Permit 1111, CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Per #: ELC2011 -00561
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 10/12/2011
Parcel: 1 S135BC00201
Jurisdiction: Tigard
Site address: 10765 SW GREENBURG RD
Project: 7 -11 Subdivision: HILLSBORO Lot: PTS 1 -2
Project Description: (2) branch circuits for new light fixtures
Contractor: ACCESS ELECTRIC & CONSTRUCTION Owner: BELANICH ROGER M
2870 SE 75TH AVE SUITE 108 22020 17TH AVE SE #200
HILLSBORO, OR 97123 BOTHELL, WA 98021
PHONE: 503 - 642 -4333 PHONE
FAX' 503 - 642 -9699
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 10/12/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/12/2011 $7 63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 -0090 You may obt a cogy_QL. r - rule sect questions to OUNC by calling 503 232 1987 or 1 800 332 2344 NNW
Issued By: _ - Perm ittee 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 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.
10/11/2011 15:02 1 � � ACCESS ELECTRIC PAGE 01/02
Electrical Permit A licatio t 0 _ FOR OFFICE USE ONLY
�� �� Rcccrvcd
II II City of Tigard \" (�`(, '`,,- R : / �1I /
13125 SW Hall Blvd.. Tigard, OR 97 - 23 �• an R
II Phone: 50 Fax: 503.598.196 '- - + Pl DateB Other Permit:
1' I. G k inspection Line: 503,639,4175 //ate Kcacty /uy: ecc Pnge 2 tor
Internet: www.tigard- or_gov '1 YP1b1 UTa . WO . . ' ' • i, ,'P'X , ,
` Notified /Method: �i Supplemental Information
i AN' REVIEW
111 New construction • ® Addition /alteration /replacement Please check all that apply (submit scis of plans wnrcros checked below):
❑ service or feeder 400 amps or more ❑ I3uildlag over three stories.
❑ Demolition ❑ O1her: where the available fault current ❑ Marinas and boatyards.
CATEGORY ' CONSTRUCTION exceeds 10.000 amps at 150 volts or 1:1 riming buildings.
less to ground, or exceeds 14.000 ❑ Commercml -use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
0 Multi - family u Master builder ❑ Other: ❑ Fir pump. ❑ fmtaltatinn of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE' INFORMATION AND 'LOCATION • , . o Addition of new motor load of 0 "A" "E", "1 -2" "1 -3
v 1001-IP or more. occupancy.
Job no - : 7 - 1 I #2556 Job site address: 10765 SW Greenburg Rd., 7t ejard t Q14 ❑ Six or more residential Watt. ❑ Recreational vcn, le parka.
[] Health - carc facilities ❑ supply voltage for more than
City /Slate /ZIP: 97223 600 volts nominal.
0 HaxaMoas r locations,
Suite/bldg. /apt. no.: Project name: 7-11 #2556 ❑ Servle co r r e e dccdOD am pa vr i to's
' - , ft1S , S'c1F iAlL i ' '
Cross street /directions to job site; Total 949oHltttna ' i Qty - T i�'cc Tot � .
- Ncw residential : An g ie- or multi family dwelling unit_
Includes attached garage,
Subdivision; Lot no.: 1,000 sq, ft. or less 168.54 4
°- Ea. awl 500 sq. fl. pi portion 32.92 1
Tax map /parcel no - Limited energy. residential 75.00 2
DESCRIPTION OF WORK ' , , . " (with above sq. ft.) .
•• Limited energy. multi - family 75.00 2
Replace Light Fixtures residential (with above sq. ft.) —
"— Services or feeders installation, alteration. and/or relocation
200 amps or less 100,70 2
' ❑ PROPERTY OWNER I 0 *lsIANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,nfx1 snips 301,04 2
Address: Over 1.000 amps or volts 552.26 ` 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: _ relocation
Phone: ( ) [Fax: ( )
200 amps or less 59 - 30 1
201 amps to 400 amps 125.08 2
Owner installation: This in :tallation is being made on properly thlat 1 own which is not 401 amps to 599 amps 1 6 x -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: Date: — A. Fee for branch circuits with
above eervice or Feeder fee. 7 42 2
[] AI'I'Y.rCANT 0 CONTkCT. rERSON '.. ' each branch circuit - _,
Business name: 3. Fee for branch circuits without
. — service or feeder fee. first 1 56, 8 56.18 2
Contact name: branch circuit _
_ Each add'l branch circuit 1 7,42 7.42 2
Address: Miscellaneous (service or feeder not included)
-- Each manufactured or modular r
City /Stale /ZiP: dwelling. service and/or feeder 67,84 2
Reconnect only 67.84 2
Phone: ( ) Fax: ' ( ) Pump or irrtgattun cii ca 67.S4 2
E Sign or outline lighting 67.84 2
—
CONTRACTOR Signal circuit(s) or limited - energy
• iniel. alddi ativrt. or nxtcnaion. Pala 2 7
Business name; Access Electric St Construction, LLC
Each additional inspection over allowable in any of the above
Address: 2870 SE 75 Ave., Ste. 10$ Additional inspection (1 hr min) 6625/ hr
'— "—° tnvcsdgai (1 III min) 66.25/lir
City /State /ZIP: Hillsboro, OR 97123 Industrial plant (1 ht min) 78.18/ hr
Phone- (5031 642.4333 Fax: (503) 642.9699 inspections for which no fee is 90.00 / hr
speLifio4lly listed Oh he min) - ,
CCB Lie.: 162666 Electrical Lie.: C -16 Suprv. Lie -: 4931S ' ' , ELECTRIC ,.EER)1IT FEES ' , , , ,
l �— Subtotal: 63.60
Suprv. Elrelriclan slgnalurt . reyui,etl. —.— Flan review (21% of permit Lc). _
Print name: Kent Zimmerman Date: 10.11.11 State surcharge (12% of permit fee); 7.63
TOTAL PERMIT F 71.23
Authorized signature: This permit application expires if a permit is not obtained within 180
— days after it has been accepted as complete.
Print name: Date; * Nurrher of Inspections allowed per permit
1tbu rid ing \ Perm( .4ELC- PCrmitApp.dac 07/01/10 445- 4fI5T(11/05 /COM/lV1LD