Permit �1,�� j'lk CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT.1
Permit#: ELC2015 00995
:,. t fis; Date Issued: 12/21/2015
•-nigpi D: 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
it t1Y::
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11131 SW GREENBURG RD
Project: Jump Sky High Subdivision: OAKBURG Lot: 27
Project Description: Add panel and(10)branch circuits for air conditioning
Contractor: A C& E ELECTRIC CO Owner: GREENBURG SPACE CENTER LLC
3535 DEL WEBB AVE NE#100 PO BOX 91305
SALEM, OR 97303 PORTLAND, OR 97291
PHONE: 503-363-2301 PHONE:
FAX: 503-363-2302
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 12/21/2015 $100.70
Specifics: amps or less
10 crt Branch Circuits w/Purchase 12/21/2015 $74.20
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 12/21/2015 $20.99
Electrical
Type of Const:
Occupancy Grp:
Total $195.89 j
Required Items and Reports(Conditions)
This permit is ' -d subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don- ' accordance w 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 .01-0010 throu h OAR 952 I; -.19A You may obtain a copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344
I- ued By: / / / ' fvf Permittee Signature: —�f� —
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' , .,moi �r /i�l Date:/00 -
LICENSE NO. (/G`-r"� /'/
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.
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Electrical Permit A i s li ,,,,..LI -: - ---,.., .--„::, :0 -. :'FOR OFFICEUSE•ONLV, ',...'-g".-':.:'-' .: !..,::,---
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Received
P ''.1:.-,'; City of Tigard
., 7 , Date/B : Zia irM Penni”: ei-6. 0/506 996
.„ ,, .. 13125 SW Hall Blvd.,Tigard,OR,,97223
71
Plan Review
l•. ; . , Phone: 503.718.2439 Fax: 50306a90 1 2015 Date/B : Related Permit#:
:. •
.'4:-; Inspection Line: 503.639.4175 Ready Date/By: Juris: BI See Page 2 for
T!`G1k!:1 Internet: www.tigard-or.govUITY OF 1"IGARF) Notified/Method: Supplemental Information
1$1,4N-Nt8TIEWS :rliff
0 New construction El Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
i 711' lAKtfillr:''Til OATEQ41r914(.00110JsTION - "`-' .--,;: -1,:,;.,: exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling Z Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
El Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
1 1:NiTIVN1.!4:14,0 SOPtisTE:0.14.AlioNA:NlilOcApoN :.:.::.,44:Igi.:,4-411z 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: 11131 SW Greenburg Rd 100HP or more.
City/State/ZIP:Tigard,OR 97223 0 Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: .i;:j-EI,iiiti;:i.".61-41111110i:A11$0.0704-0111r:
Description I Qty. I Each I Total 1 *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 33.92
IIINK-XriiiliZ.AgAf.tl:P:$.0i.t-ZMN''Ot:;'YORK' ,:ti''''''rt''' ' Limited energy,residential
75.00 2
Add Panel and circuits for air conditioning (with above sq.ft.)
Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
D:PROPERTY .„2
'OWNER 0: '''',--'::;'''Ek=TENANT4fril',:•' ,714;,,P, Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1 100.70 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: .
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
litileiliiir 0 APPLICANT ACI: 0.CONTACT PERSON, :-',Z',!::§5! Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 10 74.20
7.422
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:
Reconnect only 67.84 2
IIINSI.'%4 -:.--.:0STIToR ;t - . ;:,,;::. - - .:' - :-;-:-.: Pump or irrigation circle 67.84 2
Business name:AC&E Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:3535 Del Webb Ave NE ste 100 panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:Salem OR 97301
Additional inspection(1 hr mm ) 66.25/hr
Phone:(503)363 2301 Fax:(503)363 2302 Investigation(1 hr mm ) 90.00/hr
Industrial plant(1 hr mm ) 78.18/hr
Email: kenny@acandeelectric.com
Inspections for which no fee is
90.00/hr
CCB Lic.: 591 Electrical Lic: 24-1C Suprv.Lic.: 5391S specifically listed CA hr mm )
Suprv.Electrician signature,required: ............
: ''' ' '''''T''' " 71REIMIlAtatitt4M,I0EESV*14 -AV
Subtotal: 174.90
Print name: Kenny Gates Date: 12-18-15 0 Plan Review Required(25%of permit fee): ..
State surcharge(12%of permit fee): 20.98
Authorized signature: TOTAL PERMIT FEE: 195.88
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK®NLY:. FEE SCHEDULE rx *6-
Description""""' "'""""' ' ' "'"'"""� Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
iti7MMERCIAL W ORK'ONI Y�. =
,ELECTRICALPERMIT FEES' r
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ 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:
*No licenses are required. Licenses are required for all
other installations
I\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 '