Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 * COMMUNITY DEVELOPMENT Permit #: ELR2011 00025
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2011
Parcel: 1 S134AD06200
Jurisdiction: Tigard
Site address: 10565 SW NIMBUS AVE 100
Project: TSE Subdivision: Lot: 0
Project Description: Low voltage for HVAC wiring.
Contractor: HVAC INC Owner: ROBINSON, CONSTANCE A &
5188 SE INTERNATIONAL WAY ROBINSON, LYNN ET AL
MILWAUKIE, OR 97222 BY KG INVESTMENT MGMT
10240 SW NIMBUS AVE #L3
PORTLAND, OR 97223
PHONE: 503 - 462 -4822 PHONE:
FAX: 503 - 462 -6555
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/03/2011 $75.00
12% State Surcharge - Electrical 02/03/2011 $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 per ' is issued subjec • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do in accordance with app • -. • 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. ATTENTION: Oregon quire •u to follow the rules adopted by the Oregon Utility Noti' = '• enter. Those rules are set forth in OAR
952- 01 -0010 through OAR 9 - 001 - 0090 ou may obtain a copy of the rules or direct questions to OUNC b = ., • , 232.1987 or 1.800.332 2344.
•
1 sued By: , 1\ Ii . L _ i Permittee Sign: t:
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 Application FOR OFFICE USE ON I l
City of Tigard Received �,L 0/A•Oe�� 1
Permit No.:
111 = ` 13125 SW Hall Blvd., Tigard, OR 9722 �� :
EB 2 2011 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
T I G A R D Inspection Line: 503.639.4175 my (' Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov -- „ Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction jEt 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 2 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: 1 O s 5v,) I M l VY\ lA S A V L 100HP or more. occupancy.
❑
❑ Six or more residential units. Recreational vehicle parks.
City /State/ZIP: �'� (� ❑ Health-care facilities. ❑ Supply voltage for more than
l 1 I ‘.)12 " t�(� `^ i ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 16 f Project name: -1 - S (/1 `: flk `S 7 ' ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. l Total I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea add'l 500 sq. It or portion 33.40 I
Tax map /parcel no.: Limited
energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
l V w ` I O' I- C^ '� n 1 /Il 1 \, 11 �, I ,' n Limited energy, multi -family 75.00 2
V \/ 'Vb ` t/ nl U V �/ 'lJ'1 residential (with above sq. ft.
Services or feeders installation, alteration, and/or relocation
200 amps or less 8030 2
p PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
Ar APPLICANT I f CONTACT PERSON above service or feeder fee, 6.65 2
`' ( Li � � Fee branch circuit
Business name: V B. Fee for branch ci rcuits
Contact name: �,{) k 0p without service feeder fee, 46.85 2
`GJ r' N ♦ first branch circuit
Address: S i 8 1 V� Q ,1' Q W Each add'l branch circuit 6.65 2
'� "' 11 Miscellaneous (service or feeder not induded)
City/State /ZIP: M 1 A) AAA K l. , (V, on ?---.2---- Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503)L h q51 Fax: : ( 503 ) Lb> t f - Reconnect only 66.85 2
E-mail: . U Al l f Q � L jV', () tc , I ,)V �✓1 Pump or irrigation circle 53.40 2
i t
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
+� X"
Business name: 1 v ( ( < • l l / / energy panel, alteration, or 7 $• eo
Address:
City/State/ZIP: J V ` r }� extension. Describe: Page 2 2
Each additional inspection over allowable in any of the above
59,NA Per inspection 62.50
Phone: ( ) Fa x: ( ) Investigation per hour (1 br min) 62.50
CCB Lic.: l Electrical Lic.:210 -S 71 ltuprv. Lic.:3 - 7q b i.:5 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, requiredi4t 5,01 wti 0 Subtotal: 7 5j' . ° a
` �i C) (J l� 1 A ,, l Date: 9141 ) S review (25% of permit fee):
Print name:
I surcharge (12% of permit fee): 00
Authorized signature: 1 TOTAL PERMIT FEE: Sl .
Print name: ` I b , ' ri ' D � - / f j I This permit application expires if a permit is not obtained within I80
v / This days after it has been accepted as complete.
Number of inspections allowed per permit.
1: 1BuildingTermits \ELC- Permi[Ap... . '423/06 440- 4615T(I1/05/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:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n 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
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
I\ Building \Permits\ELC- PermitApp.doc 03/23/06