Permit CITY OF TIGARD ELECTRICAL PERMIT
• Per
$ COMMUNITY DEVELOPMENT
Permit #: ELC2012 -00312
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2012
Parcel: 25111 CA01400
Jurisdiction: Tigard
Site address: 9645 SW SUMMERFIELD DR
Project: Rethinger Subdivision: SUMMERFIELD NO.7 Lot: 339
Project Description: (5) branch circuits replace existing 200 amp panel, new floor heat circuit
Contractor: RK ELECTRIC INC Owner: RETHINGER, SUE
24495 NW OAK DR 9645 SW SUMMERFIELD DR
HILLSBORO, OR 97124 TIGARD, OR 97224
PHONE: 503 - 640 -1344 PHONE:
FAX: 503 - 356 -0513
FEES
Q uantity Description Date Amount
Specifics: 1 ea Temp Services or Feeders - 05/23/2012 $59.36
200 amps or less
5 crt Branch Circuits w /Purchase 05/23/2012 $37.10
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 05/23/2012 $11.58
Electrical
Type of Const:
Occupancy Grp:
Total $108.04 •
Required Items and Reports (Conditions)
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 5 - 001 -0090. ��, You mayy obtain a copy of the rules or direct questions to OUNC by calling 503.223 11.800.332.2344.
.[A
Issued BY: W Permittee Signature: DA.L 1 PPL �� OAJ,
/ OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This pemilt card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each Inspection.
May 18 2012 10: 02AM HP LASERJET FAX 5 0335605 1 3 P • 1
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Electrical Permit Application H,It ■ it 1 II I . , ..1 ( ) \I 1
City of Tigard Received ‘ 3-3 12. sir Pennit 14 • 0-01.3- ot.)31?-
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
. . Phone: S03.718.2439 Fax: 303.59119E0 DIMS . Other Penult:
Ti inspection Line: 503.639.4175 Date Ready/By: OM . Secrete I for
i.:Ari)
Ward: www.tigard-or.gov Nati lied/Method: Supplemental Information
• 'iqi+70'trl 4:1$•;.;',,iA.•.j:;'
0 New construction ! Addition/alteration/replacement Please obook all that slip (subnlit i sets of plem wiliness checked betow)' .
Cigar/les or ender 400 awe or mum CI Building nor throe amino
O Demolition 0 Other: where the available Belt omen D Minims end boryards.
: f .. littl . D . '7 , fe'l ; z1Wi•Zi 1. 4-1'dM6 5 ?; 1 ,i f .„ri encode 10,000 emps d 150 volts or 0 Homing buildings.
tem to ground, or encode 14,000 13 Comnierclal•use agricultural
n 1- and 2-family dwelling 0 CommerclaVInduscrial 0 Accessory building amps for all othw installation. • buildings.
C) Multi-family 0 Master builder 0 Other. 13 Piro pump. 0 InstellatIon of 75 KVA or
.. -, . ef v."- . CI Emervmoy 5y6ICTO.
A1,. Of .
.. 4 ' - . ,:
N 4.4r "
k4..,.. ... '.;.... :.. - .4.t - . , A 0 Addition of new motor load of 13 114 separately derived eystcm
Job no.: Job site address: ytit , s / / , J 100/IP or mole. ocoupanay.
-
I I] Six or more residential units. C Recreational vehldo parks.
City/State/ZIP: • I - 1 , • • 6/t ? 7 22- • 0 Health-care IltollIdes. CI Supply voltam for more than
1 0 Hamden, locations. 600 solo minted.
Suite/bldg./apt. no.: 1 P , ject name: Cl Service m finder 600 amps a mon.
1.1 q: 'i•;'.
Cross street/directions to job site: ' ZioneatIon Oa. tn.
New residential single or mufti-family dwelling unit.
Includes attached garage.
_ •
Subdivision: • I Lot no.: 1,000 so n. or less i • 168.54 4
Ea. aril 500 sq. ft. or portion 33.92 1
Tax map/paroel no.: • Limited energy, residential 75.00 2
.irf....•*.i ,.. .*:a7rfi:ILR4Ait:Wrs'?fgNli'i (with ab°ve sq. ft) . - , •
Limited energy. multi-family I 75.00 2
Peretst.0_ ., _61_ ,' VA, ge04/ residential (with ebove sq. ft
' Services or feeder. luta IlatIon n, and/or reload lOn
1 6 IA^ Co4kt:41. 200 amp or lose I 100.70 /904 /0 2
- 1 - .1-': 14 • sre Mi 4*,i' :,!.- 201 amps ta 400 ern P 13156 2
•
...PAI . , * - .. - , ,.. I ." .1 • .. n:••17... NI, . • • -C . . .
Name: tAt- ,..1rer • 401 amps to 600 amps 200.34
601 amps to 1,000 mpg
501.04 2
2
Address: 4. %/' g.t....„ 1
• Over 1.000 amps or volts 552.26 2
City/State/ZIP '0 Temporary services or feeders inscalhitIon, alteration, and/o
: 1 tl- ? 7 2-le3 relocation
Phone: ( ) I Fax: ( ) 200 amps or less 5936 i 1
Owner installation: This installation is being made on property that I own which is not
201 amps to 400 amps 125.08 1
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 16E54 2
Breach circuits new, alteration, or extension, per panel
Owner signature: Date: A. Fee for brand) circuits with
above service or reader the. 5 2.42 2
Business name: L DS COPS (, r/D/t) B. Pee he branch circuits without
service or feeder fee, first
Contact name: .... 701a. /...0 4-5 branch circuit 56.18 2
- Each &kr lbranch circuit 7.42 2
Address: PC ger 7g f Mine ianeous (urvke or feeder not Included)
City/Stata/Z1P:
Each manulliclured Of modular
/74,514,... • PA-- 7 v6 e--
/ d well ing, service ancVor feeder 67.84 2
Phone: 03 (P 3 - s 1 Fal: : ( 5 ■ 9 3) 4 J'7 Reconnect only 67.84 , 2
Pump or irrigatioa circle 67.84 2
E Sign or outline lighting 67.M 1
.i iet.M.saa,SMI:4Ki.',V$1331■10,Xel:ORI:W,"q•;•tiii.t?? ' Signal eirettit(s) Of liMifed{flefgy '
Business name RK Electric, Inc. panel, alteration, or extension. i PAP 2 2
:
Each additional Inoccdon over allowable in tar of the above
Address: 24495 NW Oak Drive Additional Inspection (I hr min) 66.29/ hr
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Investigation (I hrmin) 66.25/ hr
City/Stale/ZIP: Hillsboro, OR 97124 .
1,141301st plant (I lir min) 78.18/hr
Phone: (503) 640-1344 I Fax: (503) 356 Inspections for which no fee is 90.00/ hr
a' dfleal listed S.5 lu min
CCB Lie.: 94275 A \CI Lie.: 34-375 k I Suprv. Lie.: 47341
t k
Suprv. Electrician signature, required: (7,
/1" 1.41) Subtotal: 5 ' • -
Plan review (25% of permit Be): 3 1 0
Print name: Ron L. Kurtz Date: - 0 0 .- ,a,, Statosurcharge (12% of permit Be): I / /. 52(
If a permit Is
Authorized signature:
0(1( TOTAL PERMIT FEE: jot'. Ock
Thin permit appUestion empires me obtained within ISO
days OW Is hos boort sampled as (Ampler.
Print name: Ron L. Kurtz I Date: C- 13 - I .,....1 • Number of inspections allowed Po? Ponnit.
1:41luildifii4PMMEL.C..rerregiAppulOC On I /10 440.44157(11#05/CPWWOO