Permit CITY OF TIGARD t. ELECTRICAL PERMIT
PERMIT #: ELC2007 -00480
COMMUNITY DEVELOPMENT
DATE ISSUED: 7/16/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134AA-01900
SITE ADDRESS: 10115 SW NIMBUS AVE 500 ZONING: MUE -2
SUBDIVISION: IKOLL BUSINESS CENTER TIGARD LOT : 001 JURISDICTION: TIG
PROJECT: MY GYM
Project Description: Reconnect rooftop gas pack #5.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: . EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ROBINSON, WILLIAM R/CONSTANCE A PRO CIRCUIT ELECTRIC LLC
ROBINSON, LYNN + BELL, KAY ET PO BOX 3948
BY ELLIOTT ASSOC WILSONVILLE, OR 97070
PORTLAND, OR 97204
Phone: Contact #: PRI 971 - 563 -8211
FAX 503 - 266 -1349
FEES
Description Date Amount Reg #: ELE 3 - 601C
[ELPRMT] ELC Permit 7/16/2007 $46.85 LIC 161382
[TAX] 8% State Surcharge 7/16/2007 $3.75 SUP 5107S
Total $50.60 REQUIRED ITEMS AND REPORTS
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 952-001-01f • . You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
•
Issued : • /J/ � K j Permittee Signature: . / /``e. }j-K)
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'N: 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 Applica EC lVC . l ORR 0141(1.: l tih_ O\1.1
City of Tigard JUL 1 6 2 Received •
Date' . � Permit No:. LC..2W — e304
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Oilier Permit:
fir`-" I ` DandB .
CITY ` V , r ' ' I ! Dare Re ' ® See Page 2 for
Inspection Line 503.639.4175 BUILDING t = n, Notified/Method: IM Supplemental Information
Internet: www.ci.tigard.or.us
.. " " T Y YPE OF WORK PLAN REVIEW
��cc,,
❑ New construction 4ddition/alterationlreplacement Please check all that apply:
❑ Demolition I ❑ Other: ['Service over 225 amps, comrn'I ❑Hazardous location
❑Service over 320 amps — rating ❑Butidngover 10,000 sq. ft.,
CAIEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1 - and 2- family dwelling mmercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one straenue
['Building over three stories 0 Feeders, 400 amps or more
❑ Multi - family Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
.1011 SITE INFORMATION AND LOCATION ❑ Egress/lighting plan RV park
• Job no.: Job s a 1 ❑ Health -care facility ❑Other:
I�� �' � - r S 5 t 0 Submit 2 sets of plans with any of the above.
City/State/ZIP: i i rD ( tcz, The above are not applicable to temporary construction service.
Suite/bld no.: Project name: FEE* SCHEDULE
�� L lkrertptloo I Q17. I Fee. I Thad 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 I 4
Subdivision: Lot no. Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /partxl no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
>EL ��T V P6 fe , Ye J dwelling, or and/or feeder 90.90 2
'L_, P rat t� Services or feeders installation, alteration, and/or relocation
200 amps or less 8030 2
Cl PROPERTY OWNER I ANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: /AY G'v m 601 amps to 1.000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only I 66.85 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 1 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
❑ APPLICANT I ❑ CONTACT PERSON A Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits (
Contact name: - without service or feeder fee,
first branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 I 2
Phone : ( ) I Fax : :( )
Sign or outline lighting 53A0 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel. alteration, or
�pO u� I,f. :, , E44 - 7
extension. Describe: Page 2 2
Business name:
Address: r D.'j .39 '1 5 _ Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: ! ,3, l l j 9-�c 7D Investigation per hour (1 hrmin) 62.50
Phone: ( 7)1 5trz g Z i I I Fax: ( (5;41 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 1 �'' �I Electric 1 Lic.: • -& - Suprv. Lin.: 5007 , Subtotal LI C u�
. �_
ri
Suprv. Electrician t1-01301
signature, required: Plan review (25% of permit fee)
—
Print name: ( �� •/ Date: 7 - .. State surcharge (8%ofpermit fee) r ^ 7
ji *" r TOTAL PERMIT FEE t
Authorized signature: This permit application expires if a permit is not obtained withta 1 0
days atter it has been accepted as complete
Print name: I Date: • Fee methodalogy sot byTei -County Building Industry ServicBoard
•• Number of inspections per permit allowed
t:UbAdmgP mitstE CC-PamiIApp.doe 12/03 440- 4615TI1602/COM/WEB
Z'd 617£L - £Og /(BeN enea d£9:0l. LO 51. Inf
CITY OF TIGARD - , - .
BUILDING DIVISION PERMIT #: ELC2007- 00480
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/1612007
Phone: (503) 639 -4171 uI ra
Inspection Requests (24 Hrs.): (503) 639 -4175 'III
INSPECTION WORKSHEET FOR DATE: 10/26/2007 TIME: 7:00AM PAGE: 75
SITE ADDRESS: 10115 SW NIMBUS AVE !i00 CLASS OF WORK:
SUBDIVISION: IKOLL BUSINESS CENTER TIGARD LOT #: 001 TYPE OF USE:
PROJECT NAME: MY GYM
DESCRIPTION: Reconnect rooftop gas pack #5.
OWNER: ROBINSON, WILUAM R /CONSTANCE A, PHONE #:
CONTRACTOR: PRO CIRCUIT ELECTRIC LLC PHONE #: 971 - 553.87.1
Inspection Request Scheduled For: Date: 10/2612007 Pour Time:
Code # Inspection Description /Confirm # Contact # Message
199 Electrical final 058394 -02 503 - 793-5027 Y
i
Corrections /Comments /Instructions:
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4 P.- 71 -. d ; 4111 Pa-E5 , ' ;10 Riots-1A_
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ro.a.4) ,t_, fiii li2.4c '2. 006 .1 0066 17
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr N44 LE Date: I OJ UICY Phone #: (503) 718- i