Permit 1,11 V CITY OF TIGARD ELECTRICAL PERMIT
Permit
COMMUNITY DEVELOPMENT #: ELC2009 -00222
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/18/2009
Parcel: 1 S 134AA01800
Jurisdiction: Tigard
Site address: 10260 SW NIMBUS AVE M4A
Subdivision: SCHOLLS BUSINESS CENTER Lot: 0
Project: Scholls Business Center
Project Description: (4) branch circuits to relocate (4) lights and (6) duplex receptacles; install (4) switches
Owner: FEES
ROBINSON, CONSTANCE A & Quantity Description Date Amount
ROBINSON, LYNN ET AL, BY KG INVESTMENT 4 crt Branch Circuits 05/18/2009 $66.80
MGMT, 10240 SW NIMBUS AVE #L3 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/18/2009 $8.02
Contractor: Electrical
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: B
Total $74.82
•
• 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 R 9 ' -01 . 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: W0/2
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.
RECEIVED
iectrical Permit Application FOR O FFICE U E C)1_.1'
M Cit MAY 1 8 2009 /� o,
C' of 1 '" Permit t Io.:
11.31L S Hall Blvd_ Tigard. 1. ii ik,,�. TIGARD >�> i - t90o�a_
Sm13_B 1.4<171 Fax: - u , " . . u � Other Pmt
> - i ire 503.639.417_ • I I G DIV .: , see z
a aA - oQ�ns I Supplemental information
TYPE OF WORK PLAN REVIEW
New consaraniniusa KAdditionafalturationfrepineenrenn 1 Reese check all that apply (sit 2 sets of plans wiitems. checked below):
l °Service or feeder 400 amps or more ❑ Building over three stories.
0 Itacurellitnicon 0 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 0 Commercial-use agricultural
® I - and 2-family dwelling 0_1•Commercialrtndusttial ❑ Accessory building amps for' Al other installations. buildings.
• Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
, ['Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ['Addition of new motor load of ❑ `A ", "E ", "I -2 ", "1 -3 ",
Job no.: I Job site address: 10246 S o -N• J pn $ 0 no of ❑ long or more. occupancy.
Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 7f e 11 6 1A4 ' r / ❑H h
ealth -care facilities. ❑ Supply an for more than
❑ Hazardous locations. 600 volts nominal_
Suite/bldg. /apt no.: Project name: W i l V ❑ Service or feeder 600 amps or more.
9 FEE SCHEDULE
Cross street/directions to job site: 4 5�4.i !iS F'ert a Des:Anion I ctn.. I Fee. I Total I •
New residential single or multi family dwelling unit.
0 i .S �I/f Ali wr € Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 145.15 1 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tan map/parcel no.: • Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00
/I o
�� � a
Limited energy, multi - family I � V r j residential CQ- �/ �r V ` es dential (with above sq. R) 75.00 2
)
,,/� Services or feeders installation, alteration, and/or relocation
kw? I /Pee P-46 4. re- sld / ) LI ea sSLJJia.c 4' 200 amps or less 80.30 I 2
❑ PROPERTY OWNER I ❑ 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
Maness: Over 1,000 amps or volts 454.65 2
City/Slate/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 1.0030 2
inneonded for sale, lease. rent_ or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Own= ��` Date: Branch circuits — new, alteration, or extension, per panel
1 A. Fee for branch circuits with j
❑ APPLICANT 0 CONTACT PERSON above service or feeder fee.
each branch circuit 6.65 2
Business name: B_ Fee for branch circuits
without service or feeder fee.
Contact name: Grist branch circuit . . f 46.85- L.,G. �� 2
Wes Each add'l branch circuit %j 6.65 /Q r 9 2
ltiseellaneotrs (sendce or feeder not included)
City/State/LIP: Each manufactured or modular 2
dwelling_ service and /or feeder
Mee: ( ) I Fax:: ( ) Reconnect only 6615 2
1 E-iifitaat Pump or irrigation circle 53.40 2
CONTRACTOR or outline lighting 53.40 2
Signal circuit(s) or limited -
�i(f �M� 2 Q E 1pjth energy panel, alteration, or
r , Address: C CD `S , P� 6Q /in Rue K n J extension. Describe: Page 2 2
t City /State /ZIP: v2 GU/j 0a1)" t Each additional inspection over allowable in any of the above
�n q 7 t5 Per inspecrion 62.50
'Phone: (6'5) CS p28 Fax: ( 9S G 84.1 ') 2 .
lnvesrigation per hour t I hr r uin) 6.. 50
CO Li - 1 t/ i H .Eteenical Lk.: 0 ei /50 L- 1 Supt'. Lie.: .2 g a SS i Industrial plant per hour 73.75
;Fe -V" ELECTRICAL PERMIT FEES
gtaa_ Electrician stattatwr� required: t t Vi' Subtotal: 6�'
Prim V Date: I Plan review (25% of permit fee):
J �� K- WIA� State surcharge (12% of permit fee): $', 4-
Authorized signature: TOTAL PERMIT FEE: lei g�
Print name: This permit application expires if a permit is not obtained wit 180
Date: days after it has been accepted as complete.
A mr mber of inspections allowed per permit.
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