.. el 44 :'%tO'l il,'. DaWBy: Other Pomet.
Inspection Line: 503.639.4175 . t. - . -4 1 ' Date Ready63y: ...ro Et See Page 2 for
Internet: C44
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i — 't Notified/Method / ( Ot Supplemental Information
www.citigard.orms
. ,.: ,,, ‘. ,*.:',. .:' . ": 3: i;''':',:i 'i "::-",...''''''':.::' ‘ : '.' ''.. ",, "":" " " . "' " i ' ? " ': ' ;' ' ' . ."; ' :::::,"5 ". : '" : .. : ' 116 . e:g14,414:11C42eftili; , :?■':',. , , , :'' '-‘, :'.. .: . :.'''.
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0 New construction El Addition/aeration/replacement Please check all that apply:
['Service over 225 amps, comml 0 Hazardous location
1:1 Demolition 0 Okl Other: tii itfeflo ,,,„., ..,,, 0 Service over 320 amps - rating 013uildng over 10,000 sq. ft.,
.t
a al- arid 2-funily dwellings 4 or more new residential
;.4.
El I- and 2-family dwelling 0 Corrunerciallindustrial 0 Accessory building 0 System over 600 volts nominal units in ore structure
0 Building over three stories ['Feeders, 400 amps or more
1:3 Multi 0 Master builder 0 Other:
00ccupgart load - i over 99 persons ['Manufactured structures or
Iiiiii,f.......... .. .,..„.:-: -.:- .,' .
4 'f41 ...... k ,/::: ..t$:iWii0iiTM: DEgress/ligliting plan RV park
Job no : Job site address: 11230 SW Former St. OHealth-care facility 00ther:
Submit ,i_ sets of plans with any of the above.
City/State/ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service.
Suite/bldg./apt no.: Project name:
Dem:Option t Q 1 Po*. 1 Total I -
Cross s to job site: New residential single- or nudtd-fanully dwelling wait.
Inchades attached garage.
1,000 sq. ft. or less 145.15 4
— --
Subdivision: Lot no.: Ea. addl. 500 sq. 11 or portion 33.40 1
Limited energy, residential 75 00 2
Tax map/pareel no.: Liasitedasergy, non-residential 75 00 2
-,',.:.._':,"'•;;;;,-g::•:,:-..-G:,i'5-'3,, 44W: - .7: - '- - .T - .'' "---'''.".-. ... . :: E manu or mo
dwelling, service and/or feeder 90 90 2
Panel change + 1 circuit -
Services or feeders installation, alteration, and/or relocation
200 amps or less I 8030 86;1,0 2
',' . ';':"..1•1. . •:.'".•'''. '
201 amps to 400 amps 106 85 . 2
Name. Sherri Rogers
601 amps to 1.000 amps 240.60 2
Address: 3554 SE Bradley Ct. Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/Z.1P: IlilLshoro, OR 97123 Temporary services or feeders installation, alteration, and/or
Phone: (503)5474571 I Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that Town which is not 201 amps, to 400 amps . 100.30 2
intended f o r s a l e , l u s s e , r e n t , or e x c h a n ge , a c c o r d i n g t o O R S 447, 449, 6 7 0 , and 70 L
401 amps to t500 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
•v:1' A. Fee for branch circuits with
- ''''''''''''''''''' '''' = = - '''''''''''':''''''''' ''''' . ' - '''' ••• ' -- -.- '''' --* '-'.*= ' service or feeder fee, each
Business name: branch circuit 1 6.65 4 if 2
4 . 1 Li
a Fee for branch circuits
Contact name: Zacb 111G1 ton without service or feeder fee,
each branch circuit 46.85 2
Address:.
Each addi branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
, Pump or circle _ i
Phone: (503) 849-3297 I Fax: : ( ) Pu r iriati il • 5340 2
. Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
- iii;; i , : : ::', - .:'A. :- .Offit,Witti*? : '',:*:: - .0itiR:" . q.t.T,ETI.Ti'nEir 1: energy Panel, alteration, or
extension. Describe: Page 2 2
Business name: RK Electric, Inc.
Address: 24495 NW Oak Dr. Each additional Inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: FEdisboro, OR 97124 Investigation per hour (1 hr mm) 62.50
Phone: (503) 640-1344 Fax: (503) 356 Industrial plant per hour 73.75
llf..
CCB Lic.: 94275 Electrical Lie.: 34-375C Suprv. Lic.: 4724S Subtotal
Suprv. Electrician signature, required: K of Y review (25% of permit fee) -
State
Print name surcharge (8% of permit fee) 6 (p
- PZ /
K 4 Date:
• .A.4/7 10/341/07
. TOTAL PERMIT FEE 3. q /
Authorized siguature(e-r6r1 c M' k This permit application expires if a pond! is not obtained within 180
days after It has been accepted as complete
Print name: ( / 14' 1 . Date: 10/30/07 t Fee methodology set by Tn-Courity Building Industry Service Board
. ., . .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00736
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 1/112(307
Phone: (503) 639 -4171 ' �N @vO'lh�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/24/2007 TIME: 7 : 00Aivi PAGE: 46
SITE ADDRESS: 11230 SW FOI4NER ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ROCIR S
DESCRIPTION: Panel change and add (1) branch circuit.
OWNER: ROGER S, SHERRI PHONE #: 503547 -1344
CONTRACTOR: RK ELECTRIC INC PHONE #: 503-6401344
Inspection Request Scheduled For: Date: 12/24/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
109 Electrical final 062066-01 603.640.1344 N
Corrections /Comments/ Instructions:
`' I
►•, PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: �v 1 $ W +� Date: Ilill 01 Phone #: (503) 718 - 1144'