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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT a COMMUNITY DEVELOPMENT Permit #: ELR2009 -00142 T [ G ARE) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/28/2009 Parcel: 1 S134AA01800 Jurisdiction: Tigard Site address: 1 0260 SW NIMBUS AVE M4 Subdivision: SeHOLtSBUSINESS CENTER Lot: 0 Project: Professional Video Project Description: Install restricted energy for voice/ data, and CCTV. Owner: FEES ROBINSON, CONSTANCE A & Description Date Amount ROBINSON, LYNN ET AL, BY KG INVESTMENT Restricted Energy Permit 05/28/2009 $150.00 MGMT, 10240 SW NIMBUS AVE #L3 12% State Surcharge - Restricted Energy 05/28/2009 $18.00 PHONE: Contractor: PROFESSIONAL VIDEO & TAPE 10110 SW NIMBUS STE B11 TIGARD, OR 97223 PHONE: 503 - 598 -9142 FAX: 503- 598 -9172 Type of Use: Class of Work: Total Number of Systems: Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: N Fire Alarm: N HVAC: N Instrumentation: N Total $168.00 Intercom/Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions) Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Other Desc: 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 503.246.66 r 1.800.332.2 4. ^ Issued By: 45\nu .tom 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 R E C F ` FOR OFFICE USE ONLY ^` City of Tigard MAY 2 8 2009 RDeacteiveyd / Permit No.: Sr 22vCy:i .. dd I ( ta 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 111 ' r 1 Phone: 503.639.4171 Fax: 503.598.1960 OCITY CF �IOA ® y Other Permit: Inspection Line: 503.639.4175 Date Date/13y: furls 0 See Page 2 for T I G A R U Internet: www.ti g ard- or.gov _ Di� ! DilCG I DIVISIOI Notified/Method C 1 ' 1 Supplemental information TYPE OF WORK PLAN REVIEW ❑ New construction ❑ 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 ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. A ❑ Addition of new motor load of ❑ "A ", "E ", "I- 2 ", "1 -3 ", r 100HP or more. occupancy. Job no.: Job site address: /02.6p 5 (a) M S ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: Ts n „ CA 4 7 2 - 2 - 3 ❑Health care facilities. 0 Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. — P Suite/bldg. /apt. no.:MAL Project name: P"o{ejs,o.,J 14:14e.. * T ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: `/ J / T o./btt) 1 . c/.4../6 �C ✓rj /5,oc.i Description I QtY• I Fee. I Total 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'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 �//// / Limited energy, multi - family 75.00 2 Z "hose Et e,r n e.r, GC71/ residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ 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 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 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2 '' // / each branch circuit Business name: P ore &S ,,,,,,/ V,cho 4 7;-„,.... roc, B. Fee for branch circuits Contact name: 13raar /4 / c 4 P, without branch service or feeder fee, 46.85 2 d first branch circuit 3q(o S U) /ll' 6 S , Each add'I branch circuit 6.65 2 Address: D . wr u u i JC Miscellaneous (service or feeder not included) City/State /ZIP: �, rd © R 7 7 22 3 Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: ( 5 6 3 ) S 9e - 4 / y 2 Fax: : (So 3 ) 5—q$,.. 4 o Reconnect only 66.85 2 E- mail: b Pic( Pic /tJQ fro 0 CO "1 Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: fro 7 4�1e_ Signal circuit(s) or limited- o reSSrovrq/ /i rci@o �v�c energy panel, alteration, or 3% 50 extension. Describe: Page 2 2 Address: /O N'oritd 5 A City/State /ZIP: T sQ.1 c / e 7-7 223 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (5 1)3 ) 598 — 7/t/ z Fax: ( ) Investigation per hour (I hr min) 62.50 CCB Lic.: 1 1 4303/ 1 � 1 Electrical Lic.: 3 14 5'G$cLA Suprv. Lic.: / 2.67 Lt4 Industrial plant per hour 73.75 L.A. , It . l ELECTRICAL PERMIT FEES Suprv. Electrician signature, required �� Subtotal: Print name: Bro,/ 4,. 4 „fcl Date: 28 ,1445 09 Plan review (25% of permit fee): State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: O W OA Print name: 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. I:\ Building \Permits\ELC- PermitApp.doc 05/23 /06 440-4615T( I I /05/COM/WEB Electrical,Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: I RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: E l Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Dooi Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls El Clock Systems ❑ 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:\Building\Permits\ELC- PermitApp.doc 03/23/06