Permit CITY OF TIGARD ELECTRICALPERMIT -
RESTRICTED ENERGY
. ���; DEVELOPMENT SERVICES PERMIT #: ELR2005 -00001
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 1/3/2005
SITE ADDRESS: 10110 SW NIMBUS AVE B -11 PARCEL: 1S134AA -01800
SUBDIVISION: SCHOLLS BUSINESS PARK ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Add new T- stats.
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: T -STATS X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
ROBINSON, CONSTANCE A + HUNTER DAVISSON
ROBINSON, LYNN + BELL, KAY ET 1800 SE PERSHING
BY INSIGNIA COMMERCIAL GROUP PORTLAND, OR 97202
BEAVERTON, OR 97008
Phone: Phone: 234 - 0477
Reg #: ELE 26- 682CEP
LIC 1612
SUP 2626LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/3/2005 $75.00 Elect'I Final
[TAX] 8% State Surchari 1/3/2005 $6.00
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 questions to OUNC at (503) 246 -6699.
Issued by - Permittee Signature
OWNER INSTALLATION ONLY
The installation is being ma n erty I own which i ot-i.ntended -for sale, lease, or rent.
OWNER'S SIGNATURE: DATE: 3- v S
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N • DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
c - ° 7 v /d
Electrical Permit Application
C _ �, o f Tigard ECiV E Received y Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 P9�Re / �. �,'" eiV�2�� O,d Q d t
JAN 0 3 2005 , ^ f
Phone: 503.639.4171 Fax: 503.598.1960 I D Other Permit:
Inspection Line: 503.639.4175 JI ' ''l I ' D ate R eadyBy Julia fa See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method , Supplemental Information
CITY O FTI( ARD
lraiqe IIINIYOIRKISiON PLAN REVIEW
❑ New construction gAddition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: 0 Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling JR Commercia1industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION RV
❑EgressAightingp1an park
Job no.: 2)e Job site address: /Q //O 54 vrr (Gr S Ahe ❑Healthcare facility ❑der:
Submit 2 sets of plans with any of the above.
City/State/ZIP: 4 rC 972 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 6_ // Project name: Sf / /e5A Li S),'1C°55 FEE° SCHEDULE
Description I Qty. I Pa. I Total I ••
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
ace /2e4t, 7 s-1-6...f- (L� U o 1fai e) dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I $.TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: /14 v eta / 601 amps to 1,000 amps 240.60 2
Address: /Q /7 Q1,j /0'1(41 ge,4 S ,V e Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: / ,s 4 y d .07? 97ZZ 3 Temporary services or feeders installation, alteration, and/or
relocation q _ �
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
PPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: 7 /76 le/ C S o branch circuit
B. Fee for branch circuits
n
Contact name: (.� ya ;', Afh / without service or feeder fee, 46.85 2
Address: /gQ5 s5' rS vt�
each branch branch it
Each add'1 branch circuit 6.65 2
City/ State/ZIP: p � - t to he( 62? 57zaz Miscellaneous (service or feeder not included)
Phone: (So3) $c/ 2 — �uj I Fax: : (e)3) S92 - 3(oSy Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
/�� extension. Describe: Page 2 2
Business name: 5i4ie a S App `I CC •-
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: ) /(p /Z Electrical Lic.: 71e - 64, (1.�Suprv. Lic. Z(Z(QL( Subtotal
Suprv. Electrician signature, required: `��� ' / ' vK � `` � Plan review(25 %ofpermit fee)
� , c � State surcharge (8% of permit fee)
�
Print name: AA; ( \/7 l ta/ r Date:
'
1 �R 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: 1 v ve ✓l (4 f (lfila 1 Date: 1- 3 -.6 y • Fee methodology set by Tri-County Building Industry Service Board
•• Number of inspections per permit allowed
i:\ Building \PennilsELC- PamitApp.doc 12103 440-46 I5T(IOJ02/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 system. $75.00
(SEE OAR 918 - 260 - 260)
Check Type of Work Involved: •
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ 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
i:\ Bwtding\Permits\ELC- PamitApp.da 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00001
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/2005
Phone: (503) 639 -4171 A � ,
Inspection Requests (24 Hrs.): (503) 639 -4175 2� ''I I ..
INSPECTION WORKSHEET FOR DATE: 12/6/2005 TIME: 7:02AM PAGE: 75
SITE ADDRESS: 10110 SW NIMBUS AVE B CLASS OF WORK:
SUBDIVISION: SCHOLLS 134 INESS CENTER LOT #: 002 TYPE OF USE:
PROJECT NAME: MR. COPY
DESCRIPTION: Add new T- stats.
OWNER: ROBINSON, CONSTA E A +, PHONE #:
CONTRACTOR: HUNTER DAVISSON PHONE #: 234 -0477
Inspection Request Scheduled For: /ate: 12/6/2005 Pour Time:
Code # Ins ection Description Co irm # Contact # Message
135 Low voila 0229 ► ; 01 503-9634152 Y
E bi ii.‘__, ...---... •C %Lk w..........
Correc ions /Comments /Instruct' ns:
14 1, i tr■R— () ct:1 (i
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �❑ V (■16 Date: 14tk: Phone #: (503) 718-340