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Permit l II CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 11111 COMMUNITY DEVELOPMENT Permit#: ELR2015-00236 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/06/2015 Parcel: 1 S 134AA01800 Jurisdiction: Tigard Site address: 10130 SW NIMBUS AVE D6 Project: Rapid Technologies Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: 2 Project Description: Burglar alarm and data telecommunications Contractor: SIMPLE SECURITY Owner: HANSON, RONALD D PO BOX 80577 ROBINSON, CONSTANCE A PORTLAND, OR 97280 ROBINSON, CHESTER TRUST ET AL 203604 EAST FINLEY RD KENNEWICK,WA 99331 PHONE: 503-574-2254 PHONE: FAX: 503-245-2998 FEES Description Date Amount Specifics: Restricted Energy Permit 10/06/2015 $150.00 12%State Surcharge-Electrical 10/06/2015 $18.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 2 Audio&Stereo: 0 Boiler Controls: 0 CCTV: 0 Clock Systems: 0 Data&Telecommunications: 1 Fire Alarm: 0 HVAC: 0 Instrumentation: 0 Intercom/Paging: 0 Landscape/Irrigation: 0 Landscape Lighting: 0 Medical: 0 Nurse Calls: 0 Protective Signal: 0 Security Alarm: 1 Other: 0 Total $168.00 Other Desc: 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 95 •11 1-0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 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: C •: NSTALLATION ONLY SIGNATURE OF SUPR.EL)zC' Date: / LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 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 RECEIVE FOR OFFICE USE ONLY Received : . City of Tigard 'y'' Permit,. — '� 13125rSW Hall lvd.,Tigard,OR 97223 0�,T 6 2015 Date/B : la - �' �.�/�� °7-�� g Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for 1 Ic;ARD LIIVO fiGARD Internet: www.tigard-or.gov Notified Method: Supplemental Information e I . 1 it . - TYPE OF W i '1 a r r t` a PLAN REVIEW ❑New construction Addition/alteration/replacement Please check all that apply(submit/sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition 0 Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. 0 1-and 2-family dwelling 'Commercial/industrial 0 Accessory building less to ground,or exceeds 14.000 0 Commercial-use agricultural ❑Multi-family ❑Master builder ❑Other: Fire for all other installations. Installation ati 0 pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address: ❑Addition of new motor load of system. 100HP or more. ❑"A» "E" "I-2" "I-3" City/State/ZIP: \-v S Co ❑Six or more residential units. occupancy. ' 1 �i W t♦(� q ❑Recreational vehicle parks. ❑Health-care facilities. P Suite/bldg./apt.#: D (p I Project name: R.,PI d T'iG\N ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 /� p �j (with above sq.ft.) (� C1\'f- 741 G 1 dr aY- 1.-et 16 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax: ( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 ❑ APPLICANT I ❑ CONTACT PERSON', Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7.42 2 Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) _ Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 5 O P� SezW f. Sign or outline lighting 67.84 2 J Signal circuit(s)or limited-energy D f Address: r ?(2 (s e (S "7 panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP: o' 4 low, cog- 9 2 g D Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:(5 u3) 5 7 4- 27S Li I Fax:(503 ) -2,9S--'Lq 14 Investigation(1 hr min) 90.00/hr —Email: A i k,Q 60 s n+t Jp S e u r!� //IJG•G b Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.:/$"L D 19 Electrical Lic.:3 y_Go . .: 4/5-g/ LfA specifically listed('V hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,r equire& Subtotal: l� ,01 A,Print name: i&t kled Date:1© 4—/r ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): /f,Q0 Authorized signature: TOTAL PERMIT FEE: /6"t7 ,a This permit application expires if a permit is not obtained within 180 Print name: I Date: days after it has been accepted as complete. * Number of inspections allowed per pennit. I Building'.Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440.46t5T(It/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qtv. I Each I Total I * Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: n Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 n Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) n Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n Other: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('_hr mint COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls n Clock Systems 71. Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ViProtective Signaling n Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Building'Permits`ELC_PermitApp_ELR_ERE.doc Rev 06 17 2015