Permit CITY OF TIGARD ELECTRICAL PERMIT
2. • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00495
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/22/2012
Parcel: 1 S133CD00700
Jurisdiction: Tigard
Site address: 11736 SW SWENDON LP
Project: Baker Subdivision: COTSWALD MEADOWS Lot: 5
Project Description: (2) branch circuits for furnace reconnect
Contractor: RK ELECTRIC INC Owner: BAKER, CLARENCE H & KATHLEEN M
24495 NW OAK DR 11736 SW SWENDON LOOP
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503 - 640 -1344 PHONE:
FAX: 503 - 356 -0513
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 08/22/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/22/2012 $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 subiect 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 a nce with a• .roved 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. ATTE ON: Oregon law re. 'res you to follow the rules adopted by the Oregon Utility Notifica • Center. Those rules are set forth in OAR
952. 001 -001 through OAR 952-00 • • may obtain a copy of the rules or direct questions to OUNC by callin:e .1987 or 1.800.332.2344.
Issued • / ' Permittee Signatur • 1 _:' �' I' ( (- /
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'
the i • 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.
•
Rug 21 2012 1:05PM HP LRSERJET FR){ 5033560513 p.1
E l e ctrical Permit Applica,, . )R c)l i icr
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City of Tigard EIVED • ,,, , . QI (Ii1 Pmmit Na.: �L AO/a • % 9,,S
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' B Phone: 503.718.2.439 Fax: 503.3 8.�... 4 6 2012
Dot la : Other Permit Nam /a-40 41
' I I t ; A a I1 Inspection Line: 503.639,4175 gate Ready/By: bids. ® See Paget for
Internet: www.tlgard•or,gov NotitiedfMethod: Supplemental Inform' lion
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o:v, m J cf Yp RTS ',� t+s ;t r r fijf y r lh 7 x. w a-; t ;h C" , �� t¢, r
��!jlM�l/�•$133 .�r .Ir �• �1*i o�3i e { *1' : .,�. is'�J�eldiu 1 .5*kf��:J�l:4:Sui �1�:.: 3�,ti.ti./.iui rl uiiv ^^t l_. :LLr �J�Lti':�, ^r �•._. �� �.T iA� ,
0 New construction A ddttion/alteration/replacement Please check ell that apply (submit 2 meta of plasm wfitema cheated below):
a Service or Feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault currant 0 Marinas and boatyards
', `Xal F. 4 i :T'Pl 75!:'i Ll Lw ii r a .�`q , A 1 1'>- }.:i' �JvSJ1S1 ` f.
�a i i ' �j ^ 4 ;9�'�. 'j �} �'o ! .0 iru.ao 4p - ,sig. , s 1 t . v I{ .ve axaaed araPaatlSOwtcaor OPlaating buildieg a -
:b: „r;+tsa"f [Z P /2.E∎ 1F•?.u.1 , vENt17 . • r . tt .s.,y -R.i i,d,Qyi
lee to ground, or exceeds 14,000 0 Commetoial•irw agricultural
r: 1- and 2- family dwelling ❑ Commerclat/ittdustrial ❑ Accessory building =pi foe another installations buildings.
0 Multi-farnil ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or
,', , . • r9 p 5 C1 •, y �' i . , . 2 ❑ Hm oy "gm' huger system. opennely derived system.
=r:.,r .r " r ,. °' '
.. 7 � :stY I .3L a 1` Liur. a t ail ' ! + +at ❑ Addition of oew motor load or 0 „ ,. .. -3 ^
Job no.; •3 3. Job site address: 1 3 5u1 S • • o r mom. eY-
I �� ■ 0 s ala ss w moos residential units. 0 Romoatioael vehicle peaks,
City/State/ZIP: T j r d 9722. O Ha z a rd o us l febuuta . 0 Supply voltage for more than
❑Hecerdeueeoadoee 600 volu nominal.
Suite/bldg. /apt. P roject name: 0 Service orkoder600 es more
f rf ;si 9'i!" {,Lrn,ati :Iii .,,.,7I -1 <iWi rilliVIZ- F uA {y 2
re�
Cross street/directions to job site: uanlee qtr. Fes s . Total •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000fq.R.orlesa 168.34 4
Es. add•l 500 eq. R or portion 33.92 I
Tax map /parcel no.: Limited energy. residential 7s 00 2
G f P . „
, ry Y ,,
. ' 1, 0 " . . , - a, .'S t � t , ' d : ' �, (with shove q. R
• i� 1'� � ^�i `�y ! i � :. "��. �.� :
. ; J;'i �. {`i� 'A is �� � J,. : , . 4�'a a�. ' , �: ' !!!Jrt ^ .,� . � � ! , Y�, i . �`�, . �. ,� ' t
' Limited energy, multi- temi1y 73.00 2 ■
wr y a - 1 , A n • residential (with above sa. fl,) • Services or feeders In,tallatton,alteradon, and/or relocation _
200 amps or leas '100.70 _ 2
+z • • °= ' o' 4 ,"1 ' 1° 1 M 'n ' ty �i�ri. -�'^ 201 amps to 400 amps 133.34 2
: °� , i w'rz ad�i 1!L... ua:wt:d Its
401 amps to 600 amps 200.34 2
Name: ctik e 6 J d i C 11 c rev: c Q 16- . .or 601 1unpa to 1,000 amps 301-04 2
r
Address: (.. .-vt do 4 -„ . s Over 1,000 amps or volts 552.26 2
City/State/Z1P: (,; ��� Temporary services or feeders Installation, alteration, and/or
1 air relocation
Phone: ( ) Fax: ( ) 200 amps or less 54.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps ro4l10amps 125.08 2
Intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amp to 599 amps 168.74 2
Branch circuits -new, alteration, or extension, per panel
Owner signature: r Date: ' A. Fee for branch circuits with
a r ,r ; fac � °JN "� k ,,�'. ,� ` � :fir? e above service or feeder tb0.
�,J r'' ., T •yl i .. '1 n . `!t•' . . r1"ti ", ,,X',.,1f'q : „tt!' each branch circuit 7.42 1
Business name: R s I e - c L L B. Fee for breach circuits without r
service or feeder fee, first 1 56. I S Sip ,1 2
2
/1 „ r o I 0 W t � 5 branch circuit
Contact name: ('.�, V &eh add•l branch clrcul , 1 7.42 /, 4 0 2
Address: '' 01 C 5 W 23 "1 Ill .5+,2A 21 0 f -ail Miscellaneous (service or feeder not Included)
,
11 I- �p - Each manuactured or modular
City /State/ZIP: 67,84 2
I �� l l bo i c� r[+ (Z-3 dwell and/or faader 67.84 2
Phone: ( 5b3 ` p 1 Fax:: ( ts3 SC t5 ( Pump or irrigation citcIa 67.84 2
{~ - man : ,� • ea-in-cc.. i Sign or outline lighting 67.84 3
,. .. • . '''';1:r..!,. . � .4..., ... OC,fI ;'fi., . .. ;:,• +_ % ` , tr;i :!] `''W :`};, Si grm1 circult(s) or limited-energy
Business name: RK Electric, Inc. panel, alteration. or extension. Pace 2 2
Each additional Inspection over allowable In any of the above
P'r Address: 24495 NW Oak Drive . Additional Inspection (I hr min) 66.25 /hr
City/State /ZIP: Hillsboro, OR 97124 Investigation (I hr min) 6625/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 640 -1344 I Fax: (503) 356 -0513 Inspections for which no fox is 90.00 / hr
e • cifisal! listed Ys hr min
CCB Lie.: 94275 Electrical LIe.: 34 -375C Sup; v, Lic,; 4724-S ;`;' i ECE*GITw i 5233 "1',1_'.; :
0
Suprv. Electrician signature, required: I Subtotal: 63r (y
/ / r Plan review (25% of permit fee):
Print name: Ron L. Kurtz Date: ' a.l / a State surcharge (12%ofpermit fee): 1,6:3
Authorized signature: ( TOTAL PERMIT FEE: �. a
j - . , - T his permit application aaplres If a permit I. not obtained within ltO
days after It has been accepted as complete.
Print name: Ron L Kurtz Date: " a N i.� • Numbs of impactions allowed per permit,
1 : 1DuileinetptrnIti8LC.PermhApp.dos 07/0 I/10 440.4613T(I MS /COM/WEB