Permit i' .., r ELECTRICAL PERMIT
ill CITY OF TIGARD
COMMUNITY DEVELOPMENT PERM EL C2007 -00121
C DATE ISSUED: 2/ 27/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S134AA -01800
SITE ADDRESS: 10160 SW NIMBUS AVE F4 ZONING: I -
SUBDIVISION: SCHOLLS BUSINESS CENTER LOT : 002 JURISDICTION: TIG
PROJECT: DND HEALTH CARE
Project Description: Lighting at back area only.
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, CONSTANCE A + GUILD ELECTRIC INC
ROBINSON, LYNN + BELL, KAY ET PO BOX 674
BY INSIGNIA COMMERCIAL GROUP BEAVERTON, OR 97075
BEAVERTON, OR 97008
Phone: Contact #: PRI 503 - 957 -1173
FAX 503 - 291 -1532
FEES
Description Date Amount Reg #: ELE C2I
[ELPRMT] ELC Permit 2/27/2007 $46.85 LIC 109116
[TAX] 8% State Surcharge 2/27/2007 $3.75 SUP 3868S
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 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: �p ��`
_...,_
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.
AElectrical Permit Application FOR OFFICE USE ONLY
City of Tigard - 0 Date/ y° .7/ /D.7 6 6 Pennit No.- L_C . 7- DQf ZI iteceive
q II 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
0 Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960FEB 2 7 2007 Date/By:
T I G A It 17 Inspection Line: 503.639 Date ReadyB Sur B See Page 2 for
Internet: www.tigard or.gov Notified/Method: o Supplemental Information
CITY TYPE OF wooRK!LrAlr:�' rY Ti!:_111 PLAN REVIEW
❑ New construction- 8 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 [ Commercial industrial ❑Accessory building amps for all other installations. buildings. .
❑' Multi family 0 Master builder ❑ Other: . ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. ' larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1- 2 ", "I -Y',
Job no.: Job site address: /0/ 6 D 5 4) M 4 us 100HP or more. occupancy.
❑ ❑ Six or more residential units. Recreational vehicle parks:
City/State /ZIP: pot, V`tiQ D ,}�f �J -] Health-care 23 ❑ za dus facilities.
❑ Supply voltage for more than
[� �/ I / f 1:3 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt: no.: F 9� Project name: V (� )1-4 v 0 Service or feeder 600 amps or more.
�-� ) FEE SCHEDULE
Cross street/directions to site: Description . I Qty. I Fee. I Total I •
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. ft. or portion . 33.40 1
Tax map /parcel no.: Limited energy, residential , 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
• Y�
D (i° f Limited energy, multi - family 75.00 2
d 5 I.l',Si1 i, .1 c t ) l.(�i [ J 4'l 1. `
_j , £1 _5 b/4 1 residential (with above sq. ft.) .
✓ Services or feeders installation and/or relocation-
' a U'Z;tL- i) (/l, /� 200 amps or less 80.30 2
,0(PROPERTY OWNER I f1 ea ❑TENANT 201 amps to 400 amps 106.85 - 2
Name: ��� 14,50f � J
4, 5 a he A /co /� (� _Lv- 6.4141eh • 401 amps to 600 amps. 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Ji� 7 6 k) /V 1^111( 5 w i k L ' 3 Over 1,000 amps or volts 454.65 2
City/State/ZIP: . P� `a if ri Oil- q711 3 Temporary services or feeders installation, alteration, and/or
Phone: (5)3 ) cc', 9G/ �� Z I Fax: ( ) s--( Ec _ljq -2, 200 amps of 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 2
intended 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'
. Owner signature: Date: A. Fee for branch circuits with
y APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name:
n, , B . Fee for branch circuits
)� without service or feeder fee, y
Contact name: "` k�tio first branch circuit ) 46.85 / 2
I
Address: D f 6 7 7 Each add'l branch circuit • 6.65. 2
/ '
��� e 12 A___ _ Miscellaneous (service or feeder not included)
City/State /ZIP: U q 7D? 1 -b67L' Each manufactured or modular
•
dwelling, service and/or feeder 90.90 2
• Phone: (53 ) q - I J ED Fax:.: (tt ) -z - /3-3 ?.,-, Reconnect only 66.85 2
E -mail: Pump or irrigation circle • 53.40 • 2
CONTRACTOR Sign or outline lighting • 53.40 2
I Signal circuit(s) or limited- .. .
Business name:
/ ��I/t C/ • energy panel, alteration, or
Address: pD , fx 6 7 l f extension. Describe: Page 2 2
City/State /ZIP: Bea 1)n/4-oil D q79 ? S 067 y Each additional inspection over allowable in any of the above
er
- Phone: (5'03 ) Gf 9 7 . J) Fax: ( )_ "7 P inspection • 62.50
� � 1 S 3 .� Investigation per hour (1 hr min) 62.50 •
CCB -Lic.: ( e, Electrical Lic.: G --24 Suprv. Lic.: 3tfb i( Industrial plant per hour 73.75
ELECTRICAL PERMIT MIT FEES
Suprv. Electrician signature, required:. Subtotal:
Print name: ic,4U,,l �jSd Date: z -1? _ 0 7 Plan review (25% of permit fee):
l State surcharge (8 %.of permit fee): • 3.15
Authorized signature: O /( TOTAL PERMIT FEE: So . 00,() Print name: (G d , e , j L !) f� Dat e: 2,— z , - Q 7 This permit application expires if a permit is not obtained within ISO
I �`(JV ( days after it has been accepted as complete.
• Number of inspections allowed per permit.
1: 1Building \Permils\ELC- PermitApp.doc 05/23/06 440-4615T(11/05/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:
❑ 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 $75.00
system •
• (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
•
❑4 _
Instrumentation
•
•
❑ Intercom and•Paging Systems
❑ Landscape Irrigation Control*
•
❑. Medical
•
❑ Nurse Calls
❑ Outdoor. Landscape Lighting*
• ❑ Protective Signaling
0 Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for' all other installations •
1:\ BuildingWermitsELC= PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION j PERMIT #: ELC2007- 00121
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/27/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 F'! L �
INSPECTION WORKSHEET FOR DATE: 3/2/2007 TIME: 7 :00AM PAGE: 68
SITE ADDRESS: 10160 SW NIMBUS AVE F4 CLASS OF WORK:
SUBDIVISION: SCHOLLS BUSINESS CENTER LOT #: 002 TYPE OF USE:
PROJECT NAME: DND HEALTH CARE
DESCRIPTION: Lighting at back area only.
OWNER: ROBINSON, CONSTANCE A +, PHONE #:
CONTRACTOR: GUILD ELECTRIC INC PHONE #: 503 -967 -1173
Inspection Request Scheduled For: Date: 3/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 044221 -01 503 -957 -1180 Y
Corrections /Comments /Instructions:
PASS [1] PARTIAL APPROVAL 111 CANCEL 111 NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G'in N Date: 3 - 2`'0 1 1 Phone #: (503) 718- 24%'
CITY OF TIGARD
BUILDING DIVISION PERMIT #: E 02007- 0012
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 21271 2007
Phone: (503) 639- 4171W�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/1/2001 TIME: 7 :00AM PAGE: F a y
SITE ADDRESS: 10160 SW NIMBUS AVE F4 CLASS OF WORK:
SUBDIVISION: SCHOLLS BUSINESS CENTER LOT #: UO2 TYPE OF USE:
PROJECT NAME: DND HEALTH CARE
DESCRIPTION: Lighting at back area only.
OWNER: ROBINSON, CONSTANCE A +. PHONE #:
CONTRACTOR: GUILD ELECTRIC INC PHONE #: 503 -9f47 -'1173
Inspection Request Scheduled For: Date: 3/1/2007 Pour Time:
Code # Inspection Description - ' • • Contact # Message
120 Electrical rough -in 044 -01 503380.8229 Y'
Corrections /Comments /Instructions:
rnIN
aK. C N ►cam (Nr?
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
■
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: g t V Date: 3- 0ri Phone #: (503) 718- 1--1,LVb