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HomeMy WebLinkAboutPermit Electrical Permit Application RECEIVE City of Tigard Si P 1 7 > Received 1 ��e Platea3y: %7 2 0 Pennil d 1_ '� 2I n����7 -- 13125 SW Hell Blvd.,Tigard,OR 97223 Plan Review Le/ J Phone 50J 718 2439 fax 503.598.196QQ,CITY OF Tiaifi uate.HS I L //2p Related Permit 4. _. Internet.Inspection nixine" 5036.39,4175 CI t I n'/ ReadyOatoth hums. I It'Ann). /��t See ent 2l Inn NANNY tlt_tafd-or g(lv I:Ntfied�'Meth<ui �� AJ Supplemental Information - TYPE OF WORK t l,('irYi..1 ., ' qJ PLAN REVIEW ❑Ness construction ©Addition/alteration/replacement Please cheek alll ot. fit)isuhmn 7 seta ofptans wornic cheekedl ❑Demolition Q Service or feeder 400 amps or more ❑Building over three smnos ❑ Other: where thr available kult current 0 Marinas and boatyards_ CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or 0 Floating buildings. ❑ I-and 2-family dsvellin ■ Commercial/irtclustrial less to grouml,or exceeds 14.000 QC'umnternial-aseapricuhural g ❑ ❑ .'�cCC55Ury' building amps for all other installations. buildings ❑ Multi-family 0 Master builder ❑Other: Q Fire primp. 0 Installation of ISO R\tA or JOB SITE INFORMATION AND LOCATION Q Emergoney system larger separately derived Job 4:FS8381 Job site address:12025 SW 70th Avenue Q Add 100 HPa HP o moew auto load of systan. mnra. Q..A•. ..P.. "I-2' "I.3'. City/State/LIP:Tigard, OR 97223 ❑Six or more residential units. occupancy ill Health-care facilities. ❑Recreational vehicle parks Suite/bldg./apt,4: Project name:Progressive Periodontics Q ilartrdons knation, Q Supply voltage for more than ❑S ,vice or feeder 600 amps or more 600 volts nmminal Cross street/directions to job site: PEE"SCBhDULB Ikscripiwa I Qr.. I Fadh... I loud I • New residenlial single-or multi-family dwelling unit. Subdivision: 1 Lot it: Includes attached garage. 1,000 sq.0.or less 168.54 4 I ax map/parcel it. Fa.odd 500 sq.ft or portion 33.92 I DESCRIPTION OF WORK Limited energy,residential (with above sq. II) 7590 2 Install X-ray button, hospital grade receptacles and connect equipment Limited energy,multi-family 75.00 2 residential(with above sq.ft..1 Renewable Energy CI See Page 2 CI PROPERTY OWNER I ❑ TENANT Services or feeders installation.alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 City/State/ZIP: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301,(14 2 Phone:( ) Fax:( 1 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 "`" Branch circuits-new,alteration,or extension, + r panel PLi(A@f1s=a= I ❑ CONTACT PERSON ' - A.Pee for March circuits with Business name:Five Star Electric, Inc. above service or feeder fee. 7 42 each branch circuit Contact name:Eric Knudson B.Fee for branch circuits wmhont ' Address:756 SW Bailey Avenue service or feeder fee,first 1 56 18 56.18 2 branch circuit City/State/ZIP:Hillsboro,OR 97123 Each add'/branch circuit 5 7.42 37.10 2 Miscellaneous(service or feeder not included) Phone:( )503-324-0948 Fax::( )503-324-0973 Each manufactured or modular dwelling,service and/or feeder 67"84 ? Ismail:eknudson@fivestarelectric,org Reconnect only 6784 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Five Star Electric, Inc. Sign or outline lighting 67,84 2 Address:7 SW Bailey Avenue Signal circuit(s)or limited-energy 0 See Page 2 2 panel,alteration,or extension. City/State/ZIP:Hillsboro, OR 97123 Each additional inspection over allowable in any of the above Additional inspection Cl hr mini 66 2,e hr Phone:( )503-324-0948 Fax:( )503-324-0973 Investigation if hr min) 90.00,hr Email:egoodrich@fivestarelectric.org Industr al plant 11 hr mini 78 I8 hr Inspections for which no fee is 9000/hr CCB Lic,:158231 Electrical Lie,:34-665C Supra.Lie.:5245S spectticatly listed 1'-;hr mini I' ELECTRICAL PERMIT FEES r Suprv.Electrician signature,required: Subtotal. 93.28 Print name:Eric Gerdes Date:9/16/2020 es Plan Review Required(25%ofpermit fee): 2,a-• 2-3,3 (.1.....- r/ State surcharge(12%of permit fee): 11,19 Authorized signature: f ,� TOTAL.PERMIT PEE: �r�-� 7/ Print l � s This permit application expires if a permit is not obtained within 190 1 name: Date: days after it has been accepted as complete. • Number of inspections allowed per permit. I.sauddingkrermistELC Pernii.gpp_EI.R,.ERF.doe Rev 0687%±015 440-46151111,05:COM.wt0) Branden Taggart From: Branden Taggart Sent: Monday, November 9, 2020 4:07 PM To: eknudson@fivestarelectric.org Subject: Progressive Periodontics Permit: ELC2020-00533 - 12025 SW 70th Ave. Attachments: Invoice.pdf Hello Eric, The Electrical permit for Progressive Periodontics is ready to issue now. The balance due is$127.79, and I have attached an invoice above for you to reference. The permit fees can be paid online through our website: https://aca.accela.com/tigard/Default.aspx. From there, click on the Building tab, enter the permit number (ELC2020-00533) in the Record Number field, and click Search. Once paid, please notify us at TigardBuildingPermits@tigard-or.gov, and I will email the permit to you. Thank you, Branden Taggart r City of Tigard Senior Permit Technician Community Development 13125 SW Hall Blvd Tigard, OR 97223 (503)718-2449 brandent@tigard-or.gov 1