Permit I •
r , : CITY OF TIGARD ELECTRICAL PERMIT
y s ,
t • :> COMMUNITY DEVELOPMENT Permit #: ELC2009-00352
13125 SW Hall Blvd. Tigard OR 97223 503.639.4171 Date Issued: 07/20/2009
' Parcel: 1S135BC01100
Jurisdiction: Tigard
Site address: 11101 SW GREENBURG RD
Subdivision: Lot: 0
Project: Greenburg Building
Project Description: Retrofit lighting for energy credit. Job No. 595
Owner: FEES
ROBINSON FAMILY TRUST Quantity Description Date Amount
BY E LEE & EVELYN L ROBINSON TRS, PO
BOX 91305 25 crt Branch Circuits 07/20/2009 $206.45
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/20/2009 $24.77
Electrical
Contractor:
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 $231.22
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 acc ce_ iv ith 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. ATT TION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 through OAR 952 -0 1 . You may obtain a copy of the rules or direct questions to OUNC by calling 5 or 1.800.332.2344.
Issued • Permittee Signature: It .i��.t�(�
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: /�� U
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.
Elea rical Permit Application ��) ,2 FOR OFFICE USE O •
1111 y City of Tigard Received d r pe 6� Permit No.: �'^�' Q J9— `(73��
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit: •
TIGARD Inspection Line: 503.639.4175 Date Ready/By: lull / RI See Page 2 for
Internet: www.tigard- or.gov Notified/Method: (t1, Supplemental Information
,.W:, #..N2 •:.- ...� TYPE OF;W i - .r. PLAN,RE,
�
1=1 New construction ®Addition /alteration /Ceplaet Addition/alteration/replacement Please check all that apply (submit 2 sets of plansw /items checked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El O ther: where the available fault current ❑ Marinas and boatyards
;�,' �`-�° ;7 = �, ' F` F
CATEGORY OF' €O STRiJ I -, ": ` :; exceeds 10,000 amps at 150 volts or Floating buildings.
:
'` °`` ' TON >t;:,`• e . u-
less t ground, or exceeds 14 0 0 Commercial-use g
'° " "` "- ess o grou 0 ❑ agricultural
❑ I- 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
P "," ,r ;`} ;: , : '.i l . ,. , . ,•,.' "•" " r;.•;.,",., ° >, ,° , ,- aN. . , : ,, ,.::i y. ;i El Emergency system. larger separately derived system.
- ,: �W • .TOB SITE; INFORMATION"A? D: LOCATIOIS`�a IN °
Fti.a, � z �,, -:� a "� >,,� °_ � - ... °. ,. � .,E .,�� . dw o ^� . �:� F _..xy 0 Addition of new motor load o - - ,
I OOHP or more. occupancy.
Job no.: Job site address: 11101 SW Greenburg Rd
❑ 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.: Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: s,r � � � e .,aa ^ .
,l Y Description � Qty. � Fee. I Total
New residential single- or multi - family dwelling unit.
', Includes attached garage.
i Subdivision: 7 I Lot riot: I 1,000 sq. ft. or less 1 145.15. _ _ _ __ 4
Tax map /parcel no.: / / ✓ 6 loo l Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
, . t , s , >, z.. V- . s e `, „ ' , '. . , < ", ` .. °. w ith above s . ft.
�;�� >�.� .,,. . .. .� �.. . . .. � ��.
' vA DESGRIPION�OF`°'WORK .. ; • °,� �,,,,�....,.,...�? ( q )
Ener credit li htin retrofit Limited energy, multi - family 75.00 2 •
gy g g residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less '80.30 2
OPE OW r :• ® . w.1, _ 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
: ' 0 ®; °AE IC1SI " l above service or feeder fee
6 65 2
..,GONT9CT'.PERSQN =3,>;,: ,:
-a .� - -,�„ F � � �
,,,: each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 1 46.85 46.85 2
Contact name: first branch circuit
Address: Each add'l branch circuit 24 6.65 159.60 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
- W u mss..
,g' - ' ;iia4 " " ,:, Sign outline lighting ,, COl\TRA�T.t>RR °,�. � �<. � = °, " g g g 53.40 2
. 0 ..�, ,.,,. Kti� ... . "4 °. .. . :��oLc•:� °, :ak .. -,c.
Signal circuit(s) or limited -
Business name: AC &E Electric energy panel, alteration, or
Address: 3535 Del Webb extension. Describe: Page 2 2
City/State /ZIP: Salem, OR 97301 Each additional inspection over allowable in any of the above
Phone: (503) 363.2301 Fax: (503) 363.2302 Per inspection 62.50
Investigation per hour (1 hr min) 62.50
CCB Lie.: 591 Electrical Lie.: 2 1C Suprv. Lie.: 5387S Industrial plant per hour ,73.75
, 4' . tea- ER_ _MIT EES:e <
� °' "E?=i�� =:P F ,,,� - '�
Suprv. Electrician signature, required:
Ai s�� �` _ Subtotal: 206.45
Print name: Carl Duncan Date: July 17, 200 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 24.77
Authorized signature: TOTAL PERMIT FEE: 231.22
Print Warne: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp doe 05/23/06 440- 4615T(t I /05 /COM/WEB