Permit "` 1 CITY OF TIGARD ELECTRICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELC2009 -00525
•: Date Issued: 10/28/2009
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
, x Parcel: 1 S 135BC01100
Jurisdiction: Tigard
Site address: 11101 SW GREENBURG RD
Subdivision: Lot: 0
Project: Greenburg Building
Project Description: Replace existing service with new. Install (5) 200 amp or less services, (1) 601 -1000 amp service,
and (12) branch circuits.
Owner: FEES
ROBINSON FAMILY TRUST Qua ntity Description Date Amount
PO BOX 91305
PORTLAND, OR 97291 5 ea Services or Feeders - 200 10/07/2009 $503.50
amps or less
PHONE: 1 ea Services or Feeders - 601 to 10/07/2009 $301.04
1000 amps
12 crt Branch Circuits w /Purchase 10/07/2009 $89.04
Contractor: Service or Feeder
AC & E ELECTRIC 1 ea 12% State Surcharge - 10/07/2009 $107.23
3535 DEL WEBB AVE #100 Electrical
SALEM, OR 97303 1 ea Plan Review Electricial 10/07/2009 $223.40
PHONE: 503 - 363 -2301
FAX: 503 - 363 -2302
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $1,224.21
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: g
.� Perm 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' � ` A/ 1 P Date:
LICENSE NO. t '
CaII 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.
AI RECEVE 1 ao 5 i5
Ele Per1nit Application FOR OFFICE USE ONLY
City of Tigard D C T Q 7 200 I Received IN Permit No.: C - 'w `' T..22 Y
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review -
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIGAR 0 liate/By: Other Permit:
Inspection Line: 503.639 + e Read B Juris: El See Page 2 for
T I G A R D
Internet: www.tigard- or.gov BUILDING DIVIS 1 � o ifed/ '1- C-) Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "1 - 3 ",
I00HP or more. occupancy.
Job no.: Job site address: 11101 SW Greenburg Rd ❑Recreational vehicle parks.
❑ Six or more residential units. P
City /State /ZIP: Tigard, OR ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 0 Project name: Greenburg Building El Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Replace existing service with a new service Limited energy, multi family 67.84 2
P g residential (with above sq. ft.) ,
Services or feeders installation, alteration, and/or relocation
200 amps or less 5 100.70 503.50 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 1 301.04 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amp to 400 amps 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICAtNT 0 CONTACT PERSON above service or feeder fee, 12
7.42 89.04 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business Signal circuit(s) or limited -
usiness name: AC &E Electric
energy panel, alteration, or
Address: 3535 Del Webb Ave NE extension. Describe: Page 2 2
City/State /ZIP: Salem, OR 97301 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 363.2301 Fax: (503) 363.2302
Investigation per hour (1 hr min) 66.25
CCB Lic.: 591 Electrical Lic.: 24 -1C Suprv. Lic.: 5387S Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: i ` � _ Subtotal: 893.58
a
Print name: Carl Duncan Date: 10/7/09 Plan review (25% of permit fee): 223.40
State surcharge (12% of permit fee): 107.23
Authorized signature: TOTAL PERMIT FEE: _ 0�<f,.oZ/
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Building\ Permits \ELC- PermitApp.doc 10/01/09 440 -4615T(11/05 /COM/WEB