Permit 7 p
CITY OF TIGARD ELECTRICAL PERMIT
"! COMMUNITY DEVELOPMENT Permit#: ELC2015-00612
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/04/2015
Parcel: 1 S 134AA01800
Jurisdiction: Tigard
Site address: 10130 SW NIMBUS AVE D9
Project: Sound Health Medical Supply Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: 2
Project Description: Replacing conduit.
Contractor: CROWN VOLTAGE Owner: HANSON, RONALD D
609 SW EATON BLVD ROBINSON.CONSTANCE A
BATTLE GROUND,WA 98604 ROBINSON,CHESTER TRUST ET AL
203604 EAST FINLEY RD
KENNEWICK,WA 99331
PHONE: 360-666-0995 PHONE:
FAX: 360-666-4673
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/04/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/04/2015 $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 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 .• of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2444.
I
Issued By: %;�— _ �— 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 OOV FO1201'FI('1: I SE ONE)
City of Tigard �„G . Received
Date/B : AIM I •
lig
13125 SW Hall Blvd.,Tigard,OR 9 o�� Plan Review
1i Phone: 503.718.2439 Fax: 503.59 1 DateB : Related Permit#:
Inspection Line: 503.639.4175 \�� t���. •eady Date/By: fur' 0 See Page 2 for
TIGARD Internet: www.ti and-or. ov \tom eta-- Notified/Method:g g - � '�e9 Supplemental Information
TYPE OF WOR1 \ PLAN REVIEW
❑New construction ®Addition/alteratiot , )' ment Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition 0 Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ I-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of ISO KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
' ❑Addition of new motor load of system.
Job#:C16840 Job site address: 10130 SW NIMBUS AVE. 100HP or more. ❑"A","E","I-2","I-3",
City/Slate/ZIP:TIGARD OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: D9 Project name: I�NYeil /t1- VY i� ❑Hazardous locations. ❑Supply voltage for more than
����CCCC������� y ❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: SW SCHOLLS FERRY RD. `N// FEE SCHEDULE
Description I Qty. I Each [ Total I "
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel 4: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
REPLACE COUPLING AND STRAP CONDUIT (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: NORTH RIM 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
® APPLICANT
[E] CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:CROWN VOLTAGE INC. above service or feeder fee,
7.42 2
each branch circuit
Contact name: STACY LACOMBE B.Fee for branch circuits without
service or feeder fee,first I 56.18
Address: 1403 SE COLUMBIA RIDGE DR. branch circuit 56.18 2
City/State/ZIP:VANCOUVER WA 98664 Each add'I branch circuit 7.42 2
lo■—` Miscellaneous(service or feeder not included)
Phone:(360)666-0995 Fax: :(360)666-4673 Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: STACY@CROWNVOLTAGEINC.COM Reconnect only 67.84 2
CON'TRACT'OR Pump or irrigation circle 67.84 2
Business name: CROWN VOLTAGE INC. Sign or outline lighting 67.84 2
Address: 1403 SE COLUMBIA RIDGE DR. Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: VANCOUVER WA 98664 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(360)666-0995 Fax:(360)666-4673 Investigation(I hr min) 90.00/hr
•
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/hr
CCB Lie.: 153934 Electrical Lie.: 37-984C uprv.Lic.: 5777S specifically listed Cr hr min)
-�j ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: U Subtotal: 56.18
Print name: DANIEL TUCKER Date: 07/24/2015 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 6.74
Authorized signature: TOTAL PERMIT FEE: 62.93
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.
I-\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/I7/2015 440-4615T(t i/05/COM/WEB
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10130 SW NIMBUS AVE D9, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00612
Jeff Grove
Violation Summary:
Inspector Contractor