Permit � CITY OF TIGARD ELECTRICAL PERMIT
'"I e i COMMUNITY DEVELOPMENT Permit ELC2011 -00593
Date Issued 10/25/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 23113AB00800
Jurisdiction Tigard
Site address 15995 SW 74TH AVE 150
Project Excel Orthodontics Subdivision COUNCIL VIEW ACRES (LOTS 21 -44) Lot 30
Project Description (3) branch circuits and low voltage for data
Contractor DICKINSONS ELECTRIC Owner DOUDLE, RYAN
8449 SW BARBUR BLVD 15995 SW 74TH AVE SUITE 150
PORTLAND, OR 97217 TIGARD, OR 97224
P
PHONE 971- 249 -0261
PHONE 503- 246 -3550
FAX 503- 213 -6049
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 10/25/2011 $71 02
Specifics: Service or Feeder
1 ea Signal circuit or Limited 10125(2011 $7500
Type of Use COM Energy Panel
Class of Work ALT 1 ea 12% State Surcharge - 10/25/2011 $17 52
Electrical
Type of Const
Occupancy Gm
Total $163 54
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 w - 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 ENTION Oregon I -- n. irs ou to follow the rules adopted by the Oregon Utility Notification Center Those rules ei et forth in OAR
i p
952- 1 -0010 ihr augh OAR 952 -00 -0090 • ay obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or • •2 23
I ued By % t 1 24/ / t +' Permrttee Signature V _
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
CONTRA OR INSTALLATION ONLY
SIGNATURE OF SUPR ELEC' Date ore
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 �/
City of Tigard Rec n Permit No / LC /3
III g Dat e/B y �� R S ��
- ° 13125 S W FIall Blvd ,1 igard, OR 97223 Plan Review
11 ,_ Phone 503 718 2439 Fax 503 598 1960 Date/By Other Permit
TICARD Inspection Line 503 639 4175 Date Ready/By tuns ® See Page 2 for
Internet www tlgard - goy Natitied/Method Supplemental Information
r - �n TYPE OF WORK PLAN REVIEW
❑ New construction ,mil 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 stones
❑ 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
❑ I- and 2- family dwelling .IJ ommercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other ❑Fire pump ❑ Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately denved system
�j q i
❑Addition of new motor load of ❑"A" "E" `I - 2" "I 3"
Job no Job site address / S 9 Si" Ng A 1b1 Sx or o mrre dential units El R R c r eatioy
/Y t I ❑ Sx or mare resi ecreational vehicle parks
City /State/ZIP 4 (24' , 3 ❑ Health -care facilities ❑ Supply voltage for more than
/ ❑Hazardous locations 600 volts nominal
Suite /bldg /apt no Project name e_42.1_, 6Q* ❑ 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 adrift 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
Nat) Vile „ l � 4 r
Limited energy, teal (with it a b o v e sq 75 00 2
(/F.G LC- Ter residential (ede s installation, sq lion, alteration, and/or relocation )
�6 Services or feeders installati
200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 13356 2
401 amps to 600 amps 200 34 2
Name 400,749,17 601 amps to 1,000 amps 30104 2
Address Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP relocation
Phone ( ) Fax ( ) 200 amps or less 5936 1
Owner Installation: This installation 1s 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
Branch circuits - new, alteration, or extension, er 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 B Fee for branch circuits without
service or feeder tee, that / 56 18 56 In 2
Contact name branch circuit
Each add'I branch circuit 2 7 42 /4 e p2 2
Address Miscellaneous (serene or feeder not included)
City/State/ZIP /$late /ZIP Each manufactured or modular 67 84 2
y dwelling, service and/or feeder
Phone ( ) Fax ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E Signor outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited - energy ' 7 /
Business name f, � ^ �,} F 3 +�'rl panel, alteration, or extension Page 2 ! 2
�1 C' /, f� v r 7 C� — Each additional inspection over a towable in any of the above
Address FyUq tyro .Qetv6t4r' a Additional inspection (I hr mm) 6625/hr
City /State /ZIP / 120il/ o p/ (Jl,, ? �.� Investigation (I hr 66 25/ hr
1 LU rte•- _i Industrial plant (1 hr mm) 78 18/ hr
Phone 3 )agit 6 3-9 Fax (94 a 3 6 cfct spa Inspections
1st d('' /: nuns 9000 /hr
CCB Lice 5'734/ Electrical Ltca6. goo. Suprv, Ltc j f�� ELECTRICAL PERMIT FEES
Supry Electrician signature required Plan review (25% of permit fee)
Subtotal /94 p2 •
4 r` le �; / ��
Print name/ ea , k O ee, NNWN /I 4,.. Date rp State surcharge (12% of permit fee) /7.5 _.
TOTAL PERMIT FEE f/6 3•r/ C
Authorized signature This permit application expires ifa permit is not obtained within 180
Print name Date • days after it has been accepted as complete.
Number of inspections allowed par permit
11Building\Permit6ELC-PcrmrtApp doe 07/01/10 4404615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
Fl Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
jvj
Data "Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems
*No licenses are required. Licenses are required
for all other installations
Uiuddmg\Permns \ PLC - PermilAPP dot. 07/01110