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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT • �' . COMMUNITY DEVELOPMENT Permit #: ELR2012 -00026 • TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/09!2012 Parcel: 1S136CD01002 Jurisdiction: Tigard Site address: 7910 SW PFAFFLE ST Project: Wenyi Jia Dental Office Subdivision: 2006 -016 PARTITION PLAT Lot: 3 Project Description: Data telecommunications system. Contractor: WILSONVILLE LOCK & SECURITY Owner: PFAFFLE OFFICE, LLC 8269 I SW WILSONVILLE RD. PCCC LLC WILSONVILLE, OR 97070 915 NW TORREYVIEW LN PORTLAND, OR 97228 PHONE: 503 - 682 -2323 PHONE: FAX: 503 - 682 -5868 FEES Description Date Amount Specifics: Restricted Energy Permit 02/09/2012 $75.00 12% State Surcharge - Electrical 02/09/2012 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: Y Fire Alarm: N HVAC: N Instrumentation: N Intercom /Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N 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 OA - • - /01 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344. Issued By: / — — ' • PPermittee Signature: / f • 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. 02/08/2012 5: 191 FAX 5036825868 WILSONVILLE LOCK & SECUR LI0001/0003 Electrical Permit Applica � I FOR OFFICE USE ONLY City of Tigard % , Received y —,. /7 IN �+ DateiB : i , / �/ Permit Nu,, .f__;, /d 3 ?- o / 'r 13125 SW Hall .24 Tigard, OR 913 Plan Date/By: i n2 l / ' i l: y `f �-- Phone: 503.718.2439 Fax: 5O3.59F. _ 2012 ther Permit: / //`(J l/V DtBy: TWA t i IL I e Inspeetlon Line: 503.639.4175 Date Rcsdy /By: hair F5 Sc e Page 2 for internet; www.ligard or.gov CI OF TIGA D Notified/Method: c Supplemental Information TYPE O K- DIVISION r 'WOR PLAN REVIEW ® New construction ❑ Addition/nilef•ation /replacement hlcisin check all that apply (submit I, sets of plans w /items clacked below); 1:1 Demolition ❑ Other: ❑ Service or feeder 400 amps or more ID Building over dnwo siorins, where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volta or ❑ Floating buildings, lass lu µ or exceeds 14,000 ❑ Commercial -use agricullmnl ❑ l- and 2- family dwelling ® Commercial/industrial Q Accessory building claps for all oilier installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ID Fire pomp, ❑ Installation of 75 KVA or JOB SITE ]NI''OI�MATI�i�( AND LOCATION ❑ of Emergency system. larger separately derived system. J D Addition maw motor load of © "A" f " "' "1-2","1.1", 1.1 ", Job no.: Job site address: Praf le St — 1001W or more. occupancy. r _ ❑ Six or more residential units. ❑ Recreational vehicle parka. City /State /ZIP: Tigard /OR/9727,3 ❑ Health -care facilities. ❑ Supply voltage for inure than — El I Inafd0un lnc;nlionn. OW volts nommnL Suite /bldg. /apt. no.: Project name: Dr. Wenyi Jia, DDS ❑Sarvica or fends, 600 amps or nano, FEE SCHEDULE Cross street/directions to job site: Pacific Hwy neserIpilyn l Qty. I Fee. I Turn) — - New residential single- or ntultl- fnntlly dwelling unit. Includes attached garage. Subdivision; Lot no.: 1,000 sq. ft. or less 168.54 4 F. add'I 500 sq, ft. or portion 33.92 l 'Flux map /parcel no.: . .__ Limited energy, residential 75,00 2 DESCRIPTION OF WORK (with above N R.) • Limited energy, multi - family 75.00 2 Adding phone and data wiring and connections. lcsidenlitl (with above sq. fl.) _ L _ "' - -- Services or feeders installation, alteration, nod /or relocation 200 amps or less 100.70 2 0 PROPERTY OWNER _ ❑ TENANT _201 amps to 400 amps 133,56 _ 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volt's 552.26 2 City /State/ZIP: - — Temporary acrvlees or fccdcnt Installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less - 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that 1 own which is not • —• - -. - 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, per panel Owner signature: , -- Date: A, Fcc for branch circuits with ® APPLICANT ❑CONTACT PERSON above service or feeder feu 7.42 2 - r-- • each branch circuit Business name: Wilsonville Lock And Security B. Fcc for branch circuits without service or feeder foe, first 56.18 2 Contact name: Scott Vosburg branch circuit Each add'l branch circuit 7.42 2 Address: 8269 -1 S.W. Wil8ollvllle rd. Miscellaneous (service or feeder not included) _ _ City /State /7,1P; Wilsonville /OR/97070 Fnch manufactured or modular 67.114 J 2 dwelling, service and/or feeder Phone: (503) 682 -2323 Fax: : (503) 682 -5868 Reconnect only 67.84 2 — • Pump or irrigation circle 67.84 2 E -mail: Wilaonvillesecurityljgmail.com — Sign or outline lighting 1 67.84 2 . CONTRACTOR Signal circuits) or limited - energy p Business name: Wilsonville Lock And Security _panel, alteration, or extension. / Page 7 . " 2 - - -. —.- . - Each additional inspection over allowable In any of the above , Address: 8269 -1 S.W. Wilsonville rd. Additional inspection Cl hr min) 66 25/ hr Investigation (I hr min) 66.25/ hr City/State/ZIP: W ilsOnville /OR/97070 industrial plant (1 hr min) 78.1s/ hr Phone: (503) 682 -2323 Fax: (503) 682 -5868 Inspections for which no fee is 1)0,00 / hr spocitically listed (Vs hr min) CCB Lie.: 49329 Electrical Lie.: 3- I98CLE Suprv, Lic.: 4775L ELECT PERMIT IN;EES I( /G J� 1 s � �d /' /6I — Subtotal; 75.00 Suprv. Electrician sign lure, required: ,/�� >�T" Plan review (25% aperient fee): •...T. Print name: Lancc Hanscn j Date: 2/08/2012 State surcharge (12% of permit fee): 9.00 Authorised signature; This permit application expires ire permit is not obtained within Intl days after it has been accepted as complete. Print name: Lance I Jansen - 1 Date: 2/08/2012 r Number of inspections allowed per permit. I' taalldtaylpermii s\IiLC- PennilApp.doa 07/01/10 440- 46151'(II/11S /COM/WL'B 02/08/2012 5:20PM FAX 5038825888 WILSONVILLE LOCK & SECUR 00002 /0003 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: ❑ .Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: _ COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ® Data Telecommunication Installation n F • ire Alarm installation n HVAC n Instrumentation ❑ Intercom and Paging Systems n L • andscape Irrigation Control* ❑ Medical N urse Calls ❑ Outdoor. Landscape I_.ighting* n Protective Signaling ❑ Other Total number of commercial ial systems: ,J,,,, o licenses are required.r - Licenses are required for all other installations LUl nlldinylfbrrtdUlW ,c•Pnrml1nol >,dnc mrouIO