Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
0 • COMMUNITY DEVELOPMENT Permit #: ELR2010 -00186
T l G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/15/2010
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11131 SW GREENBURG RD
Subdivision: Lot: 0
Project: Jump Sky High
Project Description: Low voltage for phone only, no data.
FEES
Owner:
ROBINSON FAMILY TRUST Description Date Amount
BY E LEE & EVELYN L ROBINSON TRS, PO Restricted Energy Permit 09/15/2010 $75.00
BOX 91305 12% State Surcharge - Electrical 09/15/2010 $9.00
PHONE:
Contractor:
SAFE TECHNOLOGY GROUP INC
6400 NE HWY 99 SUITE 375
VANCOUVER, WA 98665
PHONE: 360 - 699 -2130
FAX: 360- 719 -1527
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: Y Fire Alarm: N
HVAC: N 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 a • • - > . .. •proved 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. A TION: Oregon la • ir= you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 $010 through OAR 952-01 0100. • .2
y obtain a copy of the rules or direct questions to OUNC by calling • .246.6699 or 1.800. 44.
Iss ed By: _ _ . � 1' � L ' 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' 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 Re and ReC`i "`d `I® o Permit No.: C o4Q ' - O C,/
,',
. q 13125 SW Hall Blvd., Tigard. OR 97223 Plan e / Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/Et : Outer Permit:
Inspection Line: 503.639.4175 Date Ready/By: Jurb: M See Page 2 for
T 1 GAR D Notified/Method: Supplemental Information Internet: www.tigard- or.gov pp
TYPE OF WORK PLAN REVIEW
❑ New construction OAddition/alteration /replacement Please check all that apply (submit rn
sets of plans wlites 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
❑ I - and 2- family dwelling ia 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: IOOHP or more. occupancy.
l / 131 . 5 u G�eil ��rs ❑ Six or more residential units. ❑ Recreational vehicle parks.
❑ Health -care facilities. ❑ Supply voltage for more than
City/State/ZIP: •/ iA ,d o R 9 7,22 3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Tom.! to sky 4-1 i! �/ ❑ Service or feeder 600 amps or more.
`r"� FEE SCEUEDULE
Cross street/directions to job site: Description 1 Qty. I 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
Ea. add'/ 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy. residential
DESCRIPTION OF WORK (with above sq. 11.1 75.00 2
Limited energy, multi - family
J a t ce / P>4o Qt- C L`/ residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 1 0 TENANT 201 amps to 4410 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 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 aoo 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
Branch circuits - new, alteration, or extension, ter panel
Owner signature: Date: A. Fee for branch circuits with
{APPLICANT 1 0 CONTACT PERSON above s or feeder fee.
7.42 2
each branch circuit
Business name: � TP Tedi az ' 0 Vt't3tA {J' n t _i , B. Fee for branch circuits without
*Y'F service or feeder fee, first 56.18 2
Contact name: 0 � S� J branch circuit
Each add'I branch circuit 7.42 1 2
Address: 6(104> NE /41.4fry e19 5 16, 6 375- Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
/� 67.84 2
lit /t (t)(,f (�f( A �r $ 4.)-4.) dwelling, service and/or feeder
Phone: ( Reconnect only 67.84 2
3Gb) tyG - a 3 0 ( - 7 /� - !,5-" 7 Pump or irrigation circle 67.84 2
E -mail:
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited- energy
Business name: '^ r> -75 2
panel, alteration, or extension. 1 Page 2
� G �e I Cl 11 n n l o y h U� lrlG Each additional inspection over allowable in any of the above
Address: 6g L./00 L./00 A /e lfr � e Q s 44; ( / 5. °7 S' Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State/ZIP: 1j a EA tir_r I) 6 g � S-
Industrial plant (1 hr min) 78.18/ hr
Phone: ( F 1 ^) Inspections for which no fee is
Gf� (� ` - °� 3 0 ax: r'1� 7��/ �S/ ! specifically l ( %hr min) 90.00 / hr
CCB Lic.: /737 3 4 I Electrical Lic.: GG•E' 7 c Suprv. Lic.: y.27;444� ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: , Plan review (25 %ofpermit fl e): 7
Asa 5-w e
Print name: Date g - iy -/ State surcharge (12 %ofpermit fee): 9, 4,0
Authorized signature: TOTAL PERMIT FEE: �, CO
� ,) / This permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete.
Print name:
3- A ,A , r Date: .9 - (0 • Number of inspections allowed per permit.
LtauildinglPermiu \ELC•PrnnitApp.dot 07/01/10 440. 46157(11 /05 /COMJWE8
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ I-Ieating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
'4 Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1 ,
*No licenses are required. Licenses are required
for all other installations
P.1Building∎PvmitALLC -Pe mitApp.dnc 07/01/10