Permit ,q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN COMMUNITY DEVELOPMENT Permit #: ELR2010 00157
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2010
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11131 SW GREENBURG RD
Subdivision: Lot: 0
Project: Jump Sky High
Project Description: Thermostat
FEES
Owner:
ROBINSON FAMILY TRUST Description Date Amount
BY E LEE & EVELYN L ROBINSON TRS, PO Restricted Energy Permit 08/18/2010 $75.00
BOX 91305 12% State Surcharge - Electrical 08/18/2010 $9.00
PHONE:
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062
PHONE: 503 - 692 -1565
FAX: 503- 691 -1879
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 • 2- 001 -0100. Y. •. - obtain a copy o .: _ ._les or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B � �� Permittee Signature: 7 °..-
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 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 ti }FFItca l(Fta11% . ; 4 9 1 .- -" —. ,ye ma) eii el F
CIS of T! 4 . :� ` \ « �.. a Received _ ��� n J 7
Plan Review
Y gird `� .; 4 Z 10 Date/By: er / .. P e rm it No.: Q'A
'E 13125 SW Hall Blvd., Tigard, OR 9 h i 1G O O/ V r` sQ O/ "'
�' Phone: 503.639.4171 Fax: 503.598.196 Date/By: Other Perm
lre�d /O ,0391
Inspection Line: 503.639 -4175 TS Date Ready/By: luris: 0 See Page 2 for
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Internet: n a /
ern t www.ligard-or.gov �^y �j 0
gard-or gov � t! ! d Nottfied/Metlwd 0 , /� 1 Supplemental Information
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.� . ,.:..... s3• ___ a�ri� �?�'x:L..,•x <Z. t. >.;. ,. ..� - :.F� o. ,., r :tea a�,2%y4 2`x, r�?, � :�� [£c � ra�k.fC k t� y '�';��T..r�. :2 - :{ , �� .'.r. � .,.,� sRwi.��.ui7V e..'.-�S. �T'�x ,n� ?ty:
I ❑ New construction M Addition /alteration/replacement Please check all that apply (submit 2 ses of plans wlitemz checked below)_
❑ Demolition ❑[Idler: ❑ Service or feeder 400 amps or more ❑ I3ulding over three stories.
i - x w} x 5 T where the available fault current ❑ Marinas and boatyards.
f y .: 4 4 tY r ,Z: al alit N Rlf 11Ojy V V ,;,,. i y cg - '& exceeds 10,000 amps at 150 volts or ❑ Floating buildings
,,',. .- _ less to N`^'n• nd, or exceeds 14,000 ❑ Com mercial-use amicuhtYal
❑ 1- and 2- family dwelling L4 Commercial/industrial ❑ Accessory building amps for all other installations. buildings
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or
rr - �,� , 1 z� '&" - - �, -�- r- > +.� 4 u s- 4 ❑ Emergency system. larger separately derived syste;
.v. y _ <{ r ,"' s r € �r �Y 7 �t3 4iViri5- c �B s
nn, • �, r,, ;� `' ❑ Addition of new motor load of
,, „+ , . _ o_ ,. -..a. . n ❑ °A ", "E "I -2 "i -3 ".
Job no.- 3saq , Job site address.. 11101 100HP or more. occupancy. ,
Sew/ GtCetT,�t Bvie ❑Six or more residential units. ❑ Recreational vehicle parks.
City/Staie/ZIP: ❑ Health -care facilities. ❑ Supply voltage for mire than
TIA/♦L,Md b �17Z23 ❑ Hazardous locations. 600 volts nominal.
. no.: �
Suite/bldg./apt. /apt Project name: ❑ Service or feeder 600 amps or more
° 3uM.1- 51C�/ a u..
".a: co'''lt- r y .',� van �-K s. z:
site: Description sheet/directions to job ite: ' ` :'F k a f Qty. > � ' `. y .F I Feee t ,.
Fee- - l j Tors! 1
New residential single- or milts- family dwelling writ.
Includes attached garage.
Subdivision: [ Lot no.: 1,000 sq. ft. or less 168.54 4
t Ea. add'1•500 sq: ft. or portion 33.92 1
Tax map/parcel no
Limited energy, residential
67.84
t � ��� rSC S i !'.-r Q Mt gt's` a x' � s � , (with above sq. ft -) 2
.._ it
-`� Limited energy, multi- family
t " �Nb �vT/g 3 residential (with above sq. ft.) 67.84 2
- Services or feeders installation; alteration, arid/or relocation
200 amps or less 100.70 2
Ig a.baittOW p , VW*�a� �:�� v� = ���,� x` �, 201 amps to 400 amps 133.56 2
Name: . 401 amps to 600 amps 20034 2
Ttr.ti. p S Icy 014 601 amps to 1,000 amps 301.04 2
Address: in O/ S u/ (t A ffirAt $ R,d Over 1,000 amps or volts 55226 2_
City/State/ZIP: TlnJ 1 7 2.2.3 Temporary services -or feeders installation, alteration and/or
relocation
Phone: ( ) . Fax: ( ) 200 amps or less I 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 arnyn 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, d er panel _
Owner signature: Date: A. Fee for branch circuits with
R kikit } `, ' '' .::� M oW s 7 fi a serv or fe fe e, 7.42
_< : 2
each branch circuit
Business name: A!em /4"..lirGOAM.i B. Fee:for branch circuits
t� F but service or feeder fee,
Contact name Kre V t N Kt „2 a 1 6 IC I : fi#sf branch circuit 56.18 2
Address ; p , E add'l brand .ci(vuit 7.42 2
10 33 'v TUA ��t .�Q us (service or. feeder not included) .
•City/StateiZIP: To w A J t, . Each Manufact or nodular
p 97b� Z 67.84 2
( 9 3 ) Z l615s I Fax: (6) 4 J dwelling, service and/or feeder
Phone: 9 �8 7� .12ewMect only 67.84 2
E -mail: . Pump or irrigation circle . 67.84 2
R ' ,, n ' e../. iii _- : , Sign or outline lighting 67.84 2
Business name: ,pt �0 W t , 6,14410,4, & Gd , / energy circuit(s) ela e rIi on, or
d ' ( energy panel, alteration, or
Address: 10330 5.04 1 V A IATh[ /Gd
extension. Describe: I Page 2 2
-City/State/ZIP: Each additional inspection over allowable in an
ry Tu A ittal.4 b+R 19062 ,nspe i y of the above
Per inspection 56.25
Phone:
6 ' 0 3 ) 6q 2 — ! ( L 5 . Fax: ( 503) L4 I - / 8 79 Investigation per hour (1 hr ruin) 66.25
CCB Lic.: 6143 1 Electrical Lic.: 34..f L I ry Lic.: y3 D Leg
Iadustriai plant per hour
• _
Suprv. Electrician signature, required: �� l,�vl ( _ /a �' ' I y � ^
Subtotal: i r
' Plan review (25% of permit fee):
Punt name: R 08 6,tx' �• LA Sqa Date: ur 9
•
State surcharge (12% of permit fee):
Authorized signature_ 9 TOTAL PERMIT FEE: d t'
/�/ _
� This permit application expires ifs permit is nat obtain within 180
Print name: v eggie. L, _� et I Date: days after it has been accepted ascomplete '� a/ / /