Permit e CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'' . s. -" COMMUNITY DEVELOPMENT Permit #: ELR2010 00285
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/28/2010
Parcel: 1 S 134AA01800
Jurisdiction: Tigard
Site address: 10110 SW NIMBUS AVE B11
Project: Horiba Subdivision: SCHOLLS BUSINESS CENTER 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 12/28/2010 $75.00
12% State Surcharge - Electrical 12/28/2010 $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 don ccor 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: Oreg ' I. - •uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 001 -0010 through OA • ;00 , •' 1 You may obtain a co y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
I ed By: Permittee Signature: i����� 4��.
7 -
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 Applicatio CEIVE FOR OFFICE USE ONLY
+ • LJjJ Rece ived f /��
Ci of Tigard / ,(//t /o i Permit L L 8c�
tY g Date/By: /�td0 /D ��
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' ` ° 13125 SW HaII Blvd., Tigard, OR 9722Ij E C 2 S 2010 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
TI GA Rll Inspection Line: 503.639.4175 CITY OF TIGAp� Date Ready/By: lulls: ® See Page 2 for
Internet: www.tigard- or.gov MlJ Notified/Method: Supplemental Information
B[ ill DING DIVISION
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 ® CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: Job site address: /POO' 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.: B - I' Project name: Horbista ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross Street/directions to job site: Description I Qty. I Fee. 1 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'I 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. residential (with above sil 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
401 amps to 600 amps 200.34 2
Name: Horbista 601 amps to 1,000 amps 301.04 2
Address: 10180 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: ( ) 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
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 Mechanial B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Matthew Rogers branch circuit
Each add'I 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 -mail: matt .rgers @reitmeiermechanical.mm Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Reitmeier Mechanical panel, alteration, or extension. _ 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 (l 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 ('/ hr min)
CCB Lic.: 153770 Electrical Lic.:3 r Suprv. Lic.: 11LEB ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, req ' Plan rev ( 25% o f p fee)
Print name: Jeff Jensen Date: 12/27/10 State surcharge (12% of permit fee):
TOTAL PERMIT FEE
Authorized signature: Na - �l�� This permit application expires it a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Matthew Rogers Date: 12/27/10 • Number of inspections allowed per permit.
1:\ Building \ Permits $ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB