Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 00238
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/02/2010
Parcel: 1S134AA01800
Jurisdiction: Tigard
Site address: 10180 SW NIMBUS AVE J3
Subdivision: SCHOLLS BUSINESS CENTER Lot: 0
Project: EID PASSPORT
Project Description: Low voltage for security system.
FEES
Owner:
ROBINSON, CONSTANCE A & Description Date Amount
ROBINSON, LYNN ET AL, BY KG INVESTMENT Restricted Energy Permit 11/02/2010 $75.00
MGMT, 10240 SW NIMBUS AVE #L3 12% State Surcharge - Electrical 11/02/2010 $9.00
PHONE:
Contractor:
ADT SECURITY SERVICES INC
2815 SW 153RD DR
BEAVERTON, OR 97006
PHONE: 503 - 469 -7212
FAX: 503 - 469 -7114
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
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: Y
Security Alarm: N 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 with approved plans. This permit will expired work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ENTION: Oregon w req ' -s you to follow the rules adopted by the Oregon Utility Notification - ter. Those rules are set forth in OAR
95 001 -0010 through OAR 952 -00 - 00. o i y obtain a copy of the rules or direct questions to OU • • - •699 or 1.800.332.2344.
sued By: ■ — ��tL _ . Permittee ' • • . - • — _!' + r `L —�
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.
CaII 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.
/ 3 - e see
Electrical Permit Application FOR OFFICE USE ONLY '
Cl of Tigard Received Perna. N
131 Hall Blvd., Tigard, OR 97223 tate/B ' i t o.: f�ea�OlO -OD it p
g Plan Review
' a Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
- I' I G A It D Inspection Line: 503.639.4175 Date Ready /By: tuns: ® See Page 2 for
'Internet: www.tigard- or.gov Notified/Method: Supplementallnformatlon
TYPE OF WORK 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 [4 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 Toad of
❑ "A" "E "I -2" "1 -3"
8? / IOOHP or more. occupancy.
Job no.: /
,/ Job O 1 - I Job site address: /� O S /(/ /� /1J c ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: /h L i e 62 9 7a A 3 ❑ L � Health-care facilities.
❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: l P rojec t name: �—�' fSS 0 L r ❑ Service or feeder 600 amps or more.
• FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 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'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
j► `' ', fli / e e r Limited energy, mu family
is J q. ) 75.00 2
/ / vi c rl esoee abve ti Services or fee installation, alteration, and/or relocation
f / 200 amps or less 100.70 2
P ROPERTY s " R I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/ State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 i
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 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 1
Owner signature: Date: A. Fee for branch circuits with
El APPLICANT 1 WCONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
servi or feeder fee, first 56.18 2'
Contact name: iet r�( 1,2,934... branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: (.50 3 ) gai V ,' ? � 4/ Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy 7/ °'
Business name: A- b r .SE d eig / T panel, alteration, or extension. Page 2 / 2
Y Each additional inspection over allowable in any of the above
Address: e2 8/5 3 of /53 ,¢d b R Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: B A V t-A Tb N 9700 r0 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( 533 ) ge 769 Fax: (23 ) .116,q- 7HHe/ Inspections for which no fee is 90.00 / hr
specifically listed (h hr min)
CCB Lic.: s/ 4 t/(I Electrical Lic.:24' 20,1e/el Suprv. Lic.: (,Fi 3 r • . ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 7 r ,,fa.GI/y
Plan review (25% a Subtotal:
of permit fee):
Print name: KJFN K q os Date: ///1/0 State surcharge (12% of permit fee): 9 00
TOTAL PERMIT FEE: R tf 0 O
• Authorized signature: This
permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N umber of inspections allowed per permit
I:\ Building , Pemeas\ELC- PcrmitApp.doc 07/01!10 440-4615T(1l 0S /COANWEB