Permit CITY OF TIGARD ELECTRICAL PERMIT
111 2 COMMUNITY DEVELOPMENT Permit #: ELC2011 00008
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/04/2011
Parcel: 2S111 CC17200
Jurisdiction: Tigard
Site address: 10250 SW HIGHLAND DR
Project: Soloman Subdivision: SUMMERFIELD NO. 4 Lot: 223
Project Description: Panel replacement.
Contractor: ACCESS ELECTRIC & CONSTRUCTION Owner: SOLOMAN, KEN
2870 SE 75TH AVE SUITE 108 10250 SW HIGHLAND DR
HILLSBORO, OR 97123 TIGARD, OR 97224
PHONE: 503 - 642 -4333 PHONE:
FAX: 503 - 642 -9699
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/04/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 01/04/2011 $12.08
Type of Use: SF Electrical
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 0 • '.'52- 001 -0090. You may obtain a cosy of th= ules •r direct questions to OUNC by calling 232.1987 or 1.800.332.2344"
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/
Issued By: - _ _. Permittee Signature: soi
• 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.
•
12/30/2010 THU 13:07 FAX 2794977 ACCESS ELECTRIC 004/005
Electrical Permit A l c ' n C I F FOR OFFICE USE ONLY •
City of Tigard a i •r .t tteceived P�tituitNo -:
pa ' 13125 SW Ball Blvd...Tigard, OR 9722 " ` 1 ' �_ �� _ _ � r ? 'L ^• _ - •
r P hone: 503.639.4171 Pax: 503,59 3 U 2010 plan Review
Date ether Permit:
Date
Inspection Line: 503.639 Read I'
TIGARt� Ready/fir In SccPaee2for
Internet: www.tigard -or.gov OP/ OF Tic + ARD Notificam.thod, BM SupplcmentalInformrtina
TYPE ' ' G DIVISION • p,AN REviEw
❑ New construction Addition/alteration/replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Demolition CI Other: ❑ Service or feeder 400 amps or more El Building Over three stories.
where the available fault current ❑ Marinas and boatysrds-
CATEGORY OF CONSTRUCTION • �� exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less 10 gmunal, nr exceeds 14,000 ❑ Commercial -use agricultural
+ ix l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other iostnllntions. buildings,
❑ Multi - family ❑ Mastcr builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ limergency system, larger separaWly derived system.
JOB SiTE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A ", "L "1.7, ", "I -3 ",
Job no.: rig (10) Job site address; 10 Z 5 W. - 100HPormore. occupancy.
['Six or more residential units- ❑ Recreational vehicle parks.
City /State /ZiP: - . ■ 2_1.1 ❑ licnlrh care facilitia, 0 Supply vOhegu fur more than
❑ Hazardous locations. fi00 volts nominal.
suite/bldg./apt, no.: _ Project name: wr ` vs, i,„, �" - - El Service or feeder 600 mops or molt. _._
Cross street/directions to job site:
` FEE SCHEDULE .
nogriution 1 our. I Fro I Total I •
New residential single- or milli-family dwelling unit. '
Includes attached garage. •
w
Subdivision: • - I Lot no.: - 1,000 sq. ft- or less 168.54 4
ax mat /parcel no.: Ea. add'l 500 sq, ft. or portion 3192 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (WW1 above so. 11) —
� (( Limited energy, multi- family
67.84 2
A w-Q_,` C�V+a. tr�.��- _ residential (with above sq. ft)
6 Services or feeders installation, alteration, and/or relocation
..... ,„..., ... 200 amps or less 1 100.70 f Data 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
�V/� 401 amps to 600 amps 200,34 2
Name:
f�t.'� Q to 11^0►, n'�,
1, e 601 amps to 1,0(N) amps 301.04 2
Address: t17 $t.d. 1.rj Lt., , 6- r t Over 1,000 maps urvolts : 552.26 2
( ity /State /7.iP: 1-- �.. _ ��(� 'Temporary services or feeders insranati0n, alteration, and/or
relocation
Phone: (s b ), 71.1 ( 7 G >- 0 Fax: ( ) 200 amps or less 59.3( -. -1.,
Owner installation: This installation is being made on property that I own which is not 201 amps l0 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- new, alteration, or extension, per panel
Owner signature: Date:
_ - -
_ A. Pee for branch circuits with
VA APPLICANT 0 CONTACT PERSON above service or feeder tee,
each branch circuit 7.42 2
Business nam £ � j 'i 4 4 C,..0 y` S II
' - Fee for branch circuits
Contact name: � � Z„,:% without service or feeder fcc. 56.18' 2
y'M ���G t^.-- first brunch circuit
Address: 2,1 0 u_ 75 6.- = U [ .1- c--- l b � Each add'l branch circuit 7.42
J . v • •-- Miscellaneous (service or feeder not included)
City /State/ZIP: 141 bt S 0 (9•1-1 9 1 / Each manufactured Or modular
dwelling, service and/or feeder . 67 -84 2
Phone: ( 3 ) 6c,)__-.,q3.3 1'a= : ( 670 61) G I Z '' 9. ('' - -- --
Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
4
CONTRACTOR Sign or outline lighting 67.84 2
Business name: &r /J e tk ti + f '�w.1r• Signal circuits) or limited-
energy panel, alteration, or
Address: 11'70 Sc 7,..C Ow ,,_ .3 , C 0) extension. Describe: Page 2 2
City /State /ZIP_ ' t t S % el 0 c . r 9' 7 t Each additional inspection over a Per allowable. us any of (be above -
Phone: ( 5v) - 4 (f ,_ 3 Fax.: (. ) _ , ' 9'49C) inspection 66.25
ti 7 � Ltvestigali ion on per hour (t ]tr mia)_ 66,25
CC13 Lie._ yo i. (old (o Electrical Lie,: 4.,- ( (,t. Suprv_ Lie.: tit) 2i S industrial plant per hour 78.18
Supty. Electrician signature, required: '�^ -"- — ELECTRICAL PERIL TEES
Subtotal: 00,2 .0
- �_.eview 5 ... p
Print name: Z,' 1‘'" Date: t 1 1 "f aif ® Plan review ( pfermit fee): ,
—. State surcharge c ( 12% of permit fcc ) � Z : 0
Authorized signature: (
' TOTAL PERMIT FEE: / 11 - 77
Print nitrite �/ � ''116 pern,it application pxpirra W permit is not obtained within 1x0
If �f Iw"� °�^ t/"�'i�. "f+� ✓ti ante: II .2. 30 � drys after it has been accepted as complete.
* Hunter of inspections allowed per punuit
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