Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 00180
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/09/2010
Parcel: 1S 134AA01800
Jurisdiction: Tigard
Site address: 10180 SW NIMBUS AVE J3
Subdivision: SCHOLLS BUSINESS CENTER Lot: 0
Project: EID PASSPORT
Project Description: Low voltage for voice and data.
FEES
Owner:
ROBINSON, CONSTANCE A
&
Date Amount
ROBINSON, LYNN ET AL, BY KG INVESTMENT Restricted Energy Permit 09/09/2010 $75.00
MGMT, 10240 SW NIMBUS AVE #L3 12% State Surcharge - Electrical 09/09/2010 $9.00
PHONE:
Contractor:
TELECOMM MANAGEMENT INC
15611 PARTRIDGE DR
LAKE OSWEGO, OR 97035 -3121
PHONE: 503 - 639 -8209
FAX:
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 $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issu the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in a rdance with appr ed pl- • s. 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 TION: Oregon law r= • • res you • follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 thro .!h OAR 952 -001 "00.- - o.'tain a copy of the rules or direct questions to OUNC by calling 503.246.669 r 1.t3A0. 2.2344.
I
Iss d 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 I UR OFFICl.: I;SI: cl:NI.V
City of Tigard Received / , D Permit No.: e l 4:241 /8e
IIII 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:4P
l - t . R1 Inspection Line: 503.639.4175 Date Ready/By: Jens ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
HYP OF WORK PLAN REVIEW
❑ New construction 11a Addition/alteration /replacement Please check all that apply (submit a 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.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: t 0 I So s(ti N ■ wi 814 s 100HP or more. occup.ancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: p o r r L. A ✓v O V rt q - z Z 3 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: -- 1-L( Project name: 5 - -I U
❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qtv. 1 Fee. 1 Total 1
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 l
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family ` 75.00 2
U 0 Ice_ 1.- D C ,- L i �v residential (with above sq. ft) 1
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
Phone: ( )
Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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 ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not inc luded)
CI /State /ZIP: Each manufactured or modular 67.84 2
City/State/ZIP: dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR
/J/� w Signal circuit(s) or limited-energy
Business name: T e(e C o h1 vyi / t' /Q Cfj c 00,9,-5 panel, alteration, or extension. Page 2 _ 2
11 Each additional inspection over allowable in any of the above
Address: p...0, g 1 . fl 3 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Lake_ / a p ex_ I ? - Q Z Investigation (1 hr min) 66.25/ hr
`' l- 1 J Industrial plant (1 hr min) 78.18/ hr
Phone: (g//3 ) 611 g al Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (h hr min)
CCB Lic.: `-3 C 3s-s- Electrical Lic.: 3- 3 C LC Suprv. Lic.: lout ea ELECTRICAL PERMIT FEES -
Suprv. Electrician signature, :
required n J Subtotal:
�` )CA'1 (I Plan review (25% of permit fee): '{t
Print name: I) 44 10 e ( ' s 5 Date: State surcharge (12% of permit fee): D D
TOTAL PERMIT FEE: elDU
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
11Building\Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(1l /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- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ 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
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10