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Permit a R ~ CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit#: ELR2010-00021 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/02/2010 Parcel: 1 S 134AA01800 Jurisdiction: Tigard Site address: 10130 SW NIMBUS AVE D6 Subdivision: SCHOLLS BUSINESS CENTER Lot: 0 Project: Rapid Technologies Project Description: Low voltage for data. FEES Owner: ROBINSON, CONSTANCE A & Description Date Amount ROBINSON, LYNN ET AL, BY KG INVESTMENT Restricted Energy Permit 02/02/2010 $67.84 MGMT, 10240 SW NIMBUS AVE #L3 12% State Surcharge - Electrical 02/02/2010 $8.14 PHONE: Contractor: SIMPLE SECURITY 4836 SW SCHOLLS FERRY RD. #226 PORTLAND, OR 97225 PHONE: 503-574-2254 FAX: 503-245-2998 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: Y Fire Alarm: N HVAC: N Instrumentation: N Total $75.98 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 is ect 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 cordance 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. ATT NTION: Oregon la ' rewTr-e% you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0 10 thro gh OAR 952-001 100. u ay 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: 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 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 /y FOR OFFICE 'USE ONLY Permit No.:~ D Dt~ City of Tigard Date/B Received ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 DateB : Other Permit: Inspection Line: 503.639.4175 Date Ready/By: Juris. ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: 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 ❑ I -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. ❑ Addition of new motor load of ❑ "A", "E", "1-2", "13", Job no.: Job site address: ( S , to. 1001 P or more. occupancy. 3v' 1VIr t V ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: ? Y 6C ❑ Health-care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: ty ~0 fe Description t . Fee. Total New residential single- or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map/parcel no.: Limited energy, residential DESCRIPTION OF WORK with above sq. ft. 67.84 2 • • Limited energy, multi-family 67.84 2 DATA f residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: B. Fee for branch circuits Contact name: ivithout service or feeder fee, 56.18 2 first branch circuit Address: Each add'I branch circuit 7.42 2 Miscellaneous service or feeder not included City/State/ZIP: Each manufactured or modular dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax: ( ) Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 • Signal circuit(s) or limited- Business name: . yN iP e c • =/V . energy panel, alteration, or Address: 14 b`I (~,Q~~ ZZ/•, extension. Describe: 1 Paget 2 City/State/ZIP: "r `OLV%0f QYZ ! -22-5 `Y Each additional inspection over (allowable in an of the above (5 3) 5 ZZ~y ( ) Per inspection 66.25 Phone: Fax: Investigation per hour (t hr min) 66.25 CCB Lie.: 52D f "t Electrical Lie.: Q3 Suprv. Lic.: 7( Industrial plant per hour 78.18 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: r Plan review (25% of permit fee): Print name: VO JA Q(/ Date: State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtai ed within 180 Print name: Date: days after it has been accepted as complete. ' Number of inspections allowed per permit. C\Building\Permits\ELC-PermitApp.doc 10/01/09 440-4615T(II/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 $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* q ❑ Burglar Alarm ❑ Garage Door Opener* F. ❑ Heating, Ventilation and Air Conditioning System* . ❑ Vacuum Systems* Y'fi7.b Z'.�e1:�:;• ❑ Other: j COMMERCIAL WORK ONLY: Fee for each commercial $67.84 y • (.; system t: t Ata ;tsy :tab C (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 El Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical 1:1 Nurse Calls •• �'j AA : 41 .7 ct .: %7: CU ��rt•; : i ^� • i S S - :� 1 !tf S\-+ l+ l WI • '+N • T: CI Outdoor Landscape Lighting* . `• .• a� �. 4 r�C �• y ❑ Protective Signaling CC 4 b� Other t •,. : �� • .% , k\ Total number of commercial systems: _ t •\ c� %A; ‘113.11.E.„ �\ *No licenses are required. Licenses are required for all other installations 1:\ Building \Prnnits\ELC- PermitApp.doc 10/01/09 •