Permit CITY OF TIGARD ELECTRICAL PERMIT
```1 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00133
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/11/2011
Parcel: 1 S 134AA01800
Jurisdiction: Tigard
Site address: 10220 SW NIMBUS AVE K12
Project: Westside Economics Subdivision: SCHOLLS BUSINESS CENTER Lot: 0
Project Description: Reconnect RTU
Contractor: WILLAMETTE HVAC Owner: ROBINSON, CONSTANCE A &
3075 SW 234TH AVE. #206 ROBINSON, LYNN ET AL
HILLSBORO, OR 97123 BY KG INVESTMENT MGMT
10240 SW NIMBUS AVE #L3
PORTLAND, OR 97223
PHONE: 503 - 628 -6841 PHONE:
FAX: 503 - 848 -2597
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 03/11/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/11/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 i ccordance wi pproved lans. is permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TENTION: Oregon I r uir s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 -0010 thr ugh OAR 952 -0 -0090 ou ma obtain a copy of a rules or direct questions to OUNC by calling 503.232.1987 or 00 .2344.
Iss ed By:
164 IVA Permittee 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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVE � DateBy: /1 It A I Permit No.: A £l /.a7 /55
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
M Phone: 503.718.2439 Fax: 503.598.1960 MAR 1 1 ; - DateBy: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: brio H See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARE Notified/Method: Supplemental Information
w n , ..
g� ( :p X41 °_ PLAN REVIEW
TYPE OF WOR s )
❑ New construction E 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 E 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 ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 10220 SW Nimbus Ave looHPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard OR 97 ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: k -12 Project name: JkI / 63 7- -- - * (De . f ee d ot i ta.9 f ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: - Description I Qty. I Fee. I 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
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
reconnect rtu 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
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: reloc Temporary services or feeders installation, alteration, and /or
tion
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
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: same as below B. Fee for branch circuits without
service or feeder fee, first 1 661. ,1 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRAC'T'OR Signal circuit(s) or limited - energy
Business name: Willamette HVAC, LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 3075 SW 234th Ave Suite 206 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Hillsboro OR 97123 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 628.6841 Fax: (503) 848.2597 Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.: 56951 Electrical Lic.: 34346CRE Suprv. Lic.: 4025LEB ELECTRICAL PERMIT FEES
Subtotal: to . a8
Suprv. Electrician signature, required: o I /
Plan review (25% of permit fee): tP / 7 c
Print name: Mike Sicard Date: 3/11/11 State surcharge (12% of permit fee):
Authorized signature: ` TOTAL PERMIT FEE: & �—
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
I:\ Building 'Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11/05 /COM/WEB