Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' a COMMUNITY DEVELOPMENT Permit #: ELR2010 -00236
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/28/2010
Parcel: 1 S 134AA02100
Jurisdiction: Tigard
Site address: 10300 SW NIMBUS AVE P
Subdivision: Lot: 0
Project: Scholls Business Center
Project Description: HVAC system.
FEES
Owner:
ROBINSON, CONSTANCE A & Description Date Amount
ROBINSON, LYNN ET AL, BY KG INVESTMENT Restricted Energy Permit 10/28/2010 $75.00
MGMT, 10240 SW NIMBUS AVE #L3 12% State Surcharge - Electrical 10/28/2010 $9.00
PHONE:
Contractor:
REITMEIER MECHANICAL
19570 SW 90TH CT
TUALATIN, OR 97062
PHONE: 503 - 603 -0205
FAX: 503 - 603 -0150
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: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $84.00
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 m, • • -• • • • • , s rules or direct questions to OUNC by calling 503.246.669 or .800.332.2344.
24
Issued By: , �� Permittee Signature: LAN/ Agez
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 L C,�j FOR OFFICE USE ON1
City of Tigard �� i Received ,.�— Permit No.:
11 q
8 2 Date /B : / 0 1 c err .... .i — 00x--3 c„ 13125 SW Hall Blvd., Tigard, OR 97223 0 C Li Plan Review
0 Phone: 503.718.2439 Fax: 503.598.1960 �. •oil Date /B : Other Permit: V — G ?..v I d W
T I R D Inspection Line: 503.639.4175 mi l OF H►W . to Read y/By: Jas: ® See Page 2 for
G A Internet: www.tigard- or.gov B s n u � IN GD I V ISI� ' otified /Method: 7"--(.9 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 ® Commerciallindustrial ❑ 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 ", "l -3 ",
Job no.: Job site address: 10300 SW Nimbus Ave. 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: P Project name: Scholls Business Center ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description ► Qty. 1 Fee. 1 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') 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Low voltage control wiring for Shaw Environmental. 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: KG Investment Management LLC 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 10240 SW Nimbus Ave. Over 1,000 amps or volts 552.26 2
City/State/ZIP: Portland, OR 97223 Temporary services or feeders installation, alteration, and/or
h' r relocation
Phone: (503)598 -9980 Fax: (503)598 -9982 200 amps or less 59.36 I
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: Reitmeier Mechanical B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Matt Rogers branch circuit
Each add'I branch circuit 7.42 2
Address: 19570 Sw 90 Court Miscellaneous (service or feeder not included)
City/ State/ZIP: Tualatin, OR 97062 Each manufactured service and/or d/ r modular 67.84 2
r dwelling, service and/or feeder
Phone: (503) 603 - 0205 Fax: : (503) 603 - 0150 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: matt .rogers @reitmeiermechanical.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Reitmeier Mechanical panel, alteration, or extension. r Page 2 757 c 2
Each additional inspection over allowable in any of the above
Address: 19570 SW 90 Court Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Tualatin, OR 97062 Investigation (1 hr min) 66.25 / hr
industrial plant (1 hr min) 78.18/ hr
Phone: 503 603 - 0150 Ins for which no fee is
Phone: ( 503) 603 - 0205 F ax: ( 503 ) 90.00 / hr
, specifically listed (%z hr min)
CCB Lic.: 153770 Electrical Lic.:3ti -‘64cieC Suprv. Lic.: 11LEB ELECTRICAL PERMIT FEES
Subtotal: - 75 — , Y-
Suprv. Electrician signature, required: 9, 54_ (25% Plan review (25 /o of permit fee):
Print name: Jeff Jensen Date: 10/27/10 State surcharge (12% of permit fee): q
��/-1���/� rp TOTAL PERMIT FEE: f- �. ----- Authorized signature: l r �A��� �� This permit application expires if a permit is not obtai e d within 180
days after it has been accepted as complete.
Print name: Matthew Rogers Date: 10/27/10 * Number of inspections allowed per permit.
I:\ Building \Pamits\ELC- PernatApp.doc 07/01 /10 440- 4615T(11 /05 /COM/WEB