Permit CITY OF TIGARD ELECTRICAL PERMIT
l i t 1 . COMMUNITY DEVELOPMENT Permit #: ELC2009 -00419
Date Issued: 20
08/13/09
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 8 01800
Jurisdiction: Tigard
Site address: 10240 SW NIMBUS AVE L6
Subdivision: SCHOLLS BUSINESS CENTER Lot: 0
Project: NW Computer Support
Project Description: (3) branch circuits for TI.
Owner: FEES
ROBINSON, CONSTANCE A & Quantity Description Date Amount
ROBINSON, LYNN ET AL, BY KG INVESTMENT
MGMT, 10240 SW NIMBUS AVE #L3 3 crt Branch Circuits 08/13/2009 $60.15
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/13/2009 $7.22
Electrical
Contractor:
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: Permittee Signature: C/r 617" e�77e7,/
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 603.639.4176 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 Application FOR OFFICE 1 :sr_ ONLY
t E ^
City of Tigaa+d :,• ��,,, � Received
,, , a 501639.417 O1SIAIQ JNia"II� 3 / ' ,�i. PermitNoCce , 0 ' _// / •
131125 SW Hall BMW_ Tit�d. OR 9 / , , tl :. • ..
Mat= 5@13.6 .41171 Fax �,� , O R LIB °' w' ZOO ' IM /
,, .,,•., Dame 1 ions R See Pace 2 for
Itatteirraet anssr.ad -ar�v h.'' , '. o , 776— N t.�tioe
T TYPE Ol1►� 2
PLAN REVIEW
® New catmatturtiern - . , • :I L 9[11 MOW check all that apply (submit 2 sets of plans urinous e l- Le d e m below).
,.,
® Ell U ILUIN (; DIVISION � `i or feeder amps or more ❑ Building over three stories.
where e the available le fault current ❑ Marinas and boatyards.
CATEGORY OF CONSIRUC ION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
I less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® I - and 2- family dwelling [*Commercialrndustrial ❑ Accessory building amps for all other installations. buildings.
Di Multi-family ❑ Master builder ❑ Other: ❑ FQe pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived systerr
S ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
) no.: 1 Job site address: /U 2 4-/O S w Al in 6V S �4 VL 1001-IP or more. occupano'
❑ Six or more residential units. ❑ Recreational vehicle paths.
Ciay/State/ZIP: P0# - / /09ra Oil_ q 7 �. 6- 4 7 ❑ Healthcare facilities. D supply voltage for more than
D Hazardous locations. 600 volts nominal_
t Project name: �? cli0
Suile/bld / no.: Proj / amps or more.
g � S ,Q �SiNr.S C D Service or feeder 600 a FEE SCHEDULE
Cress street/directions to job site: S'6 Q / / , �, ir d M s J 04,4 D optic„ Qtv. Fee. Total
'r �' "' _ New residential single- or multi- family dwelling unit.
L -• G L -' '7 Spq Includes attached garage.
Subdivision: Lot no.: L000 sq. ft. or less 145.15 l' 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax ttan /praraa l no.: Liimited energy. residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
,7 0 E,e/7 4/3 '' residential (with above sq. R) 75.00 ?
I ' /yam Services or feeders installation, alteration, and/or relocation
T IV55 /la $ L fl s � �'t/ /1%A f� 0 f t HiMK � S , a . 200 amps or less I I 8030 I 12
• ❑ PROPERTY OWNER I ❑ TENANT fin 201 amps to 400 amps 106.85 2
Die: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
A s Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation. alteration, and/or
relocation
Phone: ( ) f Fax: ( ) 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 1.0030 • 2
intended for sale, lease. rent- or exchange, according to ORS 447.449. 670. and 701. 401 amps to 599 amps 133.75 _ 2
Oaf �� Date:
Branch circuits — new, alteration, or extension, per panel
A Fee for branch circuits with I
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee. 2
6.65 ' 3 i
each branch circuit 3
IBush:Bess name: B. Flee for branch circuits
sriahout service or feeder fee. / �
Contact name: branch circuit 46.8a 2
Adailmess: Each add'l branch circuit 0 6-652
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwzlling. service and/or feeder 2
Phone: ( ) I Fax: : ( ) • Reconnect only .. 66.85 i 2
E-onamtd: Pump or irrigation circle 53.40 2
CONTRACTOR Sint or outline lighting • 53.40 2
A , n r f� c ergy' circuit(s) limited -
(/1) +l✓ G/e / ,/ , en panel, alteration, ation, or
Address: b(60 ,5( Peens r `� f 4J extension. Describe: Page 2 2
',
City/State/ZIP: -f q L tO 0 4. 9 70 ‘ Z . Each additional inspection over allowable in any of the above
Per inspection ` 62.50
Phone: ^ b
, (mss) 63g J U a D I Fay: (503) 632 y � y,) investigation per holy (t hr min) 62.50
I CC Lie.: 14 7e/ r-{ I.1 Ele ical Loc.: 3 j../6 Sur Lic. :. 2,g,1 ' S i { Indtmtrial plant per hour I 73.75
ELECTRICAL PERMIT FEES
• Supra:. Electrician signtan/um_ required: Subtotal: , 6 b / S
! i Plan review (25% of permit fee):
Print name: , l�Att Date: 8-7—Of
State surcharge (12% of permit fee): 7,2 a.' ✓
Authorized signature: TOTAL PERMIT FEE: 6 7,3 7
This permit application expires if a permit is not obtained within 180
Print name. Date: days after it has been accepted as complete-
* Nitenber of inspections allowed per permit.
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