Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN 2 COMMUNITY DEVELOPMENT Permit #: ELR2012 -00037
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02!24/2012
Parcel: 2S102AA00602
Jurisdiction: Tigard
Site address: 11960 SW PACIFIC HWY
Project: Tendercare Dental Subdivision: TIGARD HIGHWAY TRACTS Lot: 12
Project Description: Low voltage for voice and data.
Contractor: SAFE TECHNOLOGY GROUP INC Owner: AMAN, WALTER S CREDIT SHELTER TR
6400 NE HWY 99 SUITE G375 19217 SW 119TH AVE
VANCOUVER, WA 98665 TUALATIN, OR 97062
PHONE: 360- 699 -2130 PHONE:
FAX: 360 - 719 -1527
FEES
Description Date Amount
Specifics: , Restricted Energy Permit 02/24/2012 $75.00
12% State Surcharge - Electrical 02/24/2012 $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 OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23322..1199/87 or 1.800.332.2344.
Issued By: Permittee Signature: l� " " j
�/
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.
Electrical Permit Applicati CE D .
r(>1i (rrlc:r us, c> L.v
City of Tigard R GOeived / Permit No. ea AO/ 2 -�37
CC pp A
• 13125 SW Hall Blvd., Tigard, OR 9nE 2 4 2012
Phone: 503.718.2439 Fax 503.598.1960 Date/13 w Other Permit: o?aY� 7
I WARD
Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: >uri See Page 2 for
Internet: www.tigard- or.gov R[ I�LDING DIVISION Notified/Method: ] ® Supplemental Information
TYPE OF WORK .. PLAN REVIEW° '`
Please check all that apply (submit eels of plans w/items checked below):
❑ New construction E Addition /alteration/replacement
❑ mice or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other;
where the available fault current ❑ Marinas and boatyards.
CATEGORY #)F 41'RU�TtJN � .. _ amps exceeds 10,000 s at 150 volts m ❑ Floating buildings.
:
❑ 1- and 2 - family dwelling ®Commercial /industrial less to ground, or exceeds 14 ❑ Commercial -use agricultural
❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION . ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E", "1 -2 ", "1 -3 ",
Job no.: I Job site address: 11960 SW Pacific Hwy IOOHP or more. Rcueat
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard OR 97223 • ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCH EDULE
Cross street/directions to job site: ' oneriprioa T Fee Tool 1
2 _ Nov residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.:. 1.000 sq. ft. or less J 168.54 4
Ea. add' 1 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK ' ' (with above sq. ft.) 75.00 2
Voice/data/speaker cabling Limited residenttia above s q ft.) 75.00 2
Services or feeders Installationolteratioa, and/or relocation _
200 amps or less 100.70 2
Q PROPERTY OWNER I 13 mA}t1'1' 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 volts 552.26 2
City/ State/ZIP: Temporary services or feeders 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 I 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. Fee for branch circuits with
., 441Pj 3 1 0 CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: SAFE TECHNOLOGY GROUP INC. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: JASON SWEET branch circuit _
Each add'I branch circuit 7.42 2
Address: 6400 NE HWY 99 SUITE G375 Miscellaneous (service or feeder not included)
City/State/ZIP: VANCOUVER WA 98665 Each m service a or modular 67.84 2
dwelling, service and/or feeder
Phone: (360) 699 -2130 I Fax: : (360) 719 -1527 Reconnect only 67.84 2
E -mail: SALESQSAFETECHNOLOGY.NET Pump or irrigation circle 67.84 2
—
CONTRACTOR ,.,
Sign or outline lighting 67.84 2
Signal circuit(s) or limited -energy
Business name: SAFE TECHNOLOGY GROUP INC. panel, alteration, or extension.
Page 2 75 2
Each additional inspection over Allowable in any of the above
Address: 6400 NE HWY 99 SUITE G375 Additional inspection (I hr min) 1 66.25/ hr
hr
City/State/ZIP: VANCOUVER WA 98665 Investigation (1 hr min) 66.25/
Industrial plant (1 hr min) 78.18/ hr
Phone: (360) 699 -2130 Fax: (360) 719 -1527 Inspections for which no fee is
specifically listed ('/r hr min) 90.00/ hr
CCB Lic.: 173731 I Electrical Lic.: CLE79 I Suprv. Lic.: 4272LEA IF 7,15TRiCAL j'ERM1T FE
Suprv. Electrician signature, required: ,95,. ,, i r Subtotal:
w� Plan review (25% of permit fee):
Print name: JASON SWEET Date: 2 -20-12 , State surcharge (12% of permit fee): F.00
Authorized signature: ,afiriweri-- TOTA L PI RMIT FEE: Ty .003 This permit application expires if a permit b not obtained within 180
Print name: JASON SWEET I Dale: 2 - 20 - 12 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1 :\ Building\PVmitsELC- PermitApp.doe 07/01 /10
040461 s7p nros/confrw®
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
( RESIDENTIAL WORK ONLY:
Fee for a 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
FcoMMERCIAL 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
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
11 ABuildinglPamits 'ELC- PbvmaApp.doc 07/01/10