Permit CITY OF TIGARD ELECTRICAL PERMIT
11111 " - • COMMUNITY DEVELOPMEN Permit #: ELC2011 -00420
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/28/2011
• Parcel: 1S134ACO2606
Jurisdiction: Tigard
Site address: 11355 SW COTTONWOOD LN
Project: Kopacek • Subdivision: Lot:
Project Description: Replace existing (1) 150 amp service
Contractor: PRECISION NW ELECTRICAL Owner: KOPACEK, SCOTT V & LINDSEY J
12020 SE ANNA CT 11355 SW COTTONWOOD LN
DAMASCUS, OR 97009 TIGARD, OR 97223
PHONE: 503 -413 -9870 PHONE:
FAX: 503 - 594 -2873
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/28/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 07/28/2011 $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 OAR 952 -00 -009 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /CO Permittee Signature: OA / 6 /(' 72•`%'/O
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.
07/25/2011 22:28 FAX 5035942873 PRECISION NY R]002/002
Electrical Permit Applicatia, prc IIIED ,,..,,,,....,..„„:, ;SE ONIN
.
Cit of Tigard - -.
Received
Dalety: . 2 .2" // 4 • Pcnnit NI3 ' : Zeg: 2 0/fr ".eM / .. ,2 6
. . 13125 y SW I iall Blvd„ Tigard, ()R 97223 i!1V 6 2 Plan Review
11 1 : .• • Phone: 503.718.2439 Fax; 503.598.19 011 pate/BY; Other Permit:
- .. .
TIGARD
inspection I.ine: 503.639.4175 Date Ready/By: ,i . See rage 2 for
Internet: www.tigard-orgov CITY OF TIGARD Noti tietl/MelliOd: v Supplemental Informatiott
-• -
..,
• ... ' ..: ''''''''''! '... - ' HIPA'iikiiiNigigiWTIPMTO r tt4= 1 V4 W I, F. 4;4n. :kiNitUAN 4 ' ' ' ' ' "'-' ' . : 77777-777
El New conStruction M. ' ddition/alterationkcplaccment Please check rill that apply (xubmii 2 sets of plans w/itemx checked below):
0 Service or feeder 400 amps or more 111 Budding over three stories.
D Demolition 0 Other: where the available fault current 13 Marinas and houlyerdS.
i'.'' '.'‘ ', 1421711POT exceeds 10,000 :intim at 150 volts or Fl thit
1:) oatiny huile,S.
;
.: .: ' . • :. ,.
:, • ,..;.:';‘.,,..::,;.,,;:.:: .. 9
- .i7:.,, ,.!,!, ' - '.. I • ''';161,1i ). oht.SoO3rOtk:drik:f.,. ','" 0. '., ililit:, i ,Olvon Icse to ground, or exceeds H,000 El Commercial-use agricultural
1- and 2-family dwelling 0 commercial/industrial D Accessory building am for isil other installations. builthusa.
Multi-family 0 Master builder CI Other; OFirc imt".17. 0 installation of 75 KVA er
, „ ,,,,, witnpszyrtmatrumettitit " Milif,qt A 0 Frnergenoy SyitOM. larger separately dm ived system.
',i'i.":!:'.:: •••;..L:: 11 4'0 41 Kit 'I'M ' ';V li. A 0 0 'il 03 1 1 r Y 0 0 .!` iikaffipv T ' - 1 ['Addition of new motor load or 0
Job no.: Job site tttidreSSf ‘ 3 . c 544 CaToovst Duo ‘ 100HP or more.
ID six or more residential units. 0 occupancy.
Recreational Vehicle polite.
El Health-care facilities. 0 Suppiy VOltilp kV more than
C ity/State/ZIP -j- (.$(') it_Ote4c2ij q .. 1.. -4 0 Hazardous locationx. 600 volts nominal.
.
Suite/bldg./apt. no.: Project name: ID Service or feeder 600 amps or more.
- iligrgagg".7.7".".■'.#4CO.OgiNt0;-,.N.■,,::7.':'!-',;:.::!..;:;:.,:'A7F,. '
Cross street/directions to job site: Deieri I oi r t TeLl 1 ''
.. ,.. -•
New residential single- or multi-family dwelling unit.
Includes attached garage. ... ..
1,000 sq, ft. or less 168.54 4
Subdivision: lot no.:
En. a dd.' 500 sq. ft. or portion 33.92 1
lax map/parcel no.: Limited energy, residential (with 75.
15 .00 2
•,--7,19;nr,,,111,1';IjI.APKW; above sq. rt.)
;.::710Pitlilarain,,::,';'':•'.:7 . '
Limited dnergy, multi-fitmily 75.00 2
t ' . i ,I• 'CACI S , V-s■ S lk,c 0 tc ■ -C-c06/ residential (with above sq., ft)
Services or feeders Installation, alteration, and/or relocation
1 . P AN) (. 200 amps or less 100,'E) Ci
m. • m
,/: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: ,/ 1 /9 eZ7C- j CO' --- l-//li-i 601 aMps to 1.000 amps 301.04 2
I -
Address: S e-ri ' Over 1,000 amps or volts 552.26 2
.,
- Temporary services or feeders installation, alteration, and/or
City/Stale/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
•
201 amps to 400 amps 125.08 2
...
Owner instillation: This installation is being made on property that I own which is not
401 amps to 599 amps
168,54 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extensiOn. per panel _
Owner signature: ... Datc: A. Fee for branch circuits with
above serve or feeder fee
'':".'' .' . ' . '''.: ........0.,I1 '. : ,;:::• !",' . :H.iri::(:,•;, ' 7.42 2
each branch circuit ----.
Business name;
B. B. Fee for branch cirCuii.5 wttliont
W -
, i s 1_1,n,A -r,,.. a c 1 SCTViCO ur feeder fee, first 56.18 2
branch circuit _ .___
Contact name: t.,...„ 1 \ L e ‘..ke,..plo.a..J• I V) .• Each acid'l brunch circuit 7.42 2
• ._
Address 1- miscellaneouslservice or tee& not included)
- , , -
Each manufactured or modular 67.84 2
City/Stale/11P: UN„ C ) g i ( S C.) N,,.),C)2)9 dwelling, service and/or feeder
- Reconnect only C,7.84 2
Phone: (53) 4_k .... c 0 Fax: ; (St,Z ) S Zi - 1 )
_ pump nr irrigation circle 67.84 2
- -
E-mail: r v A , 41 --: u ,A, i ,i.... . Sign or outline lighting 57.84
2
.:.,,;., :.!,)!,';, ,: Rr7 . .,:,? : ; ', r)Z.'' ',' „' ,' '0740 5 Ida Signal circint(s) or limit __
panel, alteration, or extension. Page 2 2
Business name'
• Ale..04114041Ww&LjeN0E-C1N-21.A11&4,__- Each additional inspection mu. allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr .
Address; i 2 _se JA,Ni .
11westigation (1 hr inia) _____
66.25/ hr
_ .
.
City/State/ZIP: ifiAiSt q_. 1 co3 9 . inch,. plant (1 hr mit)) . 78.18/hr -
Phone: s ) 4. ....q ^i Fax: (5c,Lif 4- 2 . Inspections for which no to is 90.00/ hr
!....,,,;•:•,0 E8,7: .',." ::.:.• !,•....'...:'•••:.;
CCB Lie.: tt. s 1 cz) Electrical Lic 1 1 Suprv. Lie.: 1 - ••-•• • .., .• 7•.i v #P
. :., 0 1- - Subtot,
ii
Suprv. Electrician signature, required: 7 ,* CAC) Plan review (25% of permit fee):
. A J . ..
print nantt.4a\c...0___ t...A.1/4.4304,..1 Ia.% . Datc:1, --1. State surcharge (12% of permit fee):
_____,
TOTAL PERMIT FEF.: I fl L....
Authorized signature 2.1....L..1C:- iiiis permit e ppneation e xpires if a permit is nut nbramen within 18
.- ' day. after it hux been accepted as complete.
Print name: 4
tit. j*v..A.e _ ....-ay - 1 ‘
• Number of inspections allowed per permit,
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410-4013'1(11 /05/CONVWFID
1;\Buildireerrnits\ELC.PermitApodoe 07/0i/ I o