Permit CITY OF TIGARD ELECTRICAL PERMIT
11 4 s COMMUNITY DEVELOPMENT Permit #: ELC2012 -00595
T [ GAR0 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/16/2012
Parcel: 2S 111 CCO5800
Jurisdiction: Tigard
Site address: 10000 SW CENTURY OAK DR
Project: Jacobson Subdivision: SUMMERFIELD Lot: 81
Project Description: (1) 200 amps or less and (1) branch circuit for panel change and new refrigerator circuit
Contractor: RK ELECTRIC INC Owner: JACOBSON, TRENNA
24495 NW OAK DR 10000 SW CENTURY OAK DR
HILLSBORO, OR 97124 TIGARD, OR 97224
PHONE: 503 - 640 -1344 PHONE: 360 574 -4359
FAX: 503 - 356 -0513
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/16/2012 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 10/16/2012 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 10/16/2012 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 forth in OAR
952 - 001 -0010 through OAR / '1 A.A.. �� 95 , 2- 0001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 1 '
Issued By: o Permittee Signature: 0 A A P (-'e r ; /O Ad
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.
Oct 16 2012 1 0 : 03AM HP LASERJET FAX 5 0335605 1 3 p . 1
Electrical Permit ApplicaticilECEIVED rill:. OFFICII 1 .`;I: 0.NLY
City of Tigard Received
catent : 10/11.(1 3, Porroil No.: L- e... ,N, I;■..- 0 06'
71.-- • 13125 SW Hall Blvd., Tigard. OR 97223 T 1 6 2012
Plan Review
• . Phone: 503.718.2439 Pax: 503.598. Mate1111 . Other Permit:
,
Inspection Line: 503.639,4175 CITY OF TIGARD Date Ready/By: ,-., See Page: kr
1
Internet: www.tigard BUILWOWISON Notified/Method: li. Su , • 135411e0tA1 Issformotion
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1
, ::.:,-,r... , ;:t.. 2 .'.1.9‘r.' ; ';' , .1.' . ...1•. , ..' 2 ': - =,.L. ,- .4 - lr.a.. 1 ",s. , ai. ' ietr.,,.. 7 . ,,, A■z. , e. , ..rr-im=1/4 , ...H. , ,...-1 7 ; ;; ;,•-,. , ,, ,
El New construction rg Addition/alteration/replacement Meese aback all that apply (submit 1 sets of plans wiitocra chunked below):
0 Service or focclor 400 nmpe or more 0 Building over three glories.
0 Demolition 0 Other: where the available audt currant CI Marinas and boatyards.
1 ,i•k-mi '',1 : Vy"iiF..00,6 - • - 004,, g 4...i .- eaceods 10,000 amps at ISO volts or C1Floating buildings.
los to ground, or exceeds 14,000 0 Conuncroial agriculMral
12,1 1. and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other Instellsetens. buildings.
0 Multi-famili 0 Master builder 0 Other: 0 Piro pump. 0 Installation of 75 KVA or
--- 0 Emu mangy spasm. iargir separately derived eystem,
. , . ] . . . , „ : , : i . . . . : . .4 i i . t i t t 1 i ; ; : 4 : 1 4 ) . . _ L t r _ t f e . I 4 , 1 * i l . F 4 . : ; ' . 7 ' ` j . ) , 1 4 . . . j a . . , : , % , T e l : - ' 1 . - 1 . ; - ; . " ! # ' € 0 Addition of new motor load of
100KP or more. occupancy.
Job no.: 5450 Job site addrcss: 10000 SW Century Oak Dr
0 Six or more maidential units. 0 Roorcational vehicle parks.
City/State/ZIP: Tigard, OR 97224 0 Health fladlities, 0 Supply voltage f17r more than
0 Herescloto locations, sots volts nominal.
. Suite/bldg./apt. no.; I Project name: Trenna Jacobson "%. D Service or feeder 600 amps or 010re.
7 : . L fitgitt
Cross street/directions to job site: Descrl Man irit-mmanto. wINNE... .
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: [ Lot no.: 1,000 eq. it. or less 168.54 4
Ea. add' I 500 sq. it. or portion 3392 1
Tax map/parcel no.: Limited energy, residential
75,00 2
3Y!':4",04.1.4.0ggik=g4g..:';:.!;ir3tittadatitetitrtifOW:::::-..441-0:gifigg5:4#4.4:.'. (with above sq. R.)
Limited energy. multi-flunily
75,00 2
Panel change & new refrigerator circuit . residential (with above SQ. ft.)
Services or feeders installation and/or relocation
200 amps or less I 100.70 100,70 2
. .....r:,.: - ... -r ." .. F1 '
.... - ......i..' jarnitiriAlerttiCAMIN.:014A, .4k .-.%; ::■,.-,,..,..:: ..'i-':, 201 amps to 400 amps 133.56 2
401 amps M 600 amps 200.34 2
Name; Trenna Jacobson
601 amps to 1,000 amps 301.04 2
__
Address: Same Over 1,000 uinps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: (360)574-4359 I Fax; ( ) 200 amp or Ina 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 not
401
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. amps to $99 amps 168,54 _ 2
Branch circuits - new, alteradon, or extension, per nape!
Owner signature: Date: A. Fee fbr branch circuits with
• • i r:. 14 '=.":44.1.,
. •27''' : ;::: ' ....::: '''.. P:::;.;;.'1.-14 %
7.'e.0.-1'71■40N'14..i743...'‘'.4+1;Ff"IKt....ir.:...: above service or feeder fee,
ooch brimch circuit 1
7.42 7,42
2
Business name: RK Electric B. Fee l'or branch circuits withcad
service or Resler tbs. first 56.18 2
Contact nar.te: Carol brew 1 circuit
Bach II:ICI branch circuit 7.42 2
Address: 24495 NW Oak Dr -
Miscciianeous (service or feeder not Included)
Each manufactured or modular
City/State/ZIP; Hillsboro, OR 97124 dwelling, service and/or feeder 67,84 2
Phone: (503) 640-1344 I Fax: : (503) 356-0513 Reconnect only 67.84 , 2
Pump or irrigation circle 67,84 2
E-mail: infolgrkelectrie.ble Sign or cudine lighting 67.84 2
Si , C I . rCUIN . , SI , or limited-energy
.-.....,i..7..4,,..;::;.:.-,.e.:4";,.,:;/ .f .. . r ;i:4 - : 'V': .z ',, '', :2 ■.'W' •: , - ' , . 0 -z , vr. ,,,,, :-: - • s" .•,..'.-• . gnal -energy
Business name: RK Electric, Inc. panel, al te ra t i on, or extension. Page 2 _ 2
Each ntlditional Inspection over allowable in any of the above
Address: 24495 NW Oak Drive Addition (1 hr rain) 66,25/ hr ---
Investitv,tion (I hr min) 66.25/ hr
CIty/Stete/ZIP; Hillsboro, OR 91124 - -
lndusii ill plant (1 hr min) 78.15/ hr
Phone: (503) 640-1344 I Fax: (503) 356 lrtspcci i Los fur which no Rio is
90.00/ hr
specin c al iy i isted (% hr min) ,
CCB Lie.; 94275 I Eleotrical Lic. • 4-375C Suprv. Lic.: 4724-S
Subtotal;
Suprv, Electrician signature, required( / zy7 (7‹ if .
Plan review (25% of permit fee): 108,12
Print name: Ran L. Kurtz ate: 10/16/12 state surcharge (12% of permit fee): 12.97
, . 2
TOTAL PERMIT FEE: 121.09 ,
Authorized si 7 gnatut et, ( 9 -yi 6e, k 5 Thls iisr..111 epilliceilen expires De permit is not obtained within 180
. days after it has been accepted ns complete.
Print name: Ron L. Kurtz Date: 10/16/12 i• N,, a im.pections allowed per permit,
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UtullfSeslPemStaLC-PermilApp.dee 07/01/10 440-45157(11/05/CO24MB