Permit CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELC2012 -00008
IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/06/2012
T.
Parcel: 25111 DD06800
Jurisdiction: Tigard
Site address: 15735 SW 88TH AVE
Project: RUBOTTOM Subdivision: STRATFORD Lot: 65
Project Description: Kitchen remodel.
Contractor: PRECISION NW ELECTRICAL Owner: RUBOTTOM, GRAYDEN A & DEBORAH L
12020 SE ANNA CT 15735 SW 88TH AVE
DAMASCUS, OR 97009 TIGARD, OR 97224
PHONE: 503 - 413 -9870 PHONE:
FAX: 503 - 594 -2873
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 01/06/2012 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/06/2012 $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 Center. Those rules are set fort in OAR
952- 001 -0010 through OAR 952-118 -0090. You ma obtain a co rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �I'- /'�� f _ _ _ Permittee Signature: li/
'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.
01/05/2012 03:12 FAX 5035942873 PRECISION NY Y a002/002
Electrical Permit Application ,.• FoR OFFICE USE ONLY
City of Tigard R D: e ic e /B ived : i 5" 4 -- permit No.:. -,__ IA -- CC.t)(DEr
,
c■
1, . 13125 SW Hall Blvd., Tigard, OR. t 0 ,..\ \.). Plan Review .
Other Permit.
: 2 , ' Phone: 503.718,2439 Fax! , . . 6D ?,... '' 117Le!yr 1 . ,
pl• e c•s\ N - Date R 2 fur
eady/By: runs,: 811 S ee Pag e
T [GARD ItipeCtion Line: 503,639.4 l %.'"
Internet: www.ligard-ar.gov 4., -,,.. Notified/Methal; _ - . Supplcmen tat Information
",:;;... -:.!; :,•':`",'".., :::;-.:,.:"' !, ;;( .'...,. , ': • ',.;!;.' ..:.,••:'44iitie' T A ' r ;,•' ;,,, nf!r.:'..41 ? '1:' ':! !1',:;:% ' 0 ‘ ';'i4iii . '.;11t'lgiff,.*1:4ty,k ,! ; , :r; ; . ,,
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- -.--• Please cheek all that apply (submit 4 sets of plans whieins checked below): •
0 New construction IT■rAddition/alteratioltes :1/4 ent 0 Service Or (ceder 400 amps or more 0 Building over three stories.
\S.°
0 Dem& ltiOn 0 Other: where the available i'atili current 0 Marinas and boatyards .
ex c e ed% i 0,000 amp t ISO volts or 0 Floating buildings.
:: ' :: ." • .:;..'.;' ,..:.-,':..'."..:'.; ) ;.;!: ,ria 0 , . *,:. at; . 4tr li , • W 'il
)C55 to ground, or exceed% 14,000 9 Commercial-use agricuitural
r 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amp% for all other installations. building..
9 Multi-family El Master builder 9 Other: 0 Fire putlip. 0 Instoltatiou of 75 KVA or
9 Emergency system. larger separately derived system.
,7,14;1g1:,d,:i'AiirTNETEDIMEENIEMINEIGITHENg Cl Addition ollcw motor load of 0 "A", "E", "14", -. 1..V,
100HP or MOM. occupancy.
Job no.: Job sitc address: 1 ----)3 s s,,,,, 03+a Mie . units. Re creational 9 R vehicle parks.
0 Six or more residential
,.,
...
Ej Health-care faciticies. Li supply voltam rot more than
City/State/ZIP; .- i .-, 47, , ot _ ci 9 Hazardous locations. 600 volts nominal.
0 Service or feeder 600 ainps or more.
SUi to/bldg./apt, no.; Project name; ,th c / iiwb n 00.1 .„ , . , • T., zam ...i • , A .''' ' . ,, '.' ''''',' '''' , 0 , '
"" .. ATEngii AWBkiriaffgEallaoi
Cross street/direetions to job site: Dtactip0.11 00. Fee. T otl 1 • .
,., New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: it 1 sq. ft. or less 168.54 4
no.;
------- ... Ea. add sq. ft. or portion 33 92 I .
Tax rnap/parccl no.; , Limited energy, residential 75.00 2
.;6kg,0;0#toi:of„:0,§AC,;,::::::.0;'...,;,,,::::ii7;',:.'.Vi,'.::;:?:]:.,':,v.V (with above sq. ft,) .
.. • • .. . ..,,. ...• • .. . ,.. • .. . • . •...;;„.•.,..,•, - ,.- ,• • ..+:.....^ , , • '''' ''''"";'''''"' '' ' Limited energy, multi-family 75 2
1 • 11...4/,_______ ' - t residential iwith above sq, t1.,)
,- Services or feeders installation, alteration, and/t5 relocation
200 amps or less 100.70 2
.• , 201amps to 400 amps 133.56 2
' ..
401 amp to 600 amps 200.34 2
Name: —
- . 601 amps to 1,000 amps 301.04 2 _
•
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feedersinstallatIon, alteration, and/or
City/Statc/ZIP: relocation
Phone; ( ) Fax: ( ) 200 amps or less
_ 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that i own which is nut —
168.54 2
intended for sole, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 AMPS
Branch circuits- new, alteration or extension Cr 'anti
Owner signature: Date; A. Fee for branch circuits with
±7,;; fti,K.,.. vc::Vr,,,'i above service or feeder foe,
7.42
each branch circuit
Business name: B. Fee for branch circuits withoid _
., service or feeder fee, first 56. IS
Contact name: ,. branch circuit
., Each adti'l branch circuit ,t1 7.42 1 ' .
_.,... KM
AddreSS: Miscellaneous (service or feeder nut included) _
Each manufactured or modular
City/State/Z1P! 67.84
111
dwelling, service and/or feeder
Phone: ( ) Fax: : ( i Reconnect only 67.84
, .- Pump or irrigation circle 67,84 El
E
67,84 El
Sign or outline lighting
.....‘•:•,,, ::. , ., ,: ...,,,.; „ •:: •:1: ! ,...!... A' ■ i J yr . 1 ,•' : , , All: ! ,;,:.•,,,. :.•' :. ;' 1 ;1Z g'ri -,... , . . , ,
1.;;;11,:,!..;!..•!::,•,4;!,:-/:•:'....17;,11.•41 .":•e, ..,.,.;•.t.,...' ■,,, ..I.a &Oackr..4.4.:Aw,;;0,,m;1,&! bignai crrcuit(s) or tirmteu
encl, alteration, or extension. Page 2 IN
Business name: p c .; s % c),..j KAA,..)
. ...... Each additional inspection over allowable in so of the above
Address: v2xyz 5 c ., p 0 , c., .- Additional inspection (1 fir min) 66.25/ hr
.
„..n „eir r „ invcstigation (1 hr min) 66.25/f City/Statc/ZIP: 40i9m4 A S LA) S , CAL_ , -i it../c) , --1
Industrial plant (1 hr min) 78.i it/ hr III
Phone; (S .4 - ci 1;2,4 Qe ) Gi214 1 3 Inspections 90
for Wiliell TtO tee IS .00/ hr I s.ecificell listed A lir min
CCH Lic.:1 k ;7. el Electrical Lie,: c 41 s upry • lie :j 6
—
- subtotal;
• 1.161, "
sup,. Electrician signature, required: '
6. . . _A I • -. A. Plan review (25% of permit fee):
_ . _ ■
Print narnej,..._Aaks Date: 1,- G.-- 20%‘2,, State surcharge (12% of permit fee):
C. . .
Aulhori7ed si&mattireo TOTAL. P ERMIT FEE:
This permit application expires if a permit is not ()gained wit in 180
- ..
Print name; t its„At AA 0 Date: ,- • Number dap after it has beer accepted as complete.
of insouiAinns allowed per permit.
i.o 07/01/10 440 )/weGMAVED