Permit CITY OF TIGARD ELECTRICAL PERMIT
,1111 q
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00542
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Date Issued: 10/04/2011
Parcel: 2S 111 CCO2300
Jurisdiction: Tigard
Site address: 10385 SW CENTURY OAK DR
Project: COFFIELD Subdivision: SUMMERFIELD Lot: 20
Project Description: Panel replacement and (2) branch circuits
Contractor: ACCESS ELECTRIC & CONSTRUCTION Owner: COFFIELD WILLIAM H &
2870 SE 75TH AVE SUITE 108 FRANCES 0 TRS
HILLSBORO, OR 97123 10385 SW CENTURY OAK DR
TIGARD, OR 97224
PHONE: 503 - 642 -4333 PHONE:
FAX• 503 - 642 -9699
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/04/2011 $100 70
Specifics: amps or less
1 ea 12% State Surcharge - 10/04/2011 $19 72
Type of Use: SF Electrical
Class of Work: ALT 2 crt Branch Circuits w /Purchase 10/04/2011 $14 84
Service or Feeder
Type of Const: 0 ea 12% State Surcharge - 10/04/2011 $ -5 86
Occupancy Grp: Electrical
Total $129.40
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0090 You may obtain a co• of the r • erect questions to OUNC by calling 503 232 1987 or 1 800 332 2344.
ll
Issued By: i _ �i / Permittee Signature:
/'
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
10/03/2011 11:59 1 ACCESS ELECTRIC PAGE 01/02
Electrical Permit Application
RECE1 _ i oi: OFFICE, i E,, USi ONLY .
City or Tigard
i1I Permit No,: , — • _
^ 13125 SW Hall Blvd.. Tigard, OR 97223 QCT ® "5.1475 s Review Other Permit:
pp
Phone: 503.718.2439 Fax: 503.59$.1960 Date /fly:
'"t`IGARD hig 503,639.4175 Il , spy /9 iurty: El See Page 2 for
Internet: www.tigard- or.gov CI 1 1 OF II I j , t ,,,,,,d. Ai , Supplemental Information
V
• OF. roRK . BVILD ! PLAN ,REVIEW , ..
❑ New construction E Addition /alteration /replacement rime check .ttl that apply (submit Z Sets of glom w /items checked below),
❑ Service or feeder 400 amps or more ❑ Building over three 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, nr exceeds 14.000 ❑ Commercial - use agricultural
El 1- and 2- family dwelling ❑ COr1'lmercial /Industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi -fame ly ❑ Master builder ❑ Other: ❑ File puiirp, ❑ 1glollaiiv,1 y r 7J KVA w
, . 40B ' SITE INFORMATiON AND 'LOCATION'' 0 Emcrgancy system. larger separately derived system.
... ['Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3".
Job n0., I Jul, site atldteas: 10385 NW Century Oak Dr. t00HPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97224 - ❑ Health -care facilities, ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suitc/bldg_ /apt. no.: J Project name: Cut rie ❑ Service or feeder 60 amps or more. —
job site: ' ' r "' "' '' ' -' _W ""' R rs.( j
Cross street /directions to
,1 DrsCriptiDn I O +v.,, l Fee. i � Thud � L
New residential single vi multi dwelling unit. ,
Includes attached garage. _
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
•
Tax map /parcel no,: Ea. adel'1 300 sq. ft. or ponlon 33.92 — 1
ti
Limited energy, residential
75.00 2
DESCRIPTION OF: WORK (with above sq, ft.)
a Limited energy. muui- family
g residential (with above sq. ft_) 75.OD z
Change & 2 ekts
Services or feeders installation. alterat and /or relocation
200 amps or less 1 100.70 100.70 2
❑ PROPERTY: OWNER f . ' TtiNver 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
(501 amp to 1.000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /S1AIG /7TP Temporary services or feeders installation, alteration, and /or
relocation
Phone; ( ) I Fax: ( ) 200 amps nr less h 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is bring mad' nn prrrcorty that I own which is not
401 amps to 599 amps tt?tS.S4 Z
intended for sale. lease. rent. or exchange, according to ORS 447, 441, 670, and 701.
-—
Branch circuits — new, alteration, or extension, per panel
Owner signaluie: _ Date: A. Fee for branch circuits with
❑ •APPLICANT . Et CONTACT PERSON above service or [ceder (cc, 2 7.42 14 2
each branch circuit
BUginC, "5 name: B. Fee for branch circuits without
. service or feeder fee. first
.!3.11 2
Contact name: - branch circuit
- - Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured Or modular 67.84 I
City /State /ZiP: dwelling. service and /or feeder
Reconnect only I 67.84 a
Phone: ( ) I Fax:: ( ) Pump nr irrigation circle o /.84 z
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR . • , Signal circuit(.) or limitcd• energy
Business name: Access Electric & Construction, LLC panel. alteration, or extension. rage 2 2
Each additional in pcction over allowable in any of the abov
Address: 2870 SE 75 Ave., Ste. 108 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Hillsboro, OR 97123 investigation (1 hr min) o6.25! hr
Industrial plant (I br min) 78.18 / hr
Phone: (503) 64 2.43 33 I Fax: (503) 642.9699 Inspections for which no fee is
90.00/ hr
s .:dically listed(t2nrmin)
CCB Lic.: 162666 i 1 / Electrical Lit -: C -16 7 j / Suprv. Lic,: 4931 S iQ f f / , EutcrRICAL'.kERMX.T EES • , . ', ,
Subtotal: 11534
Suprv. Electrician ai nature, required: tI ---', Plan review (25% of permit fcc); .,
Print name: Kent Zimmerman Date: 10.3.11 State surcharge (12% of permit fee): 13.86
—__ - Tf1TAT PERMIT FEE: 129.40
Authorized signature: This permit application expires if a permit Is not obtained within 180
Print name: �_ Date: * days after It has been accepted as complete.
Number of inspections allowed per permit.
IA :flirting 07/01/10 440- 4t15TI11/05 /COM/WEa