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Permit
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2010 -00205 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/05/2010 Parcel: 1 S 134AA02100 Jurisdiction: Tigard Site address: 10340 SW NIMBUS AVE NB Subdivision: Lot: 0 Project: MCKESSON Project Description: Security system. FEES Owner: ROBINSON, CONSTANCE A & Description Date Amount ROBINSON, LYNN ET AL, BY KG INVESTMENT Restricted Energy Permit 10/05/2010 $75.00 MGMT, 10240 SW NIMBUS AVE #L3 12% State Surcharge - Electrical 10/05/2010 $9.00 PHONE: Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS INC 15495 SW SEQUOIA PKWY STE 100 PHONE: 503 - 968 -3353 FAX: 503 - 968 -3398 Type of Use: COM 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: N 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: Y Other: N Other Desc: 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 952 - 001 -0100. You ma obtain aes or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: /rd' — Permittee 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' 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 i i, \ I A) R eceived Fcl R OFFICE 1 J S E ()NIA' City of Tigard ��Cj DateB : t 0 © . Permit No.: EL P — ` / — . (.'� $ a III q 13125 SW Hall Blvd., Tigard, OR 9721 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 b 2 d Date/By: Other Permit: r Date Ready/By: Juris: VI See Page 2 for Fit, Inspection Line: 503.639.4175 Al Ar1 P ()., Internet: www.tigard or.gov T1 P 1w Notified/Method: -.mil Supplemental Information TYPE OF WORICA • - G �,vlsl� PLAN REVIEW ❑ New construction gi,Addition/alteratiO dcement 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 ", "l -2 ", "I -3 ", Job no.: Job site address: w N I 0 s * 11 `` 1.AA U.S I00HP or more. occupancy. ❑ V ❑Six or more residential units. Recreational vehicle parks. City/State /ZIP: /� ❑ Health -care facilities. ❑ Supply voltage for more than �-C� � 1� ❑Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: i v_6 Project name: ❑ Service or feeder 600 amps or more. l FEE SCHEDULE Cross street/directions to job site: ML ,N'e S te^" . , ' Description 1 Qtr. I Fee. 1 Total I • , j v New residential single - or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75,00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 ( S ,, e- 0 �. 14(4-0.4A. s, 4 � a_ Ac residential (with above sq. ft.) �'" d 7 �� Services or feeders installation, alteration, and/or relocation Mulct O 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: �t . k p�Oti 601 amps to 1,000 amps 301.04 2 Address: {/ catlo S CA./ IQ t....4 to ( Over 1,000 amps or volts 552.26 2 d Temporary services or feeders installation, alteration, and/or City/State /ZIP: P �,�� 01`— relocation Phone: 0.01— ) 7S3 _ <6 -7 S y Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: 5 k i CSS B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: S ,Le",,z._ Moveytoucc, branch circuit Each add'l branch circuit 7.42 2 Address: t 5 4/9 5' S w 5 .e f vo,,,ti ?v,, i f- (00 Miscellaneous (service or feeder not included) City/State/ZIP: I ov'� (ce t - Q Each manufactured or modular 67.84 2 tY Z y dwelling, service and/or feeder Phone: (03 ) ?6 g.,... 33-`3 ?6,2c Fax:: (93) � • 33 ?k Reconnect only 67.84 2 l - Pump or irrigation circle 67.84 2 E - mail: 5 j,votrt.. s . Cv.. Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy panel, alteration, or extension. I Page 2 . 7 ‘ `). 42-' 2 Business name: S ASS Each additional inspection over allowable in any of the above Address: l S,,, 5 J • q pici t, ki W' / Additional inspection (1 hr min) 66.25/ hr 4 Investigation (1 hr min) 66.25/ hr City/State /ZIP: �Or 1ok ct (')(t! �u`1 Industrial plant (1 hr min) 78.18/ hr Phone: ( 5b; ) ''6th, 331, Fax: ( 5/3 ?6 v— 3J9 4' Inspections for which no fee is 90.00 / hr specifically listed (V2 hr min) CCB Lic.: 4(p (5 6,7 Electrical Lic.: 37—IOSia �Suprv. Lic.: q 4 L ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: `7 - Plan review (25% of permit fee): " Print name: � e �f �>_ Date: ( a-$ 1 0 State surcharge (12% of permit fee): Gt. � TOTAL PERMIT FEE: 4'711 0- Authorized signature: Zt.. This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(1I/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 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* . _ ❑ 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 ❑ Da,. elecommunication Installation C ire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ O door 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.doc 07/01/10