Permit CITY OF TIGARD ELECTRICAL PERMIT
is • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00435
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2010
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11131 SW GREENBURG RD
Subdivision: Lot: 0
Project: Jump Sky High
Project Description: Sign lighting.
Owner: FEES
ROBINSON FAMILY TRUST Quantity Description Date Amount
BY E LEE & EVELYN L ROBINSON TRS, PO
BOX 91305 2 ea Sign or Outline Lighting 09/01/2010 $135.68
PHONE: 1 ea 12% State Surcharge - 09/01/2010 $16.28
Electrical
Contractor:
ES & A SIGN & AWNING
89975 PRAIRIE RD
EUGENE, OR 97402
PHONE: 541- 485 -5546
FAX: 541 -485 -5813
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $151.96
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTIO • a - _ • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 t• •ugh OAR 95 10 - -• '0. //
You may obtaina copy of the rules or direct questions to OUNC by calling 503.24 699 or 1.800.332.2344.
0
Issued By: � . , `�`�'"` ` � btin/{ `, Permittee Signature: X
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date: fp r^
LICENSE NO.
Cab 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
From: - 08/20/2010 14:31 #038 P.001/002
•
Electrical Permit Application ® r� %10 FOR O F I I C I LSE O N L Y
City of Tigard Received izzommeem
:� • • 13125 SW Hall Blvd., Tigard, OR 97223 - , Review
Phone: 503.639.4171 Fax: 503.598J960 w' Da Other Permit:
T G A It l Inspection Line: 503.639.4175 Date Ready /By: 0 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: IBM Supplemental Information
'1":, r' '' - h- SY -vat_W . w °. t . G u- tY i 't ' t:
�,:y?�; ^f z � � 'G �i i � '- � �t�. �. �i:^3` a' A"' .J'S ���'�'�' ar �� 'rt�'� ,$' q +'� � e�' a� •.m
x 3f'`._ ees R t __i_ ..,. � .:0.0; _ . 4 l °�_a 1: s,ls, l30; ..'x:., ', fi s . k 'sve...s s..t , f , � 14 k mr;2z e ? `,.
❑ New construction ❑ Addition/alteration /replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
1: molition ❑ Other: where the av ailable fault current 0 and boatyards.
ryw 9 t �� �` a > t ' y ` tp e 10 ,000 amps at 150 volts or ❑ Floating buildings.
(� ,ors; ZAZI r ' � tt aa- �.. ix�. ...? {xtx�v. r sr: .:. ?P . a.
l to g ro t m d , 0r14 ,000 ❑ Commercial -use agricutmrel
❑ 1- and 2- family dwelling is Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 K or
44 tY 4y ? 't t t ,. s ' p , . ti „ .. yr „�� R ❑ Emergency system. larger separately derived system.
fkg -. 9 f s .a,. S s. r) c �, t c t eS (! { s ❑ Addition anew motor load of ❑ "A" " E", " of 7 " I KVA
r� 'a`.a3<.�f._1:.. i_u_.. .v,, a...+., ,e�VrY•v °ekz?��t'tr�s.�s z.. �.�:,.,,..x,.�.4�„ «... .G'��x
Job no.: lob site address: 100HP or more. occupancy.
[- ..,.....s.....- 1.4 ❑ Six or more residential units. ❑ Recreational vehicle parks.
) City /State/ZIP: ... i �' a 7 , .t ❑ Healthcare facilities. ❑ Supply voltage for more than
T t ❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: J Project name: ❑ Service or feeder 600 amps or more.
_
• - -I._ 11. n Cross street/directions lit N iel'. n<t fthWr ;, ,1: e . ' .
eet/directions to job site: ,
/� don r •
New residential single -or multi fa
3 �� {� " -` _� C � dwelling
a kl'L Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
c Tax map /parcel no.: Limited energy, residential
above sq. ft.}
y aax <' g am ? °x SfR "j(with 75.00 2
Fr,+ K ' LI h .,g ,z! ! t Cl T a 1 a.. K �Si ti-b5 t
(with z"1 + i�� ' ' ulx....h ...xmf ..t w�AC "xLrF -' ar�:w 3k� `. Limited energy, multi- family
residential (with above sq. ft.} 75.00 2
Et�G�YICG.` 'Si LLas
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 / 2
O.- 5F,�; { ,va'aat>s11 0 ' �'?x:'t .G •,: (1 { r -m:.P, :vr�r w q
i v" � tr �1 ) e T „ � � } . • ' ' `*-4 t & P r . ii : * ^ • 201 amps to 400 amps 133.56 2
"!;u . :...x �a 2 Llwsr?rs v A,, S , Swt S w.i,»s1rYK 401 amps to 600 amps 200.34 2
N ame: P I Q 4 x 't� TK.+ 601 amps to 1,000 amps 301.04 2
Address: f `G` (-2 c ( 3 s � Over 1,000 amps or volts 552.26 2
City/State/ZIP: ° V e Par 4•( (../.44 r�� Temporary services or feeders installation, alteration, and/or
Phone: (933 5-1 24 co I Fax: (5b p L7 . a t c) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, r or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
>- Owner signature: Date: A. Fee for branch circuits with
r` , ��- •., ,VNI r r . ,,n isy»e.. e t A a a r s I wn xc k above service or feeder fee,
:h .'."c y.4!. .Wi [3 eigN 1 'W.. Iw: _�14i:3t i.aki. #.3 ,4.: :k...v:1 7.42 2
J
xs e . &. each branch circuit
Business name: ( A 5 •� l 0.1'( � qty B. Fee for branch circuits without i
service or feeder fee, first
Contact name: r9 Cr. branch circuit 56.18 2
� ' - " / "` u � Each add'I branch circuit I 7.42 12
7
Address: 8 5 ! ix c ' G 114 t . IQ(, 4 � � (r Miscellaneous (service or feeder not included)
Ci /State/ZIP: / , '° w +✓ c Each manufactured or modular
t3 Z« dwelling, service and/or feeder 67.84 2
* Phone: (szy5 54 -2 �
- o c I Fax :: ' L(2 . -LW s -. Reconnect only 67.84 2
/� Pump or irrigation circle 67.84 2
V J E M -
� el • Sign or outline lighting 67.84 i 6,8' 2
0 + X. ��
;a .;r L _v,. ,t.,., ..,,e. s.'r ..�..Se >..` fl�'Ir.a.- :,r'>€ Si circuits) or limited-energy
Business name: E A ,, \ � n . - / /� - - tion, or
-- 7
Each additional inspection over allowable in any of the above
6 T ' W.{t� �Yi( panel, altera i extension. _ Page 2 2
-v Address: cg t ` C a tau , ` r Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
v City/ State / ZIP: C � , y tt 1 � `7 . L - g ""°i
t 4 i.A4 ( Or 4 l �i Industrial plant (1 hr min) 78.18 / hr
Phone: (5D-5 Fax: (Sty5 St{ S- Inspections for which no fee is 90.00/ hr
ifieall listed % hr min
t, x«� i v t = K
CCB Lic.: Electrical Lic.: / Suprv. Lic.: Zt' 15 r !w/ a..t! ,,�zr, +ter °. � :N�•` n L. rt.
•
fr Subtotal: , i 35 (,
Suprv. Electrician signature, required: Plan review (25% of
permit fee):
Print name: f i e o p Date: i ll i to i o State surcharge (12% of permit fee): % (. 2-E'
.
- 11 r - TOTAL PERMIT FEE: ,• Si r C(
Authorized signature. Y: i / This permit application expires If a permit is not , , talned within 180
day after it has been accepted as complete.
Print name: �j / �� i Date: �' • Number of i nspec ti ons allowed per permit.
I: �iia \Permits 1 ELC P 07//01 440.4615T(11/05 /COM/WEB