Permit t CITY OF TIGARD ELECTRICAL PERMIT
il
4 COMMUNITY DEVELOPMENT PERMIT #: ELC2008 00523
DATE ISSUED: 9/10/2008
, TiGARD; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 104AA - 02400
SITE ADDRESS: 12265 SW 127TH AVE ZONING: R -4.5
SUBDIVISION: BELLWOOD LOT : 073 JURISDICTION: TIG
PROJECT: WYFFELS
Project Description: Replacing panel and (2) branch circuits for garage outlet and attic fan.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
HENRY WYFFELS ACCESS ELECTRIC & CONSTRUCTION LLC
12265 SW 127TH AVE 2870 SE 75TH AVE. STE. 108
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: Contact #: PRI 503 - 642 -4333
FAX 503 - 642 -9699
FEES
Description Date Amount Reg #: ELE C -I6
[ELPRMT] ELC Permit 9/10/2008 $93.60 LIC 162666
[TAX] 12% State Surchar 9/10/2008 $11.23 SUP 4931 S
Total $104.83 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. Yo cbta opies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
I
Issued By • Permittee- Signature: e cn e /)
OWNER INSTALLATION ONLY 1
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'N: 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.
I 09/09/2028 13:11 1 ACCESS ELECTRIC PAGE 01/02
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" 13125 SW Hail Blvd., Tigard. OR 9 223 ��
Plan Review
Phnnc; 503.639.4171 Fax; 503.598.1960 e E rs 9 ' f c Dnte / B Other Permit:
y' — T]CI 1 I nspection Linc: 503.639.^175 J hare Reii /BV: Juri i;C for
Y td Nee r'n Z
-^Ax '`a Internet: www,tigard- or.gov Notified /Method: Supplemental information
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1�ARD
❑ New construction Addition/alt O / alt Auto I N enti Plea check all that apply (submit 2 REVfEW w /it
p checked below):
❑ Service nr feeder 400 imps or more ❑ Building over !hive stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards,
CATEGORY OF ,CONSTRUCTION. exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural
E 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings
❑ Multi - family 0 Hasler builder ❑ Other: prim pump.
❑ luhtedlelivn vC 75 I:VA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
•
El Addition of new motor load of ❑ "A" "E" 'I - °l - 3',
Job no.: Job site address: 12265 SW 127t Ave ! 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
C i y /State /ZiP: Tigard ❑ Health -cart facilities. ❑ Supply voltage for more than
❑ Harardons locations, 600 volts nominal.
•
Suite/bldg. /apt. no.: Project name: Henry Wyffels ❑ Service or teener Gllo amps or more.
FEE SCHEMA ,
r Cross streeticlireclions to fob site: nrtrrlphpn ` tv, i rte. i Tool J •
New a'enidcur z41141e of multi - family tlwrIlin1 u
includes attached garage.
Subdivision: Lot no_: 1.000 sq. ft. or less 14$,15 4
_. Ea. add"' 500 sq. fi. or portion 33,4u 1
Tax map /parcel no.: —
Limited energy, residential
DESCRIPTION OF WORK ! (with above sq• ft.) 75,00
2
hail( «1 ciii.agy. multi 75.00 2
Panel change and 2 ckts. outlet in garage & attic fan residential (with above sq. R.)
Services or feeders installation, alteration. and /n relocation
200 amps or Ices I 80.30 80,30 2
0 .. NT 201 amps to 400 amps 106.85 2
PROPERTY :OWNER ❑T FNA
Name: Henry Wyffels 401 amps to 600 amps 160,60 2
Address: Same 601 amps ro 1.000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration. and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or Icss _ 66.85 I
Owner installation: This installation is being made on property thm 1 own which is nor 201 amps to 400 amps 100.30 2
intended for sale. lease. rent. or exchange, according to ORS 447. 449. 670. and 701. 401 amps to 599 amps 133.75 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date:
A. Fcc for branch circuits with
❑ APPLICANT . ❑ CONTACT FERSON above service or feeder fee, 2
6.65 13.30 2
Business name: each branch circuit -
B. Fee for branch circuits
,arbour service or feeder tee,
Contact name: 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Nfiscrllamcuns (snrvicc or feeder not Included)
City /State /ZIP: Each manufactured or modular
dwelling, s ervice and /or feeder 90.90 2
Phone: ( ) Fax: : ( )
Reconnect only 66 85 2
1: -mail: Pump or irrigation circle 53,40 2
. 'CONTRACTOR • . ,! . . Sign or outline Lighting 53.40 2
Business name: Access Electric & Construction, LLC Signal panel, l al e r Ilmlrcn
energy alteration, or
Address: 2870 SE 75 Ave Suite 108 extension. Describe: Page 2 2
City/State /ZIP: Hillsboro, OR 97123 Each additional inspection over allowable in any of the above
Per inspection 62,50
Phone: (503) 642.4333 _ Fax: (503) 642.9699 1nve:tigntien per hour (t hr ruin) 62.50
CCR I.ic.: 162666 Electrical Lic.: C16 Suprv. Lk.: 4931S industrial plant per hour 73.75
ELECTRICAL. PERMIT .GEES'
Suprv. Electrician signature. required: Subtotal; 93.60
r _ Plan rcvicw (25 of permit fee);
Print name: Kent Zimmerman Date:
". State surcharge (12% of permit fee): 11.23
Authorized signature: TOTAL PERMIT FEE: 104.83
Print name; Date: This permit application expires if a permit is not obtained within 180
days after it has been accented as compictr.
* Number of inspections allowed per permit
I,\ Building \rcrmilo \ELC -PermitApp.doc 05/22/06 440 - 461$T(11 10NCOM /WE6
CITY OF TIGARD
BUILDING DIVISION PERMIT #: RG2008-00523
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/1012006
Phone: (503) 639-4171 AA,
_..
Inspection Requests (24 Hrs.): (503) 639-4175 'LL
INSPECTION WORKSHEET FOR DATE: 2/20/2009 TIME: 7:00Am PAGE: •0
SITE ADDRESS: 1 SW 12TH AVE CLASS OF WORK:
SUBDIVISION: BELLWOOD LOT #: 073 TYPE OF USE:
PROJECT NAME: VWFFELS
DESCRIPTION: Replacing panel and (2) branch circuits for garage outlet and attic fan.
OWNER: VVYFFELS, HENRY PHONE #:
CONTRACTOR: ACCESS ELECTRIC & CONSTRUCTION LLC PHONE #: 03
Inspection Request Scheduled For: Date: 2/20/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 080655-01 503.680-6776 N
Cor ections/Comments/Instructions:
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skl- LA. fslepast\r• 1
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PASS El PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
ri F fl CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: ---‘• Ni0eL:e Date: 2. Phone #: (503) 718- VI%) •