Permit Er , CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00279
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/14/2010
:TIGARD Parcel: 1 S 134AD06202
Jurisdiction: Tigard
Site address: 10500 SW NIMBUS AVE T
Project: Solid Rock Subdivision: Lot: 0
Project Description: Low voltage for HVAC
Contractor: REITMEIER MECHANICAL Owner: ROBINSON, CONSTANCE A &
19570 SW 90TH CT ROBINSON, LYNN ET AL
TUALATIN, OR 97062 BY KG INVESTMENT MGMT
10240 SW NIMBUS AVE #L3
PORTLAND, OR 97223
PHONE: 503 - 603 -0205 PHONE:
FAX: 503 - 603 -0150
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/14/2010 $75.00
12% State Surcharge - Electrical 12/14/2010 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
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. ATTEN N: Orego5 I i requires ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -001 through OAR 952 -0 -00•:. You m. +btain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B . / _ /` � Permittee Signature: 2; 141
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 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 A pp ®' licat FOR OFFICE USE ONLY
City of Tigard 2 ��o Received ( ( permit No.: q
�J D E S Date /By: �P. /Y id '" ��.2o� "G� �C 7�
Er 13125 SW Hall Blvd., Tigard, OR 9 722 3 Plan Review
Phone: 503.718.2439 Fax: 503.592 of TiGARD Date
72
Permit:
T I GARD Inspection Line: 503.639.4175 DIVISION Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov BUIL DING Notified/Method: I( Supplemental Information
,i r t r ' ' [T YPE "OF W ORK1[ � � 4.x... i l € PLAN REVIEW gAE
. N ew construction n /alterat a� ; . . �.. � . check . .: , : .
❑
Ct10n ® Addltl0 Addition/alteration/replacement Please che all that apply (submit/ 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.
r t „, € C OF CO RU �� N" exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
"g 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. El Installation of 75 KVA or
❑ Emerg system. larger separately derived system.
i I >+ i E._. JOB SITE INFORMATION AND[ €LOCATION ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3"
- , - .., .,, „_.
Job no.: Job site address: 10500 SW Nimbus Ave. 100HP or more. occupancy.
Recreational vehicle parks.
❑ Six or more residential units. ❑ P
City /State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: T Project name: Rock ❑ Service or feeder 600 amps or more.
fir( €...- ., FEE SCHEDULE . a „1.„ I'.;;.
Cross street/directions to job site: Description l Qty. 1 Fee. l Total I *
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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTI OF WORK- f 4 (with above sq. ft.) 75.00 2
. •_ .,: € ... •pl..
Limited energy, multi- family 75.00 2
Low voltage control wiring. residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
i - 201 amps to 400 amps 133.56 2
�PROPERTY�OWNER Sif ?, - t ® TENANT p P
401 amps to 600 amps 200.34 2
Name: Solid Rock
601 amps to 1,000 amps 301.04 2
Address: 10500 SW Nimbus Ave. Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: Tigard, OR 97223 relocation
Phone: (503)603 -0205 Fax: (503)603 -0150 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 extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee,
® i'CONTA CT PERSON t
®APPLICANT 7.42 2
�i � -- ,,,,., � -.� � MINIMAL- - � � �. .�� . - �, . � - -. 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'l branch circuit 7.42 2
Address: 19570 SW 90 Court Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State /ZIP: Tualatin, OR 97062 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 matt rogers @reitmeiermechanical corn Sign or outline lighting 67.84 2
„ `, „ .e ? , , �`l, CONTRACTOR 1 W ;.E, Signal circuit(s) or limited energy 76%
Business name: Reitmeier Mechanical panel, alteration, or extension. 1 Page 2 2
Each additional inspection over allowable in any of the above
Address: 19570 SW 90 Court Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Tualatin, OR 97062 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 603 - 0205 Fax: (503) 603 - 0150 Inspections for which no fee is 90.00/ hr
specifically listed (92 hr min)
CCB Lic.: 153770 Electrical Lic.: Suprv. Lic.: 11LEB ,,;, E,;OiELECT4ICALiiPERM.MFEES iE r Y.ig :
Subtotal: 75
Suprv. Electrician signature, requir /'-) Plan review (25% of permit fee) '
Print name: Jeff Jensen Date: 12/10/10 State surcharge (12% of permit fee): 9 .00
TOTAL PERMIT FEE g7 . O a
Authorized si na�>
g This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Matthew Rogers Date: 12/10/10 * Number of inspections allowed per permit.
1:\ Buildng \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(11/05/COM /WEB