Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2011 -00120
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/03/2011
Parcel: 2S101 DB00100
Jurisdiction: Tigard
Site address: 7320 SW HUNZIKER RD 200
Project: Angel Vision Subdivision: Lot: 0
Project Description: Electrical for TI.
Contractor: AC & E ELECTRIC Owner: ROBINSON FAMILY TRUST
3535 DEL WEBB AVE #100 21360 NW AMBERWOOD DR
SALEM, OR 97303 HILLSBORO, OR 97124
PHONE: 503 - 363 -2301
PHONE: 503 - 645 -8531
FAX: 503 - 363 -2302
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 03/03/2011 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/03/2011 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
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 R
952- 001 -0010 through OA 2- 001 -0090. Yo may-ff8tam a co•• • • - rul iree4questions to OUNC by calling 503.232.1987 or 1.800.332. .
Issued By: _ — _ •ermittee 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 the next available inspection date.
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 ' Receid ) /1) Permit No.:
13 [25 SW Hall Blvd., Tigard, OR 97223 P r ,.,..AC) ) - / /_ Ck) l
t g e �• 1C Plan Review/ 4/ i `
C Other Permit ` Ar -
Phone: 503.7181439 Fax: 503.598.196 � `�, an I_
Inspection Line: 503.639.4175 \` O Date Ready/By: Icris: ® See Page 2 for
TIGARD ,A Notified/Method: Su
Internet: www.tigard- or.gov ( a` ``\ O *\ th Supplemental Information
� .
TYPE - 6OF , . 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 stones.
❑ 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. 0 Installation of 75 KVA or
SITE INFORMATION LOCATION: ❑Emergency system. larger separately derived system.
S - ' . JOB SIEINFOR
. - ... .... ` . - ❑ Addition of new motor load of ❑ "A ", "E", "1 - 2 ", "l - 3"
Job no.: Job site address: 7320 Hunziker Rd 10BHP or more. Occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard Or ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 200 Project name: Angel Vision ❑ Service or feeder 600 amps or more.
FEE :SCHEDULE
Cross street/directions to job site: Description I QIy. I Fee. I Total I •
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 t
Limited energy, residential
2
_ I " DESCRIPTION OF WORK _. _ (with above sq. ft) 75.00
a6
Limited energy, multi - family 75.00 2
Remodel 7 &1>!�� cC f •� f r residential (with above sq. ft.)
�� Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 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
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 ,vith
APPLICANT = I. ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each brunch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 .
Contact name: branch circuit
Each add'I branch circuit 9 7.42 66.78 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: / Stale/ZIP' Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: 67 84
COiVLRACTOIt- . -
Sign or outline lighting
Siena' circuit(s) or limited-energy
Business name: AC &E Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 3535 Del Webb Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Salem OR Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 363 - 2301 F : (50 363 - 2302 Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lie.: 591 Electrical Lie.: -1C Suprv. Lie.: 5387S ELECTRICAL PERMIT - -
Suprv. Electrician signature, required: Subtotal: 122.96
/ _ _ Plan review (25% of permit fee):
Print name: Carl Duncan �tr J._ Date: 3/4/2011 State surcharge (12% of permit fee): 14.76
TOTAL PERMIT FEE: 137.72
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er o inspections allowed per permit.
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