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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ii I '. CO MMUNITY DEVELOPMENT Permit #: ELR2013 -00316 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/11/2013 Parcel: 1 S 134AA01800 Jurisdiction: Tigard Site address: 10260 SW NIMBUS AVE M9 Project: Professional Video Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 2 Project Description: Data telecommunications system. Contractor: PROFESSIONAL VIDEO & TAPE Owner: HANSON, RONALD D 10260 SW NIMBUS STE M4 ROBINSON, CONSTANCE A TIGARD, OR 97223 ROBINSON, CHESTER TRUST ET AL 203604 EAST FINLEY RD KENNEWICK, WA 99331 PHONE: 503 - 598 -9142 PHONE: FAX: 503 - 598 -9172 FEES Description Date Amount Specifics: Restricted Energy Permit 12/11/2013 $75.00 12% State Surcharge - Electrical 12/11/2013 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: 0 Boiler Controls: 0 CCTV: 0 Clock Systems: 0 Data & Telecommunications: 1 Fire Alarm: 0 HVAC: 0 Instrumentation: 0 Intercom /Paging: 0 Landscape /Irrigation: 0 Landscape Lighting: 0 Medical: 0 Nurse Calls: 0 Protective Signal: 0 Security Alarm: 0 Other: 0 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. Yo • a co y of the rules or direct questions to OUNC by calling 503.232.198 r 1.800.332.2344 Issued By: z. 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 ED FOR OFFICE USE ONLY CEN City of Tigard Date/13 Permit No.: i 7223 13125 SW Hall Blvd., Tigard, 1 Received IN 12013 Plan Review Phone: 503.718.2439 Fax: 503.598.19 Other Permit: Date/By: r1t --CA'a' I t c A R t? Inspection Line: 503.639 C, oF T t lkiAD Date Ready/By: Juris: la See Page 2 for Internet: www.tigard- or.gov �7n Notified/Method: Supplemental Information TYPE OF W ®G���� 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 aCommercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: Job site address: /0 2 (o 0 ,54J l ;� 4<r S 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks, City/State /ZIP: ./ r Q 'v1 0A 7 Z 13 ❑ Health -care facilities. ❑ Supply voltage for more than 9 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Al - q Project name: / Fp >, a , ., r./ d ❑ 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 Ea, add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi- family a f7 L A sy5,1 residential (with above sq. ft.) 75.00 2 Renewable Energy ❑ See Page 2 Services or feeders installation, alteration, and/or relocation ❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City/State /ZIP: Temporary services or feeders installation, alteration, and/or Phone: ( ) Fax: ( ) relocation 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 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 Owner signature: Date: Branch circuits- new, alteration, or extension, per panel ❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with above service or feeder fee, 7.42 2 Business name: each branch circuit B. Fee for branch circuits without Contact name: service or feeder fee, first 56.18 2 branch circuit Address: Each add'l branch circuit 7.42 2 City/State /ZIP: Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 Phone: ( ) Fax: : ( ) dwelling, service and/or feeder Reconnect only 67.84 2 E -mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 ���tu 7t,� Signal circuit(s) or limited - energy I See Business name: r`' '! ° "r panel, alteration, or extension. t Page 2 75 i 2 Address: /0 2 CO stiAl/ Su �� f't ii Each additional inspection over allowable in any of the above , Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: � tt 9, 1:::R g' 722 Investigation (1 hr min) 66.25/ hr Phone: (5o3) 5-2r-- 9/y a Fax: (5 ) S ys - 9/i72, Industrial plant (1 hr min) 78.18/ hr Inspections for which no fee is CCB Lic.: / y3.031 Electrical Lic.:12 (. 7LL4¢ Suprv. Lie.: specifically listed ('h hr min) 90.00/ hr Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES 1 Y� ,-� �' _- Subtotal: - 7 5 : r 4 Dec- Print name: �o r „ cl' , G h /' / Date: 11 U 7-42/ 3 Plan review (25% of permit fee): State surcharge (12% of permit fee): `i Authorized signature: TOTAL PERMIT FEE: 0 - This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. l: \Building\ Permits \ELC_PermitApp_ELR_ERE.doc Rev 05 /21/2013 440- 4615T(11/05 /COM/WEB Electrical Permit Application — City of Tigard • Page 2 — Supplemental Information • Limited Energy Permit Fees: Renewable Energy Permit Fees: "RESIDENTIAL WORK ONLY: FEE SCHEDULE . ' , . <` . Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 • 5.01 to.15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 ❑ Burglar Alarm • Wind g eneration systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 ❑ Garage Door Opener* 50.01 to 100 kva • 552.26 2 >100 kva (fee in'accordance with 552.26 2 ❑ Heating, Ventilation and Air Conditioning OAR 91s- 3o9 -ooao) System* Solar generation systems in excess'of 25'kva:' Each additional kva over25 7.42 3 • ❑ Vacuum Systems* >100 kva— no additional charge 0.0 3 'Each additional inspection over allowable in any of the above: El Other: Each'additional inspection is charged at an hourly (1 hr min) 66.25/ hr, 1 Inspections for which"no fee is 90.00 / fir specifically listed ('A hr min) ' 1 ['COMMERCIAL WORK ONLY: • ' ELECTRICAL PERMIT FEES °a;;.'., • Fee for each commercial_system $75.00 Subtotal ' ' (SEE OAR 918= 309 -0000) Plan review, if required (25 %,of permit fee): State surcharge,(12% of permit fee): . Check Type of Work Involved: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 ❑ Audio and Stereo Systems days after it has been accepted 'as complete. * Number of inspections allowed per permit._ ❑ Boiler Controls • . ❑ Clock Systems Data Telecommunication Installation • ❑ Fire Alarm Installation • ❑ HVAC ❑ Instrumentation, . ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls . ❑ Outdoor Landscape Lighting* ' ❑ .Protective.: Signaling' ❑ Other • Total number of commercial systems: *No, licenses are required. Licenses are required :d for all other installations I: \ Building\ Permits \ELC_PermitApp_ELR_ERE.doc Rev05 /21/2013 .N