Permit +A a! CITY OF TIGARD ELECTRICAL PERMIT
I
COMMUNITY DEVELOPMENT Permit #: ELC2010 00279
x, ,�, Date Issued: 06/09/2010
T L G",`t�RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S111CC17900
Jurisdiction: Tigard
Site address: 10380 SW HIGHLAND DR
Subdivision: SUMMERFIELD NO. 4 . Lot: 230
Project: Marasco
Project Description: Panel replacement and (1) branch circuit.
Owner: FEES
MARASCO, JAMES S REV LIV TRUST Quantity Description Date Amount
10380 SW HIGHLAND DR
TIGARD, OR 97224 1 ea Services or Feeders - 200 06/09/2010 $100.70
amps or less
PHONE: 503- 692 -3451 1 crt Branch Circuits w /Purchase 06/09/2010 $7.42
Service or Feeder
1 ea 12% State Surcharge - 06/09/2010 $12.97
Contractor: Electrical
ACCESS ELECTRIC & CONSTRUCTION
2870 SE 75TH AVE SUITE 108
HILLSBORO, OR 97123
PHONE: 503 - 642 -4333
FAX: 503 - 642 -9699
Type of Use: SF
Class of Work: ALT 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 - - • •ance with - • • oved 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. • ENTION: Oregon law r-quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 001 -0010 through OAR 952 -• • - / 0 A. ay obtain a copy of the rules or direct questions to 0 • • calli :. • . 46.6699 or 1.800.332.2 44. .
ssued By: � � � � / / P•rmittee Si. nature: % �ilfe1W
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 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.
06/08/2010 TUE 13:50 FAX 2794977 ACCESS ELECTRI 1001/002
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Pectlr�cal Perm AnUlicati ' �' - " l �; r r� ,� ? ": i I, n , P'
d FOR OF . E • ONI 1 r� � �9 � �' �, ����
_ � 1 :� 'dtmi:kbi u. l i igi A Y.:4 '. �k r nu t.r�. iGudd,'W�� ww,,,,a^ L'4: e ,',z40,48t40,7z..42-467.0, ,r.
F z CI Of Tigard Permit No.: 8 f! 0 �'
;tfr °� 13125 SW IIall Blvd., Tigard, OR 97223 J _
. 1 L ,;ti . Phone: 503.639,4171 Fax: 503.598.1960 (y- i ,; 1� Other permit:
,...1;,11' Inspection Line: 503.639.4175 > � i ' ca d See Page 2 fur
t nratrtii Internet www.tigard-or.gov \ S'` ® \ �L rtorified/Nlothod: Supplemental Infurmation
TYPE OF WORK 4 J ,vv\ • PLAN REVIEW • .
0 New construction Addition /alteration/r eplaccment Please chock all that apply (submit 1 scis of plans wlitcros checked below):
❑ Service or feeder 400 amps in. more ❑ Building over three stories.
❑ Demolition 111 OthCI:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. •
teas to ground, or exceed: 14,000 ❑ Commercial -use agricultural
� 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family 111 Master builder ❑ Other: ❑ Fire pump. ❑ 1..141660a of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system, larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 1 0 3YO1L,,) 6'V l ,,¼-. r` tJ� D r 100HP or more. occupancy.
Q Six nr more residential units. ❑ keereatioual vehicle parks. •
city /Slate/%IP: q t r„� �9. or- • 9' '� )_)....,(4 ❑ Health -care facilities. ❑Supply voltage for more than
'' ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: f Project name: . P -� S C. 0 Service or feeder 600 amps or mare. FEE SCIIEDULE
Cross street/directions to job site: V Description 1 Oty. 1 per. L t'atnl I"
Ncw residential single- or multi- family dwciling unit.
Includes attached garage.
Subdivision; Lot no_: 1,000 sq. it. or Icss . 168.54 4
Tax map /part cl no.: Ea. add'I 500 sq. ft. or portion 33.92 1
I.imited energy'
nergy, residential
DESCRIPTION OF WOItK _ (with above sq. ft.) 67.84 2
`` Limited energy, multi - family
i&A L � e,frs,/ — 't" j ,'/
C "4t„h 1 - residential (with above sq. ft.)
67.84 2
1 Services or feeders installation, alterations. and/or relocation
200 amps or less / 100.70 /00.)0 2 •
[(PROPERTY OWNER J ❑ TENANT 201 amps to 400 slaps 133.56 - 2
401 amps to 600 amps 200.34 2
Name: - Tavel c,S 1 \ru V V U "Tf 0'S 601 amps to 1,000 amps 301.04 2
Address: I b 3g0 SW o � ,,,_, t c ,, () ('- Over 1,000 amps or volts 552.26 2
City/State/ZIP: '` '` r tw . -�_Q r , -11.--- 4 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (. 3) ,Coq ). — Yi,51 l Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 168.54 2
Branch circuits - ncw, alteration, or extension, per panel
Owner signature: Date:
A. Fcc for branch circuits with
® APPLICANT 0 • CONTACT PERSON above sctvice or feeder fee, / 7.42 7, (i 2
l each branch circuit
Business name: Ll L,,te. t`� C."} ri L } C oe\ gr. r v t> i 0 ` . B. Fcc for branch circuits
Contact name: , -,k. - 2_,., ww � without iii fCC(IC f CC, 56.18 2
• first branch ch circuit
Address: 4,....s `70 S `1 a `, A, -<..- *&k..{,,., 10 Each add'I branch circuit 7.42 2
City/State/ZIP! �\ Miscellaneous (service or feeder not included)
( it
Y ' l4. k , \S } o-ro Q v- • I 1 -j Each manufactured or modular
67.84 2
Phone: (S 0�) (p Lf �� ✓a, Fax: ( 3) 4 - 1 (eq
dwelling, and/or feeder
_ Rec onnect only 67.84 2
E -mail: >�. y -4- 0.. �!, 4 Ct_C jQ 1' e...C CT's , t V.,.. Pump or irrigation circle 67.84 2
"`��� CONTRACTOltt Sign or outline lighting 67.84_ 2
Fusiness name : Signal circuit(s) or limited -
I� L(y .S .- u,,t 1 t . Co E S L ' r b � energy panel, alteration, or •
Address: 2 7 0 5£ -7 s kv" ,,,N, S _ (b 3 extension. Describe; Page 2 2
City /State /ZIP: P 1, t S b 04 - 10 - C O) '1 I )_-... Each additional inspection over allowable in any of the above
Phone: (7D ) G r,{ t f '2 Fax; (,§15) - C r f' _ et G4 q Pcr inspection 66.25
Investigation per hour (I hr min) 66,25
CCf4 i.ic.: ( )4( ( Electrical Lie.: C (4i 1 Suprv_ I.ic.: qq ' Industrial plant per hour 78.18
Suprv. Electrician signature, required: __- -- .,„ _ ELECTRICAL. PERMIT FEES
___ �" Subtotal: Q
Print name: ' �. : , w.er k.". Date:
/ Plan review (25% of permit fee): 8 10 State surcharge (12% of permit fcc): I /, • 1 1
Authorized signature: TOTAL PERMIT FEE: 1 ), j , 01
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed par permit,
r\ no, iftut \rc,a,iiulFa.C- rermitApp,doe tai01/0? 440 -40157(11 /05 /COMfWGD