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Permit CITY OF TIGARD ELECTRICAL PERMIT . 1 1 1 q COMMUNITY DEVELOPMENT Permit #: ELC2011 00053 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/28/2011 Parcel: 1 S 134AD06200 Jurisdiction: Tigard Site address: 10565 SW NIMBUS AVE 100 Project: TSE Subdivision: Lot: 0 Project Description: Electrical for TI. NOTE: FEES FOR ADDITIONAL WORK SHALL ALSO BE CHARGED PLAN REVIEW FEES. Contractor: HILLSBORO ELECTRIC LLC Owner: ROBINSON, CONSTANCE A & 21185 NW EVERGREEN PKWY #110 ROBINSON, LYNN ET AL HILLSBORO, OR 97124 BY KG INVESTMENT MGMT 10240 SW NIMBUS AVE #L3 PORTLAND, OR 97223 PHONE: 503 - 439 - 9666 PHONE: FAX: 503 - 601 -3680 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 01/28/2011 $100.70 Specifics: amps or less 4 ea Services or Feeders - 201 to 01/28/2011 $534.24 Type of Use: COM 400 amps Class of Work: ALT 1 ea Services or Feeders - 601 to 01/28/2011 $301.04 1000 amps Type of Const: 1 ea Services or Feeders - Over 01/28/2011 $552.26 Occupancy Grp: 1000 amps or volts 24 crt Branch Circuits w /Purchase 01/28/2011 $178.08 Service or Feeder 1 ea Plan Review Electricial 01/28/2011 $416.58 1 ea 12% State Surcharge - 01/28/2011 $199.96 Electrical Total $2,282.86 Required Items and Reports (Conditions) 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 OA' • -- - 001 -0090. You may obt ain_a_copy -- - - - - o - • • - stions to OUNC by calling 50 .' . 987. 1.800.332.2344. Issued By: '= 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' Date: LICENSE NO. 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. Electrical Permit Application FOR OFFICE USE ONLY City of Tigard ,r Dateiv Received . t / . �} Permit No.: • 13125 SW Hall Blvd., Tigard, OR 97223 � P l an Review / j il h ' 11 Phone: 503.639.4171 Fax: 503.598.1960 Date/B �' • ' A G WN Other Permit: 1 /311 hOM UCH i f lCi A R f) Inspection Line: 503.639.4175 'I©'\ t Date'ReadyBy: / t/- Juris: ® See Page 2 for Internet: www.tigard .` `� 1 ( Notified/Method: �/ / I I - Supplemental Information TYPE OF WORK O V'lG .% � NAS C �v `''"I ma c '' ' LAN REVIEW ❑ New construction ❑Addition /alteration /reply e t _`0 P ase check all that apply (submit 2 sets of plans w /items checked below): ervice or feeder 400 amps or more ❑Building over three stones. ❑ Demolition ❑Other: VOL' `� ffff 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 ❑ I- 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 ❑ Emergency system. larger separately derived systen JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of / * \ 1001-IP or more. occupancy. Job no.` j 7 Job site address. , Sl � t V t(JJ� ��� ❑ Recreational vehicle parks. V Ct. 1(� 1 ❑Six or more residential units. City /State /ZIP: ;L / c -ck c t \ZZ ❑ Health -care facilities. 0 Supply voltage for more than J t Hazardous locations. 600 volts nominal. Suite/ bldg. /apt. no.: Project name: — 'r Service or feeder 600 amps or more. 1c(� \ �L \ • \_, �� t.� /�: t+ nv tn�tn el ls r , y. FEE SCHEDULE C g C s ADP I `, o N $ Description I Qty. I Fee. I Total I• (��` Y New residential single- or multi - family dwelling unit. c WoN $140— %E P►tot i P4„ ki\i‘S 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 sq. 75.00 2 DESCRIPTION OF WORK ( with above q. ft. ) _ Limited energy, multi - family 75.00 2 c residential (with above sq. ft.) `` ■ _ Services or feeders installation, alteration, and/or relocation �`,t - t"1c jet .! �C�, 200 amps or less , 100.70 t/01) t -1J 2 El PROPERTY OWNS ❑ TENANT 201 amps to 400 amps 4 Nk.„, 133.56 5 >4 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 1 j 301.04 3 2 Address: Over 1,000 amps or volts ( 552.26 Esa. roc, 2 Temporary services or feeders installation, alteration, and /or City/State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 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, ter panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT CI CONTACT PERSON above service or feeder fee ZL\ 7.42 / y'' o f 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first Contact name: branch circuit 56.18 2 Each add'] branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular City /State /ZIP: dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax:: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy Business name: Electric, panel, alteration, or extension. Page 2 2 Hillsboro LLC Each additional inspection over allowable in any of the above Address: 21185 NW Evergreen Pkwy #110 Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: Hillsboro OR 97124 Investigation i pant hr hr m) 66.25/ hr Industrial plant (1 hr min) 78.118 / hr Phone: ( 5 0 3 439-9666 Fax: (5 03 ) 6 01 - 3 6 8 0 Inspections for which no fee is 90.00 / hr specifically listed (Y2 hr min) J CCB Lic.: 134481 Electrical Lic.: 34-499C Suprv. Lic.: ?C.// ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: IV r / Subtotal: / �� �� .C i {�� Plan review (25 °/n of permit fee):q/6.51- Print name: Date: State surcharge (12% of permit fee): / 4 ,ci - TOTAL PERMIT FEE: 3 , z Authorized Signature. This permit application expires if a permit is not ob foe d within 180 days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. I.t Building \Permits\ELC -PermitApp.doc 07/01/10 440- 4615T(l I /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: n Audio and Stereo Systems* H Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* • . ' • ' • • n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems H Boiler Controls j Clock Systems H Data Telecommunication Installation H Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems Landscape Irrigation Control* TI Medical H Nurse Calls H Outdoor Landscape Lighting* n Protective Signaling I I Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations l BuildinglPermits \ELC- PermitApp.doc 07/01/10