Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00582
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Date Issued: 10/19/2011
Parcel: 25111 DC04800
Jurisdiction: Tigard
Site address: 15666 SW SUMMERFIELD LN
Project: POTTER Subdivision: SUMMERFIELD NO 7 Lot: 368
Project Description: Panel replacement and (1) branch circuit
Contractor: ACCESS ELECTRIC & CONSTRUCTION Owner: POTTER LIVING TRUST
2870 SE 75TH AVE SUITE 108 BY POTTER, DONALD H & MARY TRS
HILLSBORO, OR 97123 15666 SW SUMMERFIELD LN
TIGARD, OR 97224
PHONE: 503 - 642 -4333 PHONE
FAX 503 - 642 -9699
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/19/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 10/19/2011 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 10/19/2011 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 OA' •52- 001 -0090 Y r- • • - - -s or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
I F P
7
Issued By: �_E Permittee Signature:
tee 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.
10/18/2011 10:39 1 " ° - ACCESS ELECTRIC PAGE 01/02
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Electrical Permit Application i _ FOR OFFICE -11SE ONLY
III City of Tigard OCT 18 2011 Received 1 •
" 13125 S Hall B lvd., Tigard, OR 97223 ~ _�� �s-
i ITY OF TIGAR Plan Review
Phone- 501 7 1 R 2419 Fax 501 5911 I9 4r f1D 0,,,o. Oiher Permit.
TIC ARD Inspection Line: 503.639.4175 BUILDING DIVISION t)ate Ready /By El See Pale 2 for
Internet: www.tigard- or,gov Notifed/Method Supplemental Information
LYPI: Ox WV1 iLC PLAN REVIEW
El New construction ® Addition /alteration /replacement Please check all that apply (submit 2 IC's of plans wlueme checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ DCmotition ❑ Other: wlicie die u.ailable roll curient ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Finatmg buildings,
less to ground, or eneeds 14,000 ❑ Commercial - use agt 'cultural
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system
' JOB SITE INFORMATION AND LOCATION ['Addition of new motor load of ❑ " h" "L' "1•Z "' "1.3'.
r
1001-it.
Job no.: Currie ,lob site address: 15666 SW Summerfield Lane ❑ Six oor or more an more residential untta ❑ Recreational vehicle parks
City/State/ZIP: Tigard, OR 97224 ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hnzardour. 1peationr 500 volts nominal
Suite/bldg. /apt. no.: Project name: Bob ❑ Service or feeder 500 amps or mgre
-- -- 'FEE SCHEDULE '
Cross street /directions to job site: Desrriation I Qty. I F ce - I Total I •
.. New residential single• or multi- family dwelling'onit•
Includes attached garage. _
Subdivision: Lot no.: 1,000 sq. ft. or less 168 54 4
Ea. add'l 500 sq 0 or portion 33.92 l
Tax map /parcel no.: Limited energy, residential 75 00 2
' DESCRIPTION OF WORK (with above sq. F.)
- Limited energy, multi - family 75 00 2
Panel Replacement, 1 ckt residential (with above sq ft )
Services or feeders installation, alteration, and /or relocation
100 amps or Icss I 100.70 100 70 2
° ! ' . PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133,56 2
401 amps to 600 amps 200,34 2
Nnntc Dun & Mary Putter
601 amps to 1,000 amps 301 04 2
Address: 15666 SW Summerfield Lane Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation. alteration. and /o
City /State /ZIP; Tigard, OR 97224 relocation
Phone: (503)670.7667 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 am to 599 am _ 168.54 2
Branch circuits - new, alteration, or extension, per Banc)
Owner eignafirre Date: - A Fee for branch circuits wish
'ITV '
' ' ❑• APPLICANT 0 CONTACT [ PI R;SON above service or feeder fee, 1 7 42 7 42 2
;,t. .. . each branch circuit
Business name: B. Fcc for branch Circuits ,r.rihnrr
-- - Service or feeder tee, first
56 18 2
Contact name: branch circuit
Each add'l branch Circuit 2
Address:
MiNecIlancous (service or feedei not Included)
City/State/ZIP: Each manufactured or modular
Y dwelling, service and /or feeder 67 84 2
Nhone: ( ) Fax: : ( ) R.nco aert only 67 54 7
- - --- Pump or irrigation circle 67 84 2
E -mail:
Sign or outline lighting 67 84 2
GONTRAG [OR si ciicont(.) tor t,n„i I -er,c, 5y
Business name: Access Electric & Construction, GLC panel, alteration, or extension. _ Page 2 2
Each additional inspection over allowable in any of the above
Address: 2870 SE 70 Ave., Ste. 108 Additional ,nnpcct,on (I hr min) I L Al) 25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZiP: Hillsboro,
OR 97123
.._ Lndustnal plant (1 hr mm) 78 18/ hr
Phone: (5113) 642.4333 Fax: (593) 642.9699 Iiispea.tikiny fw which no fee is
specifically listed ('R hr min) 90 00/ hr
CCB Lie.; 162666 Electrical Lie.: C -16 Suprv, I.ic.: 493IS ELECTRICAL PERMIT FEES
Subtotal: 108 12
Suprv. Electrician signature. required: Ur -- S --.� Plan review (25% of permit fee):
Print name: Kent Zimmerman Date: 10.18.11 Stale surcharge (12% of permr fee), 12.97
— TOTAL PERMIT FEE: 121,09
Authorized signature: This permit nppticnfion expires if a permit is not obtained within 180
days after it bus bees accepted as complete.
Print name: Date: , i Number 0I inspections allowed per permit
l lRuiIdinglPcrmus \CLC- PermiiApp n7 /0l/10 440.4615T(11/05 /CQM/W1:.ti