Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a • COMMUNITY DEVELOPMENT Permit #: ELR2010 -00183
T i C AR O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2010
Parcel: 1S134AA01800
Jurisdiction: Tigard
Site address: 10260 SW NIMBUS AVE M8
Subdivision: SCROLLS BUSINESS CENTER Lot: 0
Project: KG Investments
Project Description: HVAC system.
Owner:
FEES
ROBINSON, CONSTANCE A & Description Date Amount
ROBINSON, LYNN ET AL, BY KG INVESTMENT Restricted Energy Permit 09/30/2010 $75.00
MGMT, 10240 SW NIMBUS AVE #L3 12% State Surcharge - Electrical 09/30/2010 $9.00
PHONE:
Contractor:
REITMEIER MECHANICAL
19570 SW 90TH CT
TUALATIN, OR 97062
PHONE: 503 -603 -0205
FAX: 503 - 603 -0150
Type of Use: SF
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This pe .•' is issued subje o the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be • • e in accordance with ap• •ved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
da s. ATTENTION: Oregon law =qt, es •u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9.2- 001 -0010 through OAR 952 -• 3100. ' 3 ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800. 2.2344.
i ���
sued By: — �_ / Permittee Signature . / LI J� �!
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 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.
• RECEIV ..
Electrical Permit Application FO12 OFFICE USE ONLY
City of Tigard S E P 1 4 2010 Received
UPI 9 /4 Permit No.: Q�� Ig 3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Ill Phone: 503.639.4171 Fax: 503.598.1960CITY OF TIGARD 1iw/° : Other Permit:
Inspection Line: 503.639.4175 Da te Ready/By: Iuris: 0 See Page 2 for
. I -1 G A R D BUILDING DIVISIO Notified /Method: Supplemental Information
Internet: www.tigard -or.gov
TYPE OF WORK PLAN REVIEW
❑ New construction Tel 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 0 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" "l -3"
(� 100HP or more. occupancy.
Job no.: Job site address:
60 s _) � V 1 M b 4 i1v , ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: r2 r 0 223 ❑ Health -care facilities. ❑ Supply voltage for more than
I 1 7 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: M _ S Project name: k 6 T 4.- J- e 4 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Desatpdon 1 Qty. 1 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'l 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
L OW VO If t rah - FM 1 (,t)1 Ir I h residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
.®, PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: k 401 amps to 600 amps 200.34 2
7 -rwet S yne. 601 amps to 1,000 amps 301.04 2
Address: 10 24O 3(A) NIwtbtn, s ke, Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: ) Of / 7 223 relocation
Phone: (5,3 ) Si _ c(Qy(j Fax: ( 3) 5� a Z
200 amps or less 59.36 1
q 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 with
El APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
, II-- each branch circuit
Business name: 12 e. 1-
rneIPM "tCC/ta hl I B. servicebrmfeederfee, ft w i thout
Contact name: /�j� branch circuit 56.18 2
`f" Each add'l branch circuit 7.42 2
Address: 1q 570 5W 9,04 (4 Miscellaneous (service or feeder not included)
I Each manufactured or modular
City/State/ZIP: ty TUa_ la - q7r im 0R - 1 dwelling, service and/or feeder 67.84 2
Phone: (503) 6 20 .5 Fax:: (So,) 3 — C7 / .SC7 Reconnect only 67.84 2
�3 Pump or irrigation circle 67.84 2
E- mail:o ✓,,F. 15 0-req. B- (Cr- iner.i a vt t ca_) 9 ftal -', Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: `1 panel, alteration, or extension. - Page 2 2
� P 1 I kne_iP %,e AP. C Iyx In i C et Each additional inspection over allowable in any of the above
Address: ) c5 70 L5(,) ck -.t-1_ C r i Additional inspection (1 hr min) 66.25/ hr
� [ Investigation (1 hr min) 66.25/ hr
City/State/ZIP:
1/00. to 1 , h OR- 170 6 2 Industrial plant (1 hr min) 78.18/ hr
Phone: (503 ) , _ 02_0 5 Fax: (503 ) 603 — his U Inspections for which no fee is 90.00/ hr
specifically listed (' /: hr min)
CCB Lic.:15377p Electrical Lic.:3L1 -6 Suprv. Lic.:11 �/ / ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 7 /A d to ro // / Subtotal:
Plan review (25% of permit fee):
Print name: Je (T Date: State surcharge (12% of permit fee):
,fir Je�Se TOTAL PERMIT FEE:
Authorized signature: This
permit application expires if a permit is not obtained within 180
�{ days after it has been accepted as complete.
Print name: /kit A t.jj ny. 1,-5 Date: q /7// • Number of inspections allowed per permit.
r:l Building \Pewits \ELC- PermitApp.doc 07/01/10 440-46 15T( 11 /05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
❑ Other.
.COMMERCIAL WORK ONLY: -
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
jgz 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
,:\ Building \Pcmits\ELC - PermitApp.doc 07/01/10