Permit CITY OF TIGARD ELECTRICAL PERMIT
4
,11 COMMUNITY DEVELOPMENT Permit #: ELC2010 00600
T I G A A D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/27/2010
Parcel: 2S111CA13900
Jurisdiction: Tigard
Site address: 9765 SW SATTLER ST
Subdivision: Lot: 0
Project: Horton
Project Description: Panel replacement.
Owner: FEES
HORTON, DWIGHT Quantity Description Date Amount
9765 SW SATTLER ST
TIGARD, OR 97224 1 ea Services or Feeders - 200 10/27/2010 $100.70
amps or less
PHONE: 503 - 780 -0579 1 ea 12% State Surcharge - 10/27/2010 $12.08
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: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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 952- 001 -0100. You may obtain a cop of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344•
Issued By: _ _ = 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 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.
10/25/2010 I[ON 12:53 FAX 2794977 ACCESS ELECTRIC (002/002
I FOR OFFICE USE ONLY
City of Tigard ECEiV
Electrical Permit Application Received
D _
ty �a a R Dada y: Permit No.: _
M 13125 SW Hall Dlvd, Tigard, OK 97223 2 6 2 y , ' Ito �� - c r jilt()
II Plan Review
Phone: 503.639.4171 Prot: 503.598.1960 0 C 1 nnteBy: Other Permit:
Inspection Linc: 503.639.4175
I' I (V A E. D P Dale Ready /LIT n,,,.. 161 See Pagel for
Internet www.tigard- or,gov % OF TIGA Notifted/Methud; ' rf // Supplemental foformotioo
• TYPE OF WOI LDIN 1 , PLAN REVIEW
El New construction E Addition /alteration/replacement Please check all that apply (submit a acts of plans w/itcma checked below):
❑ I)eII101ItIOII Met where Service ur feeder 400 amps or more ❑ Building over three stories. •
where the available fault current 0 Marinas and boatyards.
. . CATEGORY. OF CONSTRUCTION' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Fil leis to ground, or exceeds 14,000 ❑ Commercial•use agricultural
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for n0 other installations. buildings.
❑ Multi - family C] Master builder ❑ Other: ❑ Fuo pump. ❑ installation of 75 KV A ur
JOB SITE INFORMATION AND LOCATION ❑ Emergency system, lager separately derived system.
❑ Mdition of new motor load of ❑ "A" 'B" "1 -2 "; "1 -3"
Job no.: SI S - r Job silo address: 9.7 6.5 5t,,..) r J• 5 l00HPormorn. occupancy.
❑ Six or more residential units, ❑ Roen banal vehicle parks,
City /Statc/ZIP: 1 _ t % , r . • 9' )� U. ❑ Health-care facilities. ❑ supply voltage for more than
i ❑ Hazardous locations. 600 volts nominal.
Suitc/bldgJapt. no.: Projcct name: 1..\,, 04-4_0 vn,. ❑ Service or feeder 600 amps or more.
FEE SCIIEDULE
Cross street/directions to job site: lresadptioa 1 art,. I Fee. I Total i •
New residential single- or multi- family dwelling unit.
includes attached garage
Subdivision: Lot no.: 1,000 sq. R or less 108.54 4
Tax map /parcel 110_: Ea. add'l 500 sq. IL or portion - 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above aq.11.)
"
Limited energy, multi - family 67.84 2
C \t. 4 ,1 A A residential (with above sq. ft,)
• Services or feeders installation. alteration. and/or relocation
I 200 amps or less 1 100.70 2
E J
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Z A1/4.3 ; t 0 _ . 401 amps to G00 amps 200.34 2
4. 601 amps to 1000 amps 301.04 2
Address: T tr- 44_ , Over 1,000 amps or volts 552.26 1
City /Starr: /ZIP: 7 Z Cote IR C - 9 7 y1- `4 'Temporary services or feeders installation, alteration, and/or
relocation
Phone: (5b3) 7/0 0 0 -. 0 s 0 1 I Fax: ( ) 200 amps or less 59.36 L 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 arms 125.08 2
intended for salt, (ease, rent, or exchungc, according to ORS 447, 449. 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel •
Owner signature: bate: - -_ A. Fee for branch circuits with
APPLICANT I ❑ CONTACT PERSON above service or feeder fee.
` 1 ( each hnmch circuit. 7.42 2
Business name: Q- G(rGSS Ij l.t-44. f i G.. 4, O t&fl d 4r 4_ -c-
B. Fee for branch circuits
i without service or feeder fee,
56.18 2
Contact name: K4_ hT 2 vv. t∎ . v 1M t".. e/'\ first branch circuit •
Address: La 7 0 SL ? S Lam` e. 4.4 • 1 0 'a Each add'l branch circuit 7.42 2
City/State/ZIP: /$laic /ZIP: Miscellaneous service nr fccdcr n ot inducted)
Y b-1 t t S 6p.rp r- - q / (),. -- j Each manufactured or modular
p dwelling, service and/or feeder G7,84 2
Phone. (rd3 CO O- - -• C' Fax: : (.7) 6 [f1- - /'(o clot Reconnect only 67.84 - 2 •
E-mail: Pump or irrigation circle 67.84 2
-
CONTRACTOR Sign or outline lighting 67.84 2
Business name: A cL.e_s t `��L L C� f . 0 �\ • -. a� Signal circuit(s) or limited -
energy panel, alteration, or
Address: 1_7 7 v S t S k.e.-. • f j 3 y extension. Describe: Page 2 2
City/State/ZIP: t. 'L \ \ tM
V7 Q r 1 j-- ' Each additional inspection over alltwablc in any of the above
•
Phone: i) G ` , 1 t �+ 3� �9 F ax: r 5z �` - 7 / P CI inspection 66.25
�) 6 O 6 Q Q / ) i / C nvestigation per hour (1 hr min) 66.25
CCR Lie.: / 6,1_ G,G t/ Electrical Lia,: C_- I U Suprv. Lie,: L/) 31 S Industrial plunt per hour 78.18 r
� - ELECTRICAL PERMIT fr7sli',S
Subtotal: l 0 .7 .0
Suprv. Electrician signature, required: j(`
Print name: v e..v. � \ •
tM r ` _ -._ Dalc; 1 O /a S r Q Plan review (25% of permit fee);
State surcharge (12% of permit fcc): I 1, . 01
Authorized signature; L ' TOTAL PERMIT FEE: I 11_, n
,� rl j� This permit application expires if a permit is not obtained within 180
Print Hama (� h [--. ` tMa�v� l M� 1)td (0 / j , S O days after it has been accepted as complete.
F ' Number of inspections allowed per permit.
1'\ Buidiol ;1Pamin\ELC- PerroitApp.doc NNI 44046157(11 /05/COM/wIn