Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00038
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/17/2011
Parcel: 1S134AD06200
Jurisdiction: Tigard
Site address: 10565 SW NIMBUS AVE 100
Project: TSE Subdivision: Lot: 0
Project Description: Fire alarm.
Contractor: ACTION TECHNOLOGY SYSTEMS Owner: ROBINSON, CONSTANCE A &
835 SE 17TH AVE ROBINSON, LYNN ET AL
PORTLAND, OR 97214 BY KG INVESTMENT MGMT
10240 SW NIMBUS AVE #L3
PORTLAND, OR 97223
PHONE: 503 - 231 -1992 PHONE:
FAX: 503 - 231 -1402
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/17/2011 $75.00
12% State Surcharge - Electrical 02/17/2011 $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: Y
HVAC: N 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 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 -0090. You may obtain a copy of the rulest questions to OUNC by calling 503.232,1987 or 1.800.332.2344.
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Issued By: . - ��r_ _ Perm ittee 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 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.
Feb 16 2011 4:13PM ActionTech 503- 231 -1402 p.1
icatio A- ��'��'"
Electrical Permit
Apgl n �, r� �. ri;lc t,r,•tl -t: INF. (11V1.1' •
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^• Received ].,,
City of Tigard ,,= 1 ,%\ a Pe rmit No! — U- J/ - -r
- ,., Dens: G .�i � a 13125 SW Hall Blvd., Tigard, DR 97223 , l aP Review
u Phone: 503.718.2439 Fax: 503.598.19 60 , a r at+ OtherPermlt:
Line: 503,639.4175 lt'
I'ti;A.i; Inspection q, `^I ��� ykled/Mtbo BeePegefor
Internet: wwW.tigard `i ` � ,9;4.8‘11:664Y/BY:
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Or,g � O ° 'tit/ d/Mettt d� a o�*aa on
Internet:
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❑ ®Addition /alteration/replaeem' ent Please chock all that apply (submit j eats of plant w /llama checked below);
❑ Demolition QOyer; ❑ Service or feeder 400 ampa or more ❑ 8uildmg over three steriee,
where the available
:.... ........_
..,ir.,., -'+W( ,::,_, =: ; {r;::.. P.1 , 1;. i s ' .::: ,.a' , ii i'" ;i: - �'y axceede 10 000
Marinas
: �,:. ,.E ....: ',tit:.., -..._. .. . , ti ...�' a � 1!��1S;i��`1�1� °,,, , � , = ��',i''a "i:;= .':,,. 15D ❑ Fln
f- u;, ....',,,.._�,,..,,...,.. ° .: ,'::".? iif5:,.;:'.f4'y:;,�- :- .::3i9r:r.:,:..., gbulld lass io gr of or ampa exc ee at ds 54volts , 000 or Q Gom - use iage. agrloulturt 1
❑ 1 - and 2- family dwelling ® Commercial/industrial
❑ Accessory building amps for all other installations, buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump.
stall rlon of 75 KVA or
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g tzj7L '- nr ...�....., O e ' t: .11) 41: it r"`� loath ❑❑ Addition of new m, load of 17"A". larger s pa separately
=,e „ ir_..� „•fk 1 n ',p !'' � n r � 1y ” x o1y derived system.
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'mu ... � , ?; A tea n wmotor oa c „ ».., _ , . tom -
Job no,: 20738 Job site address: 10565 SW Nimbus 1001•IPormore. ooaupanoy.
❑ Six or more residential unite. ❑ Recreational vehicle parka,
City /State /ZIP: Portland, OR 97223 In Health - oars faailities. C Supply voltage for mote than
❑ Hazardous location. 600 volts nominal.
Suite/bldg./apt. no.: Bldg. S Project name; TSE/TT D Service or &ader 600 am a or more.
;I1 m'liel:::I;:' .. _ - .:_, :,i0tt
Cross street/directions job .= . e a a!i `.1 °.
e directions to ob s1tC: �' t�' 'aSP „ : ,, r
T ne.crl0den Qty, I n.. 1 row l
Pint residential single- or multi - family dwelling unit. -
Includes attached garage.
Subdivision: Lot no,: 1,000 eq. ft. or lass 16854 4
Tax map/parcel no.; 13a. add'1500 sq. ft. or portion 33.92 1
,•r.t , 5 , } v s .r.:., .y...., .,, - / :^: p ty p- ,, Limited energy, residential '
.... t •.:•rl...... „.a.:lt' :f.... r�ilQi�:'_.... ” , ” lY1N r �. .. gy.
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- - t 1 ''r" .d;,'' 75.00
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Limited 2
i mited energy, multifamily 75.00 2
TSE/TE fire alarm additions residential (with above sq. it) _
• — Services or feeders installation alteration and/or relocation
:1.,,,,. . 200 amps or less 100.70
..... .:�:':6r ® .. : -' •'p .:',;,..- ,'.: a +1 <F .�,,.:. -':.''!:a,; - ::t, - 201 a
- -- _ ' 2
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_.'. -. �. ,,. w: ; : r . , - _, ,��w„ ' iir '� , , `,::.�,F � a 1, m t 400 amps
. ,..._ . „ .,.._ . w ���., ,:•.,;:;: 13356 2
Name: 401 amps to 600 amps 200.34 2
—
601 amps to 1,000 amps _ 301,04 2
Address; _ Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or leas 59.36 1
Owner installation: This installation is being made on property that I own which is riot 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 fbr branch circuits with
t. 1. : ,, , t_._...-1111=': , ri 4..'a ] x,•;, �bl A ::::, _ er fee, 742
wr, ..✓i - T� - r.:r a avaearvicaorfood
-:: s i :1 .r �t9 ; iv s° �?1, ' each branch circuit 2
Business name: B. Fee for branch circuits wirhaur
service or feeder fee, first
Contact name: branch circuit 56, I8 2
Each add'! branch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
City /State /ZIP: Each manufactured or modular 67 S4 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67 2
E Pump or irrigation circle 67.84 2
: �,.. a, a} . 'nc' . Sign or outline lighting 67.84
�' ! i .: .ri ii � ..}^� :A - t i7Av,, � ,• , !Fri ` a)(�(. n e ' � � 'a, 1 . . _ " ,,: jr .: -, n 'a. _:- - n
rc„ :1f::Y ' Si gna l =tufts) or lim energ
Business name. Action Technology Systems LLC panel, alteration, or extension. 1 page 2 2
Each additional Ins, ecdon over allowable In an ' of the above
Address: 835 SE 17rh ave Additional inspection (1 hr min) 66.25/ In
City /State /ZIP: Portland, OR 97214 Investigation (] hr min) 66,251 hr
- Industrial plant (1 hr min) 78.18/hr
—
Phone: (503) 231 - 1992 Fax: (503) 231 - 1402 inspections for which no the is
157630 5.oetfleall listed S5 hr min
CCB Lie,: 1111 90.00 / hr
Electrical Lie.: 26775CLE r_
' Suprv. Lie.: 474SLEA. !_;t�st;c' =':t �i':; BNB "' <_'f, • p ,. •,:,.;:,...,_„ ,,..:era
Suprv. Electrician signature, required a Subtotal: 75.00
' Plan review (25% of permit fee):
Print name: Richard 1. Busktud igi Date: 2/16/11 — State surcharge (12% of permit The); 9.00 •
1� TOTAL PERMIT FEE: 84,00
Authorized signature: " � :
+ � + This p ermit application expires ire permit ie not obtained within 180
Print name: Rena Kirkland Date: 2/16/11 days after it has bee@ acccptad ere complete,
Number of inspections allowed per permit.
L'\ Building0Pertnitel3LC •PerroltApp.doc 07/01110 440 - 46I5T (I4O5/COM/WEB