Permit •
�` ' • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT • PERMIT #: ELR2007 - 00154
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/22/2007
PARCEL: 1 S 134AA -01800
SITE ADDRESS: 10260 SW NIMBUS AVE M6A ZONING: I -
SUBDIVISION: SCHOLLS BUSINESS CENTER LOT: 002 JURISDICTION: TIG
PROJECT: CAPSULE
Project Description: Low voltage for voice and data cabling
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
ROBINSON, CONSTANCE A + TELECOMM MANAGEMENT INC
ROBINSON, LYNN + BELL, KAY ET 15611 PARTRIDGE DR
BY INSIGNIA COMMERCIAL GROUP LAKE OSWEGO, OR 97035 -3121
BEAVERTON, OR 97008
Phone: Contact #: PRI 503- 639 -8209
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FEES Reg #: ELE 3- 463CLE
LIC 135355
Description Date Amount
[ELPRMT] ELR Permit 5/22/2007 $75.00
[TAX] 8% State Surcha 5/22/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00 •
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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:
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 Application'' FOR OFFICE USE ONLY
( : �•. 'Y City. of Tigard Date/B : 0 (t' Permit No.:Et & ails a s •
° 13125 SW Hall Blvd., Tigard, OR 97223 - Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 • Date/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: ' t'.1 6...... Hi, See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans wiitems checked below):
❑ New construction ❑ Addition/alteration/replacement
❑ 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 ❑ Floatinpbuildings.
less to ground, or exceeds ❑ Commercial -use agricultural
12 L
1- and 2- family dwelling CommerciaUindustrial ❑ 'Accessory building • amps for all other installations. buildings:
❑ Multi- family ❑ Master.builder ❑ Other: 0 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 -3 ",
• i
Job no.: • Job site address: 10 6 0 SW N /"aid S Six or more. Recreation.
❑ S o or r more residential units. 0 Recreational vehicle parks.
City /State /ZIP: Po� L N / O , ❑ Health -care facilities. .0 Supply voltage for more than
❑ Hazardous locations. 600 volts - nominal.
Suite/bldg. /apt. no.: �1/,( Project name: L) ges(Aix ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 1,4q. nesertptlon I ..tom. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
- . Includes attached garage.. •
Subdivision: 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.)
- ^ Limited energy, multi - family
• � Rte _ f pA 1.4BL.IIv6 residential (with above sq..ft.) • 75.00' 2.
Services or feeders installation, alteration, and/err relocation
•
• 200 amps or less' - 80.30 2 I
❑ PROPERTY OWNER ❑ TENANT _ 201 amps to 400 amps. 106.85' 2 '
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address :. Over 1,000 amps or volts 454.65 2'
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) • Fax: ( ) 200 amps or less 66.85 l
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
❑ APPLICANT I ❑ CONTACT PERSON above service or-feeder fee,
•
• each branch circuit 6.65 2
Business name: • 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
Miscellaneous (service or feeder not included)
City/State /ZIP: . Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
- E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting '53.40: 2
/ • Signal circuit(s) or limited -
Business name: e L cc°04i A /fQNafe xi C DIF (. energy panel, alteration, or x
Address:
0 v. e vx i 2 g 3 extension. Describe: / Page -2 60 2
City/State /ZIP: O S e v O Z 9 �d la Each additional inspection over allowable in any -of the above
/ Per inspection - 62.50
Phone: ( 'Q ) Q 1 Fax: 1011 /Ql( *11133,. g P (1 )
6 3 9 Zv � ( ) / Investi anon, er hour 1 hr min , '62.50.
r I ndustrial plant per hour 73.75
CCB Lic.: 1 3 SS �'I' ectrical Lic.: p� , Suprv. Lic.: 3 - �'� P P
j ELECTRICAL PERMIT FEES
I
Suprv. Electrician signature, required: con Subtotal: ,CO
• Print name: �� t O ECU. Date: Plan review (25 % of permit'fee):
State surcharge (8% of permit fee):
signature: t o no
•
Authorized si
� TOTAL PERMIT FEE: • � 1 , co
Print name: I Date: This permit application expires if a permit is not obtained within 180
days'after it has been accepted as complete. .
• Number of inspections allowed per permit.
IABuildingTermits\ELC- PermitApp.doc 05/23/06 440-4615T(I1 /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
izr 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:I Building \Permits\ELC- PermitApp.dot 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00154
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/22/2007
Phone: (503) 639- 417 . 11 1 I � I
Inspection Requests (24 Hrs.): (503) 639 -4175 � '!�i L .
INSPECTION WORKSHEET FOR DATE: 5/30/2007 TIME: 7:00AM PAGE: 12
SITE ADDRESS: 10260 SW NIMBUS AVE M6A CLASS OF WORK:
SUBDIVISION: SCHOLLS BUSINESS CENTER LOT #: 002 TYPE OF USE:
PROJECT NAME: CAPSULE
DESCRIPTION: Low voltage for voice and data cabling
OWNER: ROBINSON, CONSTANCE A +, PHONE #:
CONTRACTOR: TELECOMM MANAGEMENT INC PHONE #: 503 - 639 -8209
Inspection Request Scheduled For: Date: 5/30/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 049257 -01 503. 789.1456 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ • ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' voeur Date: OI'b 01 Phone #: (503) 718- 1AL
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