Permit 1q CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00388
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/11/2007
PARCEL: 1 S 134AA -02100
SITE ADDRESS: 10340 SW NIMBUS AVE NB ZONING: I -P
SUBDIVISION: SCHOLLS BUSINESS CENTER LOT: JURISDICTION: TIG
PROJECT: MCKESSON
Project Description: Low voltage for Burglar Alarm.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: BURG ALARM X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
ROBINSON, CONSTANCE A + PROTECTION ONE ALARM MONITORIN
ROBINSON, LYNN + BELL, KAY ET 15500 SW 72ND AVE
BY INSIGNIA COMMERCIAL GROUP PORTLAND, OR 97224
BEAVERTON, OR 97008
Phone: Contact #: PRI 503- 624 -0244
FAX 503- 443 -2927
Reg #: ELE 34- 428CLE
FEES LIC 116325
Description Date Amount
[ELPRMT] ELR Permit 10/11/2007 $75.00
[TAX] 8% State Surcha 10/11/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questi ns to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: C�G� �� Permiftee 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'N: 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.
• • • , Gam N i - f F n �N p , "
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Electrical Permit Application i O OFFICE ON LY a � . ., 4,
t cr y "'t'�: R
14 C i t y o f Ti Date/By: ) Permit N o
, n o y:10•r i t� �a�7— 3g•
5 13125 SW H Blvd T i ga rd , O R 97223 Plan Review
l ' + Phone: 503.639.4171 Fax: 503.598.196Q ;:,, Other Permit:
> "' ` Inspection Line: 503.639.4175 L l r .( _ Date /By:
2001 Date Ready /By: Juris: ® See Page 2 for
T IG ARD;
:u- Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
.TYPE OTA, \G DIVISION 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 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
❑ 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 71008785 Job site address: 10340 SW NIMBUS AVE IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: PORTLAND, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: N -B Project name: MCKESSON ❑ Service or feeder 600 amps or more.
FEE SCHEDULE ':
Cross street/directions to job site: Description I Qt I Fee. I Total 1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
' DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
BURGLAR ALARM INSTALL Limited energy, multi- family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 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 1 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
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
.' ❑ APPLICANT ❑ CONTACT PERSON ' above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6 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
" CONTRACTOR Sign or outline lighting 53.40 2
Signal panel, or limited
Business name: PROTECTION ONE
energy panel, alteration, or
Address: 15500 SW 72 AVE STE 100 extension. Describe: 1 Page 2 75 2
City /State/ZIP: PORTLAND, OR 97224 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 624 -0244 Fax: (866) 223 -9925 Investigation per hour (1 hr min) 62.50
CCB Lic.: 116325 Electrical Lic.: 34 -428CL Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 75.00
Print name: Date: Plan review (25% of permit fee):
. State surcharge (8% of permit fee): 6.00
Authorized signature: `P TOTAL PERMIT FEE: 81.00
111 This permit application expires if a permit is not obtained within 180
Print name: NICOLE ROG RS Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Pennits\E1.C- PennitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB