Permit U CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111111 2 = COMMUNITY DEVELOPMENT Permit #: ELR2012 -00036
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/23/2012
Parcel: 1 S136CD01002
Jurisdiction: Tigard
Site address: 7900 SW PFAFFLE ST
Project: Proforma Graphics Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: Low voltage for voice and data.
Contractor: DYNALECTRIC Owner: E &S HOLDINGS LLC
5711 SW HOOD AVE 8020 SW PFAFFLE ST
PORTLAND, OR 97239 TIGARD, OR 97223
PHONE: 503 - 226 -6771 PHONE:
FAX: 503 - 226 -7720
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/23/2012 $75.00
12% State Surcharge - Electrical 02/23/2012 $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 • - •. 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 • accordance 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. ' TTENTION: Oregon - • •'res you to follow the rules adopted by the Oregon Utility Notifica enter. Those rules are set forth in OAR
952 -0 1 -0010 through OAR 95 •01, -009 may obtain a copy of the rules or direct questions to OUNC by calli •. - -_ • _ • 87 o 1.8%).332.2344. ...
,„,,
Iss -d By: : . /LL.� : / Permittee Signatu =• '�
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.
Feb. 22. 2012 4:14PM Dynalect r icitegon No. 0832 P. 1
E lectrical Permit Application : 1()1( 01,1.1 •t: I'm.: UNI,V
City of Tigard e/Br . er e /R E�e2 r 0 3 4
Perm Na:
• 13125 SW Hall Blvd., Tigard,0 3 N. Q ti Plea review /Z n ��
91.96 � � Date/8y: Other Permit: �D ����
Phone: 503.718.2439 Far. 0
I I rte ,\ I: L1 Inspection Line: 503,639.41 �// 2 A r^O Dale AeadylBy: hob: I See Page 2 far
Internet: www.tigerd or.gov �V , y ��� Naified/Method: Supplemental Information
TYPE OF WO V� I � Q� . ` . PLAN REVIEW
❑ New construction ® Addition/alterad b�p1 ent Please shock apply (submit h sets of plena YAMS checked below):
❑ Demoli tion ❑ Other: � V t7 Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
' • CATEG01lYOF ; dills 'RUCrlOIV .. • 7 . exceeds 10.000 amps at 190 volts or 0 Floating building?,
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2-family dwelling ® CommerciaVindustrial ❑ Accessory building amps thrall other installations. buildings.
❑ Multi-family 0 Master builder ❑ Other: 0 Fire Pumii 0 Installation of 75 KVA or
larger
JOB ' s1TE 'INFORM d' t • LOCA - 1 O . .' . ❑ uditionssystem i. 2 derived system
.. t] Addition of DEW motor load of Q °A °."E", I", °1 -7 ",
•
Job no.: 112076110 tb I Job site address: ' � r , l S v 600 it. Sived low *row.
❑ Six or more residential units. . 0 Recreational vehicle parks.
City / State/ZIP: -nat 4 d 1 Z - Cl ileehh�re Mines. 13 Supply voltage for more than
! ❑ Haaardous locations. 600 voila nominal.
Suite/bldg. /apt. no.: I Project name: pa a a p ph es ❑ Saving or feeder 600 amps or more.
Cross street/directions to job site: ;.c.. • • . '.,,, , FEE.SCHEDIJLE
J I ndentation I illy, 1 pee. . . Total ( 4
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. It. or portion 33.92 1
Tax map/parccl no.:
Limited energy, residential 75.00 2 • ) *E SC.It1fP�'I.011 F VYOIZIC . , - ` (with above sq. fl.)
ti _ � r �� � b t � Limited energy, multi- family 75.00 2
` residential (with above sq. ft.)
Services or kedera installation, alteration, and/or relocation
200 amps or less 100.70 2
❑PROPERTY OWNER • I r -. ; < T>?a �A rlr 201 am to 400 am 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 volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fay( ( ) 200 amps or less 59.36 ' I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps l0 599 amps 168.54 i 2
intended for sate, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Pee for branch circuits with
above service or theder fee,
❑ APPLICANT I CONTACT. p1"BSON each branch circuit 7.42 2
Business name: 0\A Wile ; e e 0 D. Fee for branch circuits reUJrout
'' _l service or feeder r fee. first 56.18 2
Contact name: L a lel N , L, Q Vl branch circuit
Each add'l branch drcuit 7.42 2
Address: $yrys,( /S bz, i ) Miscellaneous (service or feeder not Included)
Each manufactured or modular
City/State /ZIP: dwelling, service and/or feeder 67.84 2
Phone: (513 ) Li i y . 0 Fax :: (55, )/{341. d 2; 3 Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 _ 2
Sign or outline lighting 67.84 2
- CONTRACTOR •', Signal cireuit(s)orlimited-energ' 1 n r p
Business name; p �� (�. `�" panel, alteration, or extension. I Page 2 , lJ 2
Each additional Inspection over allowable In any of the above
Address: 1 371 I Hood rlV`el i Vt.L__ Additional inspection (I hr min) 66.25/hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: PM 4- j h d (& 1(7.2 /i Industrial plant (1 hr min) 78.181 hr
Phone: (1%; )22 W • t n 9 1 I Fax: (5I S LZ Lo - — 41 g inspections for which no fee is 90.00/ hr
specifically listed (i4 hr min)
CCB Lic.: 6 913 Electrical Lic.: '2( 9161 Suprv. Lic.: 1 5, ELECTRICAL PERMIT FEES ..
G �� Subtotal: '7 . (I U
Suprv. Electrician signature, required: St_ 7 0'G a) e f k if Plan review (25% of permit fee):
end i ' � �' D a te: o
Print name: ' i State surcharge (12% of permit fee): d O
Z Z TOTAL PERMIT FEE: g . U CP
Authorized signature: t� r e N h �� Thi perm app expires if n permit Is not obtained within 180
days after it has been accepted as complete.
Print name: en ( 1Ift() I ate: 74 2,/ (2 • Number ofiuspections allowed per permit_
1:1Hml Gag\PamitsIELC•Peroiiapp.doe 07/01/10 4- w-4615r(1I /0I /COMJWEO
Feb. 22. 2012 4:14PM Dynalectric Oregon No. 0832 P. 3
, Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESID1f3NTIAL WORK ONLY:.
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systerns*
❑ Burglar Alarm
LI Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
; 'COMMERCIAL WORK ONYX
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
1: • ata Telecommunication Installation
❑ Fire Alarm Installation
❑ IHVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
LI Other
Total number of commercial systems:
*No licenses are requited. Licenses are required
for all other installations
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