Permit CITY OF TIGARD ELECTRICAL PERMIT
0 • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00569
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/19/2010
Parcel: 2S109AB09500
Jurisdiction: Tigard
Site address: 14258 SW 132ND PL
Subdivision: RAVEN RIDGE Lot: 24
Project: Ernest
Project Description: (1) branch circuit for hot tub.
Owner: FEES
ERNEST, LARRY R & SANDRA A Quantity Description Date Amount
14258 SW 132ND PL
TIGARD, OR 97224 1 crt Branch Circuits 10/19/2010 $56.18
wo /Purchase Service or
PHONE: 503 - 590 -0409 Feeder
1 ea 12% State Surcharge - 10/19/2010 $6.74
Electrical
Contractor:
ACCESS ELECTRIC & CONSTRUCTION
2870 SE 75TH AVE SUITE 108
HILLSBORO, OR 97123
PHONE: 503- 642 -4333
FAX: 503- 642 -9699
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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 952 - 001 -0100. You may obtain a cosy of •irect questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By. ' %f_ - Permittee Signature:
`" OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE 1 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.
10/15/2010 FRI 9:12 FAX 2794977 ACCESS ELECTRIC (002/003
Electrical Permit Application i FOR OFFICE USE. ONLY
III City Tigard of Ti and 0+` g+ Datc/B � Received �
AlT — -�
v 13125 SW Hall Blvd., Tigard, OR 972 A \ PMo Revi
: ew
d ` Phone: 503.639.4171 Pax 503.598.19' t '3 � Ante/By. Other Permit:
'1 A It a Inspection Line: 503.639.4175 OC� , u is early/By; (uric_, ® Sec Page 2 for
Internet www.tigard-ar.gov ..c\ , , y I• •, tilled; _ 0 Suppkmeatgtlaformation
TYPE OF WORK CA
%
INt \ 4 1 . 1 ��\ PLAN REVIEW
❑ New construction [I Addition/altcration/re�`�� Please check all that apply (submit 2 sets of plans or/items checked below):
Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition
❑ whop the available fault current ❑ Marinas and boatyards,
CATEGORY OF CONSTRUCTION • exceeds 10.000 amps at 150 volts or ❑ floating buildings.
1 - and 2 - family dwelling ❑ Commercial/industrial ❑ Accessory building • less to gr o f a exceeds 14,000 ❑ build mcrcial -use agricultural
amps far all other installations. buildings_
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
JOB Sfl'lE INFORmATE . LOCATION ❑ Emerbwncy system . large scparatcly duriv d system.
❑ 100 oo efoew motor lend of ❑ - " " " «1_2 ", "r.3
Job no.:" $ bq 1 Job site address: , `" h� Q 1 Six or or more. y
J C 4 C�{� ❑ Six or otorc residoatial uairs. ❑ Recreational vehicle parka.
City /State/ZIP: / r , ❑ I leatth -c re facilities. ❑ Supply voltage for more than
�� sr� ) D 1.-0.)...4 ❑ Hazardous locations. 600 volts nominal.
Suitc/bldgJapt no.: Project name: E t ' Y�/VY S+ ❑ scrvicc or food or 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: tttscriation i ow. I Pia I real I
New residential 5 iagIe- or multi- family dwelling unit.
Indudcs attached garage.
Subdivision: Lot no.; 1,000 sq. R or less I I 168.54 I I 4
Tax map /parcel no.: _ Ea. add'I 500 sq. ft. or portion. 33.92 1
DESCRIPTION OF WORK - Limited energy, residential
67.84 2
..._ • (with above sq. R) _
140 �V ` Limited energy, multi -family 67.84 2
tC \'�' �. t] t residential (with above sq. ft) •
services or feeders installation, alteration, and/or relocation
1 200 amps or less 100.70 2
• PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: ��. �• 1-61.(Z - 401 amps to 600 amps 20034 2
Address: w y Ls S W 1 ).-Y-°- sgirtiveltak 601 amps to 1.000 amps 301.04 2 1,_4 Ovcr 1,000 amps or volts 552.26 2
City/State/ZIP: �. , _ _, .Q � C. 1 � � Temporary services or feeders instrllation, alteration, and/or
'- '" � relocation
Phone: (. ) r Dike I 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
Owner signature: Date: Branch circuits - new. alteration, or ex tension, per panel
A. Fee for branch circuits with
al APPLICANT • ❑ CONTACT PERSON above service or feeder fcc,
7.42 2
` ✓t)-
each branch circui name: Business nac: kL „b% �L
1.c_A,� r L + v�6 Co 1•�u 13. Fee for branch circuits
Contaot (tarn: 444_,,`-x- ,v �tM� r- w\ K..1� without service or feeder fcc, \ 56.18 �p • 2
first branch circuit
Address: 17- • S (,_ 'j g4' t'►v.& . v.. / s) Each add'/ branch circuit 7.42 2
Miscellaneous (service or feeder not included) .
City/Slate/ZIP:
t. 6.,- .. ct Each manufactured or modular 67.84 2
dwelling, service and /or fccdcr
Phone: (> ) G t;i Fax:: ( 9 V 64), `oe p 10f�`7 ' ^ \ Reconnect only _ 67.84 2
V
E -mail: Pump or irrigation circle 67.84 2
• CONTRACTOR Sign or outline lighting 67.84 2
C� � r. A f � L 4 -L A f6 ) r Signal panel, or alteration, limited-
Business name: A.
'�. C rd ►. energypunel, alteration, or
Address: 11 t. 5 — g •4'1... • , A 1 O 1 extension. Describe: Paget 2
City/Stare/ZIP: ti ' 1' t,.. . . r, , 9 1 1 3•— Each additional inspection over allowable in any of the above
(3) ` (41_43'5 3 Fax: ( ` ,_ —Iraq `q 6) Per inspection 66.25
Phone:
�� � Investigation per hour (1 Ic min) 66.25
CCB Lit,: / , (SW Electrical Lic.: C 14 Suprv. Lic.: yq 3 I S Industrial plant pct hour _ 78.18
ELECTRICAL PERMIT FEES
. Suprv. Electrician signature, required: .
• Subtotal: , ri .
Print mume: D Plan review (25% of permit fee):
Ke,r �; ».,tv, -tN.o, tr 10 s /i+ y
I
r State surcharge (12% of permit fee): ( ,
Authorized signature: `—�-
��-�� - TOTAL. PJRMIT FIE: J1 1 •
Print name: Phis permit application expires if n permit is not obtained within 180
Date: days niter it has been accepted as complete-
• Number of inspections allowed per permiL
I;Vlui,dj... nnasaILc- PermirApp roc 1 0/01/09 440- 1615T(11 /05/COM/wnn
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