Permit •
CITY OF TIGARD ELECTRICAL PERMIT
q
s COMMUNITY DEVELOPMENT Permit #: ELC2009 -00162
TI GARO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/13/2009
Parcel: 1S 134AA01800
Jurisdiction: Tigard
Site address: 10170 SW NIMBUS AVE H3
Subdivision: SCHOLLS BUSINESS CENTER Lot: 0
Project: Scholls Business Center
Project Description: Rewire furnace, new bathroom, install light switch.
Owner: FEES
ROBINSON, CONSTANCE A & Quantity Description Date Amount
ROBINSON, LYNN ET AL, BY KG INVESTMENT 3 crt Branch Circuits 04 /13/2009 $60.15
MGMT, 10240 SW NIMBUS AVE #L3 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/13/2009 $7.22
Contractor: Electrical
WINNER ELECTRIC INC
5950 SW PROSPERITY PK
TUALATIN, OR 97062
PHONE: 503- 638 -5028
FAX: 503- 638 -4242
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $67.37
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 OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /�
Issued By: ' 3 ` ( J\— \ Permittee Signature: Z A `( C a
I U` ( f +
OWNER INSTALLATION ONLY 1 ,
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.
- lect'ical Permit Application RECEIV 1 0 R 01- F I C E t SE c,.1.1
City of Tigard -7 C .O4 Permit � �� 70 �I (nZ
13125 SW Hal Blvd, Twat OR 97723
APR 0 9 20 ! , y' "
Pboo= 503.639.4171 Fax: 503998.1960 Other Pernik
keipeCtiMer Li 503- 639.4175 ' G1r�TMet,�Q� T�' • Rud 1 0 See Page 2 fer
1 wnwtiigard�r�o. �aQr :;1;. `
TYPE OF WORK PLAN REVIEW
® New constractioen iyi Additionfalteratiookcplarocmsot Finite check all that apply (submit 2 sets of plans wfta s wed below):
['Service or feeder 400 amps or more ❑ BuIIdmg over three stories.
® Desediticra ❑ Other where the available fault cement ❑ 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 (pi Commercialrmdustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: O Fire PumP. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
j ❑Addition of new motor load of ❑ "A °, "E , "1 -2" "1 -3"
`` l tool P or more. occupancy.
Job no.: Job site address:
/4 - _ ,o s W #i)' &tts A en ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Pae'L444 (1 q '1 aa. S o t iocalions. ° � marl than
Suite/bldg./apt. no.: 14 I Project name: $cJ 4s 8454.5 5 Ced.. ['Service or feeder 600 amps or more_
street/directions to job site: f FEE SCHEDULE
Cross street/
directions
���1 S/�aj�S /4 l� d. too I On. ► Fee. ( ram 1 •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea add'I 500 sq. It or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
r+
Limited multi-tinnily
energy, multi - mily 7500 2
R, 0.3 )R,� r u R N A C; 7, )J , Pam L residential (with above sq. ft) -
Services or feeders installation, alteration, and/or relocation
lt)✓ M e . g a i t / t u t o r . . - ' 4 1 L $ 1 ` -1 ' 200 amps or less 80.30 2
❑ PROPERTY OWNER I f
0 TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 l
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 10030 2
iced for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps - 133.75 2
Branch circuits — new, alteration, or extension, per panel
i Owner signature: Date: A. Fee for branch circuits with
1 ❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, e� J?
6.65 13. 0 2 .
each branch circuit o�
Business name: B_ Foe for branch circuits
Contact Mme: without service or feeder fee, first branch circuit 46.85 �4 Q 2
cuit
Adalont'ss: Each add'l branch circuit 6.65 - 2
M iseellaneous (service or feeder ant included)
City/State/ZIP: Each manufactured or modular
duelling, service and/or feeder 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
Ems: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business Signal circuit(s) or limited-
B s / At e/L- Ef e.c / LL p energy panel, alteration, or
Adams: Sc/50 S L^5 Re t�S Pe P4/Lk 1 J extension. Describe: Page 2 2
Ciry/State/ZIP• 1....• AL 4 /),,, o' q 70 6 z Each additional inspection over allowable in any of the above
Pa inspection 62.50
Phone: ( ) ‘3.i 6 I Fax: (463) 6s8 yd 4 /2 Investigation per hour (1 br rte) 62.50
CCB Lie.: / A.l'74 4 I Electrical Lic.: 34). /Jo l Sue`'. Lie.: erg `S Industrial plant per hour 73.75
a
/ . 1 . � ELECTRICAL PERMIT FEES _
Supcv. Electrician signature, required: p] , � Subtotal: 40,15
Print Warne: pie: Plan review (25% of permit fee):
J El egy W /}I I y'; ° O 5 State surcharge (12% of permit fee): "' " i
Authorized signature: TOTAL PERMIT FEE: 4131
Print name: I Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
' taiamba of inspections allowed per permit.
dec .5r23/IDS 4IP45t5UU1tta500irluen