Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00386
T I G A tb 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/28/2010
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11131 SW GREENBURG RD
Subdivision: Lot: 0
Project: Jump Sky High
Project Description: Electrical for TI.
Owner: FEES
ROBINSON FAMILY TRUST Quantity Description Date Amount
BY E LEE & EVELYN L ROBINSON TRS, PO
BOX 91305 2 ea Services or Feeders - 200 07/28/2010 $201.40
amps or less
PHONE: 48 crt Branch Circuits w /Purchase 07/28/2010 $356.16
Service or Feeder
1 ea 12% State Surcharge - 07/28/2010 $66.91
Contractor: Electrical
AC & E ELECTRIC
3535 DEL WEBB AVE #100
SALEM, OR 97303
PHONE: 503 - 363 -2301
FAX: 503 - 363 -2302
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $624.47
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 ma o... - .. igki . or direct questions to OUNC by calling 503.246.6r •9 or 1.800.332.23 4.
Issued B �_ /. C�L_ _ Perm ittee Signature:
..41100111P 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.
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.
Electrical Permit Application
City Ci}� of Tigard R eceived
11111 7 6- Permit No.: y , ) `0 ` �'3 gj
` :J � / 7, LCv l �
13125 SW W Hall Blvd., Tigard, OR 97223 Date/B Plan Review
. Phone: 503.639.4171 Fax: 503.598._1. \ .. Date/By: Other Permit: � 014 ?,90 I U —K) LS 5
T 1 G A R D Inspection Line: 503.639 1 � r; ' rLQ�O Date Ready /By: � ® S Page 2 for
Internet: www.tigard or.gov Notified /Method: 7 . ' Supplemental lnformation
`\ f�
,TYPE OF WORK �rc �a PLAN REVIEW
New construction Addition /alteration /re \9 Please check all that apply (submit 2 sets of plans w /items checked below):
El p� ° �� ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑ ,
Other: p, ti�� 1 � where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUI�P N exceeds 10,000 amps at 150 volts or 0 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 ", "1 - ", "I - ",
Job no.: Job site address: ///3/ 5W ��¢,flfubt,. Six rm more occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ID Health -care facilities. ❑ Supply voltage for more than
/,Ritef � 12 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: 0- wr►t S IC [
// / /4/,l ❑ Service or feeder 600 amps or more.
,, / FEE SCHEDULE
Cross street/directions to job site: �JJ Description I Qty. 1 Fee. 1 Total I
New residential single- or multi - family dwelling unit.
_ _ __ _ Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: '
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
-7--- residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 20 /. yb 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 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
y relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, y8
7.42 ,b . /L, 2
each branch circuit C
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 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 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: ,�/ panel, alteration, or extension. Page 2 2
� � e���xe,
e. Each additional inspection over allowable in any of the above
Address: a ,> 3 D / )�./ / Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: ( C f /t/Ctj Investigation (1 hr min) 66.25/ hr
g' /6
/ 7 02 9 7 L 30! Industrial plant (1 hr min) 78.18/ hr
Phone: I Inspections for which no fee is
c5 > 3 - aa� / Fax: (so3) — 90.00 / hr
specifically listed (% hr min)
CCB Lic.: — .. Electrical Lic.: , _ C Suprv. Lic.: j /J ELECTRICAL PERMIT FEES •
Suprv. Electrician sign. ure, required: / ( 7 t /I 7/1 11 . Subtotal: . h(
A - - Plan review (25% of permit fee):
Print name: Date: 7� Sao /o State surcharge (12% of permit fee): Lk, , 9
(�'Q / z TOTAL PERMIT FEE:
Authorized signature:
i 7
This permit application expires if a permit is not obtained wi hin 1 0
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
I: \Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T( I 1 /05 /COM/WEB