Permit .14 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00548
T 1 G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/06/2010
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11131 SW GREENBURG RD
Subdivision: Lot: 0
Project: Jump Sky High
Project Description: Electrical for snack bar.
Owner: FEES
ROBINSON FAMILY TRUST Quantity Description Date Amount
BY E LEE & EVELYN L ROBINSON TRS, PO
BOX 91305 20 crt Branch Circuits 10/06/2010 $197.16
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/06/2010 $23.66
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 $220.82
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 OAR
952 - 001 -0010 through OAR 9 2- 001 -0100. You may f les or direct questions to OUNC by calling 503.246. • 699 or 1.800.332.2344.
Issued By: Permittee Signature: ji■i/ &Li/
OWNER INSTALLATION ONLY 1
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
City of Tigard c
�� Receiv 4.
Q p ale /By l � a) 10 7T i t No.: �� _ g
.
q 13125 SW Hall Blvd., Tigard, OR 972 �/ t Q� Plan Rev r " / •
F° 1. Other Permit yQ ��� l -
III
Phone: 503.639.4171 Fax: 503.598 Date /Bv: V
T I G A R D Inspection Line: 503.639.4175 Ot�� GP Permit
o.te Ready /13y: n ris ® ( See Page 2 for
Internet: www.tigard- or.gov �(l;�� /Method: ( Supplemental Information
TYPE OF WORK ® �t t e' PLAN REVIEW
❑ New construction ® Addition /alteration /repl +`� Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current El Demolition El Other: "� ❑ 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. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of
Job no.: Job site address: 11131 SW Greenburg Rd IOOHP 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.: 0 Project name: Jump Sky Hi ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. 11. or less 168.54 4
Tax map/parcel tto . Ea. add'I 500 sq. ft. or portion 33.92 I
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. 0.)
New circuits for snack bar Limited energy. multi- family 67 84 2
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
ldress: Over 1.000 amps or volts 552.26 2
City /State /ZII': Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 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
Owner signature: Dale: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee.
7.42 7
each branch circuit
lusiness name: B. Fee for branch circuits
without service or feeder fee. 1 56 18 56.18 2
Contact name: first branch circuit
Address: Each add'l branch circuit 19 7.42 140.98 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
67.84 2
dwelling. service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: AC &E Electric Signal circuit(s) or limited -
energy panel. alteration. or
Address: 3535 Del Webb Ave NE extension. Describe: Page 2 2
City /State /ZIP: Salem, OR 97301 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 363.2301 x: (5 ) 363.2302
Investigation per hour (I hr min) 66.25
CC13 Lic.: 591 Electrical Lic.: 4- C Suprv. Lic.: 5387S Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
"uprv. Electrician signature. re 631376 Subtotal: 197.16
1 --4-'0 0 " -----
. rint name: Carl Duncan Date: 09/29/2010 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 23.66
Authorized signature: TOTAL PERMIT FEE: 220.82
Print name: 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 \ Permit s \ELC- PermitApp doc 10 /01/09 440-401 5T(1 I /05 /CO 1 /WF.B