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Permit CITY OF T I GA R D ELECTRICAL PERMIT • PERMIT #: ELC2008 -00269 ` COMMUNITY DEVELOPMENT DATE ISSUED: 5/12/2008 T1GAitD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 25101 DB -00104 SITE ADDRESS: 07300 SW HUNZIKER RD 110 ZONING: C -P SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: ACUITY Project Description: TI - (10) branch circuits. 5/15/08 ADD: (3) branch circuits for ADA restroom. 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: SIGNAUPANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 12 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: ROBINSON DEVELOPMENT A C & E ELECTRIC CO PO BOX 91305 3535 DEL WEBB AVE NE #100 PORTLAND, OR 97291 SALEM, OR 97303 Phone: Contact #: PRI 503 - 363 -2301 FAX 503 - 363 -2302 FEES Description Date Amount Reg #: ELE 24 -IC [ELPRMT] ELC Permit 5/12/2008 $106.70 LIC 591 [TAX] 12% State Surchar 5/12/2008 $12.81 SUP 47025 [ELPRMT] ELC Permit 5/15/2008 $19.95 (additional fees not listed here) REQUIRED ITEMS AND REPORTS Total $141.85 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 7 05/15/2008 08:39 503 - 363 -2302 AC &E ELECTRIC PAGE 01/02 Electrical Permit Applic ` )$ �,it e)I la(t I , � f)nl r ' ; ; C i of Ti ard Rcacivcd Permit Nn, L :v.--`. ty g ��Q Aate/ FL ('v7 0Gl d ' DO��5 a 13125 SW Hal Blvd. T OR 9 7164Y g � 2 0 U Plan Review - ` e ' Phone: 503.639.4171 Fax: 503.598.1960 > may: Otter mil; gee, a - 0v74, / ` Tnspcction Line: 503,639.4175 JoN l ® Sec Page 2 for CITY 3 ;1G/4 D DateRea T f R n PlotifredlMcthod: - + Internet: www.tigard-or.gov Supplemental information i;r, , r , . u, „ 11'. , t ar,� .SmnD� n `, a, - t. r r , N I I 1 ,lit ': if 1. tii 'Id° ill r a s Q� 1 } p � 1 { % 1 1 Yn 1) a 11 r 41 1 t. pyyyyyy����y�7� H i I ri ,{ I + r 1',' . i „ 11i l l � �iN i ! !Kr 1r `�, �( : II° ,� ��� : hi! t�{ h�Si> i���F�' ��, �� 'I���lf���l'�l�Il��fl�l�i14,11 J��� Jl���������, , ��u� • ,n,n. h.v��ll���11�7 ����h'; ���it1r�H,��•9•�I��,ti�l ❑ New construction ® Additionlaltcration/replacement Please check all that apply (.grdnnit a seta of plans w /items checked below): ❑ Service or feeder 400 amps or more • ❑ Building over three stories. ❑ Demolition 0 Other: where the available fault current © Marinas and boatyards. 15 ; i t i�iN 1 4 �11, tI f� :l � i} I I ft,� 'i, i o � N, a ro a {- a I l 4G excecdc 1 Qt1110 amps nt 150 volftl oe in Floating buildings. i.;a,,' ;+ ' } �� �(� y_.,,, �,,,,,, �} � Y !� �q {' 1`( I Ili � � I , lcsato ground. or *weds 14,IHl0 1:1 Commercial-use agricultural ❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other inatatlntiona, buildings. ❑Multi- family ❑ Master builder ❑Other: ❑ Fire pump. 0 T5tnllationof75KVAor © Emergency system. larger separately derived syrdem, �tl'I' (r , 4 7U i ate , , l i ° q •.'' 1 L1 �1 ' F 11 0 i 0 to • , 1 I 1:0 1111 g11Cl Lest! it 8111,1 ? tqw ,„ I „ - ;. � ,r!IA.. y � ,, 1 I .� '", •.} i:,n ro l .n,.' •14 • • `• ,r ',:} leN�.4 ni;Cli i litlil 1� Addition of new motor load of [! 'A" E "1.2 1.3 , Job no.: Job site address: 7300 Hunzikcr Rd 100 a* mere, occupancy. ❑ Six or more tesidentint units. I3 Recreational vehicle perks. City /State /ZIP: Tigard, OR ❑health -care facilities. ❑ Supply voltage For more than ❑ liate dons locations. 600 volts nominal. Suitc/bldg. /apt. no.: 1" Fir I Project name: ADA Restroom ❑ Service or feeder 600 amps or more. fig l 'Talil lr tEFI o"' i�s' I1 i � ll1i1N 'i . i, A ,r t. , -! ; _I �a �-.mt �im�V�, � S I � y �i' � �' iii , Cross street/directions to job site: D®crtpdon Qv. Pee. Tani • New residential single- or imilti- family dwelling unit Includes attached garage. - Subdivision: I Lot no.: 1,000 SI. R or less 145.15 4 Ea. add - I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential �#ii ;a'i' liii llliiiI►; ( ;i 1 4 } ? i, i � a + l i mta a f, i.!`1, t E� 1 I 11 'Ii l f t l , (with abovcaq. R) 75.00 2 f 1 amiss V6 i1 4,«b' fll } ir ' .'' �. ;I S� , 6 t A - J . Limited energy. multi- family 75.00 2 ADA Restroom residential(whh above sq.,R,) Services or feeders installation and/or relocation 200 amps or less 80.30 2 11'11; ` 1i ' ! t + + {!' X11 4411111+1101111414A/141 � 1 i I II 201 am s to 400 s 106.85 2 „••,., ;I5m �t a i„m s{ `"•t l,,.�f' , r i ' ilP��ltl��u, + , rIl. ,.1 t i� P P Name: 401 amp to 600 amps 160.60 2 601 amps to 1.000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City /State/ZIP: Temporary services or feeders Installation, alteration, and/or relocation Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that t own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, runt, or exchange, according to ORS 447, 449, 670, and 70I. 401 amps to 599 amps 133.75 2 _ Branch eircnits- new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with rii • t ' I Y 1i i i F, ' ' I a v. 1 iIt q n t 'e i t lit; ,, , ' : ' ( above sc vicc or feeder fcc, SlilllwEi ; ;�{i�Ili{} iI��,G +1��li u � r l l� I�i _ i t �I ,I i j EEil )1f !+? , ,' i bi se s d lisa4r I li r, r' 6.65 2 each branch circuit 1usiness name: 13. Fee fbr branch circuits without service or feeder fee , I first branch circuit i q, Contact name: ei jr Address: Each add'l branch circuit 3. 6.65 .J-338 2 Miscellaneous (service or feeder not included) City /State/ZIP: Each manufactured or modular dwelling, service and /or feeder 90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 i 1 11 . '�i;>; I ;Iiii iiII II1 III�I I INiI I ilh9l I Sail 1. i.�Nl {!! PORN4 l ! I�Il1li!I f il;H;lll fPf ,s aIVIN. 4']>I!I RI 561 n d Sign or outline lighting 53.40 2 � Business name: A C & E Electric Signal circuit(s) or limited - energy panel, alteration, or Address: 3535 Del Webb extension. Describe: Page 2 2 City/State/ZiP: Salem, OR 97301 Each additional Inspection over allowable in any of the above Pa inspection 62,50 Phone: (S03) 363 -2301 f ax: (503) 363 -2302 Tnvcstigation per hour (1 hr min) 62.50 CCB Lic.: 591 Electrical Lic.: 24 -IC Suprv. Lic.: 47025 Industrial plant per hour • 73.75 '1il i 1 i hlfiiil;11' `i. ik 1 a, 1*4"� .17. i+ '.�.,`vi ! 9 t . Ir111.1 ;1 i Suprv. Electrician signat required: Subtotal: -604Y Print name: Dan Allen Date: 05 /1 Plan review (25% of permit fee): /9 ,�j 5 State surcharge (12% of permit fee): _.„2.23" , 37 Authorized signature: TOTAL PERMIT FEE: 4773'7 , 3 y Print name: Date: This permit application expires if A permit i5 not Obtained within 150 daps Lions allowed d p p e n rp permit. l ns complete. N C Ri / 4 - trmbcrofineprxtionselowdccnni t. /�/f 1: 113ulldinglPerm ltnlEI- C.- PermitApp,dnc 05/21/06 440.4615T(IUD5 /COM/WBB • CITY OF TIGARD , r ~ BUILDING DIVISION PERMIT #: ELC2008 00)269 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 511212008 Phone: (503) 639 -4171 ���ps fll Inspection Requests (24 Hrs.): (503) 639 -4175 , _ . _. INSPECTION WORKSHEET FOR DATE: 5/29/2008 TIME: 7:00AM PAGE: 26 SITE ADDRESS: 07300 SW HUNZIKER RD 110 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: ACUITY DESCRIPTION: TI -• (10) branch circuits. 5/15/08 ADD: (3) branch circuits for ADA restrod:rn. OWNER: ROBINSON DEVELOPMENT, PHONE #: CONTRACTOR: A C & E ELECTRIC CO PHONE #: 503-363-2301 Inspection Request Scheduled For: Date: 5/29/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 070507 -02 503 559- 9855 14 Corrections /Comments /Instructions: n ` / I 7° S I� wia1. ■ s Nt7P it \)b PASS 0 PARTIAL APPROVAL ❑ CANCEL • n NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G----; I vU Date: 29( bi Phone #: (503) 718- . CITY OF TIGARD , ` 7 BUILDING DIVISION PERMIT #: ELC2008.00269 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/12120011 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 1± INSPECTION WORKSHEET FOR DATE: 5/29/20(18 TIME: 7:00AM PAGE: 27 SITE ADDRESS: 07300 SW HUNZIKER RD 110 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: ACUITY DESCRIPTION: T1- (10) branch circuits. 5/15/08 ADD: (3) branch circuits for ADA restroorri. OWNER: ROBINSON DEVELOPMENT, PHONE #: CONTRACTOR: A C & E ELECTRIC CO PHONE #: 503-363 -2301 Inspection Request Scheduled For: Date: 5/29/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 130 Ceiling cover 070507 -01 503 - 559.9855 Y Corrections /Comments /Instructions: ' k,"& \ L CZ \W1/4. t),4L. k-ZiNi \id_tie p ./ Q z7 14, c t c 1•1 QAW . f _______ ----- PASS ❑ PARTIAL APPROVAL ❑ CANCEL 1 I NO ACCESS FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: N vQa Date: 2V C)1 Phone #: (503) 718- vifi CITY OF TIGARD " . BUILDING DIVISION PERMIT #: EU :2000- 00268 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5t12/200U Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 `� °__,, INSPECTION WORKSHEET FOR DATE: 5/19/2008 TIME: 7:00AM PAGE: 27 SITE ADDRESS: 07300 SW HUNZIKER RD 110 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: ACUITY DESCRIPTION: TI - (10) branch circuits, 5/15/06 ADD: (3) branch circuits; fair ADA restroc;n. OWNER: ROBINSON DEVELOPMENT, PHONE #: CONTRACTOR: A C & E ELECTRIC CO PHONE #: 503- 363 -2301 Inspection Request Scheduled For: Date: 5/19/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 125 Wall cover 070069-01 503-559-9855 Y Corrections /Comments/ Instructions: 1 i N5 `60 1 5 i kbfe 6PNLO'S'Ivn 01\1 J PASS PARTIAL APPROVAL ❑ CANCEL 1 I NO ACCESS n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: v i V kS`6 w Date: 4111A_ 4' ?S % Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: EL C200t3- 00269 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 511212000 Phone: (503) 639 - 4171 Inspection Requests (24 Hrs.): (503) 639 - 4175'! INSPECTION WORKSHEET FOR DATE: 5119(2008 TIME: 7:00AM PAGE: 26 SITE ADDRESS: 07300 SW HUNZIKER RD 1 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: ACUITY DESCRIPTION: 11 (10) branch circuits. 5/1108 ADD: (3) branch circuits for ADA restrooni. OWNER: ROBINSON DEVELOPMENT, PHONE #: CONTRACTOR: A C & E ELECTRIC CO PHONE #: 503-363 -2301 Inspection Request Scheduled For: Date: 6/19/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 130 Ceiling cover 070069-02 503-659 -9866 Corrections /Comments /Instructions: 040Q crr Nc.,c1E la \ 4 id) W.-1‘...b.“ to ce. Fut_ 11 S ()DV �(�.. _ i ( , N ®A PS gliktA ae 66J PASS / PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL n ALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: G r 1 V g Date: U® G Y V Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: Et-C2008.00269 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/12/2008 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5/15/2008 TIME: 7 :00AM PAGE: 53 SITE ADDRESS: 07300 SW HUNZIKER RD 110 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: ACUITY DESCRIPTION: TI - (10) branch circuitP. OWNER: ROBINSON DEVELOPMENT, PHONE #: CONTRACTOR: A C & E ELECTRIC CO PHONE #: 503363 - 2301 Inspection Request Scheduled For: Date: 5/15/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 125 Wall canter 069933.01 503. 559 - 9855 N Y Corrections /Comments /Instructions: i XPASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL n CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED Inspector: OG ; Date: 1, rl. Phone #: (503) 718- -too CITY OF TIGARD ‘ . BUILDING DIVISION PERMIT #: ELC200B OO269 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/i212009 Phone: (503) 639 -4171 I�L . Inspection Requests (24 Hrs.): (503) 639 -4175 s'.:. INSPECTION WORKSHEET FOR DATE: 5/1312008 TIME: 7:02AIVI PAGE: 28 SITE ADDRESS: 07300 SW HUNZIKER RD 110 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: At.nUI TV DESCRIPTION: T1 - (10) branch circuits. OWNER: ROBINSON DEVELOPMENT, PHONE #: CONTRACTOR: A C & E ELECTRIC CO PHONE #: 503- 363.2301 Inspection Request Scheduled For: Date: 6/13/2008 Pour Time: Code # Inspection Description - Confirm- #� Contact # Message 105 Underground/slab cover ( 06976'3.01 503-559-9855 Y Corrections /Comments /Instructions: � / � { gym • PASS n PARTIAL APPROVAL n CANCEL n NO ACCESS n FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 6- ‘6(mL Date: 1 MA Phone #: (503) 718 - )46 =� ' CITY OF TIGAR® ELECTRICAL PERMIT PERMIT #: ELC2008 -00269 COMMUNITY DEVELOPMENT DATE ISSUED: 5/12/2008 T 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 101 D B - 00104 SITE ADDRESS: 07300 SW HUNZIKER RD 110 ZONING: C - P SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: ACUITY Project Description: TI - (10) branch circuits. 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: WISERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 9 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: ROBINSON DEVELOPMENT A C & E ELECTRIC CO PO BOX 91305 3535 DEL WEBB AVE NE #100 PORTLAND, OR 97291 SALEM, OR 97303 Phone: Contact #: PRI 503 - 363 - 2301 FAX 503 - 363 -2302 FEES Description Date Amount Reg #: ELE 24 -1C [ELPRMT] ELC Permit 5/12/2008 $106.70 LIC 591 [TAX] 12% State Surchar 5/12/2008 $12.81 SUP 4702S Total $119.51 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 th- • :0 days. •TTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR : 2- 001 -0010 through • • R 9 -00 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. lss ed By: J � Permittee Signature: K ✓ / �� / �`� 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'N: l l 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. Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Received � . j /� U Permit No.: e� - e0.26 II Date/By: SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit: T 1 G A R D Inspection Line: 503.639 Date Ready /By 3 °r El See Page 2 for Internet: www.tigard or.gov Notified /Method: ( � „. ..(i Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction E Addition /alteration /replacement Please check all that apply (submit 2 sets of plans 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, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 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 JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 "I -3 ", Job no.: Job site address: 7300 Hunziker Rd 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: Tigard, OR ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: 110 Project name: Acuity TI ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. 1 Fee. 1 Total I * New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family Y TI remodel residential (with above sq. ft.) 75.00 I 2 Acuity Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 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 less 66.85 1 Owner installation: This installation is being made on property that I own which is not 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 Owner signature: Date: Branch circuits — new, alteration, or extension, l er panel A. Fee for branch circuits with ❑ APPLICANT 0 CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, I 46.85 46.85 2 first branch circuit Address: Each add'I branch circuit 9 6.65 59.85 2 Miscellaneous (service or feeder not included) ` City /State /ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) • Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: A C & E Electric Signal circuit(s) or limited - energy panel, alteration, or Address: 3535 Del Webb extension. Describe: Page 2 2 City /State /ZIP: Salem, OR 97301 Each additional inspection over allowable in any of the above • Per inspection 62.50 Phone: (503) 363 -2301 Fax: (503) 363 -2302 Investigation per hour (1 hr min) 62.50 CCB Lic.: 591 Electrical Lic.: 24 -IC uprv. Lic.: 4702S Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: 106.70 Print name: Dan Allen Dat : 05/12/08 Plan review (25% of permit fee): State surcharge (12% of permit fee): 12.81 Authorized signature: TOTAL PERMIT FEE: 119.51 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. t \ Building \Permits\ELC- PermitApp.doc 05/23/06 440 46IST(1I/05 /COM/WEB