Permit Electrical Permit Application ECEIVED FOR OFFICE USE ONLY
City o Tigard Received
AUG 24 2020 q 7 Permit
f g Pan Re p/�-/ /�i ko EGG/Uj/r+'GD7( F
v hone S50 Hall Blvd.,Tigard,OR 972238.19 plan Rev ew Related Permit N:(5(�1? �., ,,,,t3
= Phone: 503.718.2439 Fax: 503.598.19 DateiBy. (�
�ITti �`FTl�!�R� '," leis a SeePage2for
Inspection line: 503.639.4175 Ready Date/By:�qq /`
TIGARD p 'I II i Notified/Method7"(/2,. "y,C l `! Supplemental Information
.o Internet: wwwdigard-orgov �� __ --
"_ YPE OF WORK y, - 1(--0Ai. PLAN REVIEW
_
❑New construction NI Additionlaltcrationileplacemcnt
Please cheek all that apply(sub it 2 sets of plans whlenu ehcke cd)
0 Service or feeder 400 amps or more ❑Building over three stones.
❑ Demolition ❑Other: where the available fault current 0 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 X Commercial/industrial D Aecessor) building amps for all other installations, buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE:iNrORMATION AND LOCATION ❑Emergency system. larger separately derived
w motor load of
ne of
Job4: 1 Job site address: 9020 SW Washington Sq. Rd lOOHP❑Addition of new
or ❑system"E","l-z",•`1a",
❑Six or more residential units. occupancy.
City/State/ZIP: Tigard OR 97223 Health-care facilities, 0 Recreational vehicle parks.
❑Hazardous locations. ❑Supply voltage for more than
Suite/bldg./apt.#: 5 Project name: Dr. Henderson600 volts nominal.
7D0 Service or feeder 600 amps or more
Cross street/directions to job site: - FEE SCHEDULE
Ilescri lion (1-MI. i Each I 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#: Ea.add'l 500 sq ft.or portion 33.92 1
'111 ( DESCRIPTION OF WORK Limited energy,residential
, ; ,P.._ ,., 7500 2
Existing Dentistry. (1) New Dental Chair, New Pano Room, (with above sq.ft.)
Limited energy,multi-family 75.00 2
New Lab, retrofit existing Lighting to LED residential(with above sq.ft.)
,. Renewable Energy 0 See Page 2
tL (, 3,Q PROPERTY OWNER ❑ TENANT h , ❑€ Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: 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 1
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
Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT:. y, `� � T W„"'c„u,RW ' A.Fee for branch circuits with
Business name: above service or feeder fee, 7 42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 1 56.18 2
Address: branch circuit
City/State/ZIP: Each add'/branch circuit 8 7.42 2
Miscellaneous(service or feeder not included)
Phone: ( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email. Reconnect only 67.84 2
CONTRICI OR -, , lid Pump or irrigation circle 67.84 2
Business name: Bright Star Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: 13450 Richey Rd panel,alteration,or extension
City/State/ZIP: Boring OR 97009 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(971 )998-8459 Fax:(503) 907-9809 Investigation(1 hr min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Email: ion@brightstarpdx.eom Inspections for which no fee is
specifically listed(Y hr min) 90 00/hr
CCB Lic.:205016 Electrical Lic.: C 1076 Suprv.Lic.:5993S ELECTRICAL PERMIT FEES
pry.Electrician signature,required: Ronald Mitar Subtotal:
Print name: Ronald Mitar Date:8/24/20 ❑Plan Review Required(25%of permit fee).
State surcharge(12%of permit fee):
TOTAL PERMIT FEE: /42, _2?
Authorized signature:
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 06,17/2015 440-4615T(l i/05/COM/WEB