Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00635
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/09/2011
Parcel: 2S110DB92091
Jurisdiction: Tigard
Site address: 15431 SW FOUNTAINWOOD PL
Project: HILDEBRAND Subdivision:■TAINWOOD AT SUMMERFIELD A CO Lot: 9
Project Description: (2) circuits for laundry room remodel.
Contractor: ACCESS ELECTRIC & CONSTRUCTION Owner: HILDEBRAND, CARVER & MILDRED BER
2870 SE 75TH AVE SUITE 108 HILDEBRAND TRUST
HILLSBORO, OR 97123 15431 SW FOUNTAINWOOD PL
TIGARD, OR 97224
PHONE: 503 - 642 -4333 PHONE:
FAX: 503 - 642 -9699
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/09/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/09/2011 $7.63
Type of Use: SF 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 - •r•ance . -' • 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. ATT' NTION• Oregon -w requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-0410 thr gh OAR 952-0•1-4: 7. may obtain , a� copy
� ft
of the rules or direct questions to OUNC by call'. • = _: :A or 1.800.332. 44.
Issued y: 'i�'� �v / ✓ Permittee Signa , L�
C,O / C
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.
11/09/2011 @S:55 1 ACCESS ELECTRIC PAGE 01/02
Electrical Permit Appi i cRtrgEIV ED
FOR OFFIC:1.: 1.:SV QNI A'
City of Tigard
7 01 ii iteceived
nnie/r3 , 0 _. ermi N o.:
JAM P 't N . l
11 * 13125 SW I lall Blvd., Tigard, Ofi\MY23 9 - - Plan RaviCw
: : : ' Phone: 503.718.2439 Fax 503.598.1960 Date/13 : Other Permit: ai ji,gp/
I I G D
_
Inspection Line: 503.639.417trry (*TIGARD Date Ready/Hy: hair El See Page 2 for
A R
Internet: www.tigard-or.gov BIIILDING DIVISION Notified/Method: Supplemental Tnformation
': „.'":!Wf.,01*..' :s:':. :), 1 : -.: .4'' ' : T :% • . ' '''■ : ,. :: .'''::.....‘....: : • ....,: ''.,...:: ; ';' .::: t"4: ;i t.t4k***: : .■': • "' l in.';: ;... ..':.
o New construction El Addition/alteration/replacement Please check all that apply (submit 2 sets of plans watems checked below):
0 Service or feeder 400 amps or morn 0 Building ever three stories.
El Demolition 11I Other: .4..... It. Ay.;b1,1. &nit antrnnt El Marinaa Awl 13n3tyarric
6;tidOitt: ''.:::',:c ' ..::: ' exceeds 10,000 amps at 150 volts or 0 FlOating buildings,
less to ground, or exceeds 14.000 0 Commercial-use agricultural
0 I- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Firc pump. Li Installation of 75 KVA or
larger separately derived sysittn,
P. 1„
.,,k i..... ,.,..7 :
-. . .,..., .,.0.:;i;!,V;Y; .!.:':.:... ,.:: . '...'......'.;:.:' El Addition of new motor load of
Job no.: 15431 Job site address: 15431 SW Fountainwood Place 1 00 UP pr ,,,, occupancy.
['Six or more residential units. 0 Recreational vehicle parks,
City/Statc/ZIP: Tigard, OR 97224 0 Healih-eare facilities. 0 Supply voltage for more than
014axardous locations, 600 volts nominal.
Suite/bldg./apt. no.: Project name: .leiker I i
14 I f.• 7; 0 Service or fender 600 amps or more.
CD 24 OD
V M : M..;, „:
,4f,g:.ii)E4
Cross street/directions to job site: ri,xription a 1 Qty. 1 rec. 4 11 I •
New residential singie or multi-family dwelling unit.
Includes attached garage. . .
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Ea add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy. residential
75.00
A $PPOIV*0;*0.4k;;41/h0::KI').,!;6:".:;..',:.q.'.. (with above sq. it) 2
Limited energy, multi
75.00 2
Add 2 ckt for Laundry Room _ residential (with above sq
Services or feeders installation, alteration, and/or relocation
200 amps or Ic33 100.70 , 2
in vittiffitivowicizaKi,zr.',', ;,:.,,::;;;',.::: ..;.:".; ,4MAiticti'72:,: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200,34 2
Nome: Bernick ifillanbrand
601 amps to 1,000 amps 301.04 2
Address: 15431 SW Fountainwood Place Over 1,000 amps or volts $52.26 2
Temporary services or feeders installation, alteration, and/or
City/Stutc/ZIP. Tigard, OR 97224
relocation
Phone; ( ) 1 FeX: ( ) 200 amps or less 59.36 1 -
ampsto400 amps
Owner installation; This installation is being made on property that t own which la not 201 -- 125,08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168,54 2
Branch circuits - new, alteration, or extension, er panel _
Owner signature: Date: A. Fee for branch circuits with
_ ......_
ififiket';';' trAiiititaftrilT,76:'il.M?;;',. ...1=11 42 2 til§oN't .: .,!:::; above service or feeder fee,
7,
each branch circuit .
Business name: B. Fee for branch circuits without
service or feeder fee, Prat I 56,1 8
56,18 2
Contact name: branch circuit.
Each add'i branch circuit 1 7.42 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fa.x: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: --- _
• ”
Sign or outline lighting 67.84 2
.':'. .'•:,•.'.......'. ' '', • '.: :.::. ',. !'...... . • .....'.'.1 r':' . . 1 : 1 : ' S i r A I eirnilit(s) or linntarl-pnprgy
Business name: Access Electric & Construction, LLC _panel, alteration, or extension. Page 2 2
— Each additional inspection over allowable in any of the above
Address: 2870 SE 7r Ave., Ste. 108 Additional inspection (1 hr min) 66.25/ hr
investigation (I hr min) ' 66.25/ hr
City/State/ZIP: Hillsboro, OR 97123 ,
Industrial plant (1 hr mm) 78.18/ hr
Phone; (503) 642.4333 Fax: (503) 642-9699 Inspections for which no fee is
; 90.00/ fir
— specifically listed ( hr min
CC1:1 Lie.: 162666 Electrical Lic.: C Suprv. Lie.: 4931S ...:.!: :. .:.. 1 :" . .: .: ' 2 :gbeIRII.CALtrOgrtEEES.....-' ..•*'!' .'..
,--- .
Subtotal! 63.60
Suprv. Electrician signature, requi --- red: • ..._
- • Plan review (25% of permit fee):
Print name: Kent Zimmerman - 1 Date: 11.09.11 State surcharge (12% of permit fee): 7.63
TOTAL PERMIT FEE: 71.23
Authorized signature:
This permit application expires ir SI permit is nut obtained within 180
days after it has been accepted as complete.
Print namp.• - Date: • Number of iropaction3 allowcd per permit.
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