Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00695
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/22/2011
Parcel: 2S101AB00100
Jurisdiction: TIGARD
Site address: 12025 SW 70TH AVE
Project: Dr. Sunil Thanik Subdivision: 1996 -024 PARTITION PLAT Lot: 2
Project Description: Electrical work for new dental office. 12/22/11, issued pending plan review. Plan Review approved 1/6/12 By GN
3/27/2012: REPRINT permit to add (1) data telecommunications system. DLH
Contractor: FIVE STAR ELECTRIC, INC. Owner: SUNIL THANIK
PO BOX 555 470 SW 6TH ST.
BANKS, OR 97106 LAKE OSWEGO, OR 97034
PHONE: 503 - 324 -0948
PHONE: 503 - 699 -6628
FAX: 503 - 324 -0973
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 12/22/2011 $201.40
Specifics: amps or less
44 crt Branch Circuits w /Purchase 12/22/2011 $326.48
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Signal circuit or Limited 12/22/2011 $75.00
Energy Panel
Type of Const: 1 ea Plan Review Electricial 12/22/2011 $150.72
Occupancy Grp: 1 ea 12% State Surcharge - 12/22/2011 $72.35
Electrical
1 ea Signal circuit or Limited 03/27/2012 $75.00
Energy Panel
0 ea Plan Review Electricial 03/27/2012 $18.75
0 ea 12% State Surcharge - 03/27/2012 $9.00
Electrical
Total $928.70
•
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 95 - 1 -009 . 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: Permittee Signature: DV 1/ Ci�O"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:
•
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4176 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.
CITY OF TIGARD ELECTRICAL PERMIT
• t: COMMUNITY DEVELOPMENT Permit #: ELC2011 -00695
• Date Issued: 12/22/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S101A600100
Jurisdiction: TIGARD
Site address: 12025 SW 70TH AVE
Project: Dr. Sunil Thanik Subdivision: 1996 -024 PARTITION PLAT Lot: 2
Project Description: Electrical work for new dental office. 12/22/11, issued pending plan review.
Contractor: FIVE STAR ELECTRIC, INC. Owner: SUNIL THANIK
PO BOX 555 470 SW 6TH ST.
BANKS, OR 97106 LAKE OSWEGO, OR 97034
PHONE: 503 - 699 -6628
HONE: 503 - 324 -0948
FAX: 503 - 324 -0973
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 12/22/2011 $201.40
Specifics: amps or less
44 crt Branch Circuits w /Purchase 12/22/2011 $326.48
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Signal circuit or Limited 12/22/2011 $75.00
Energy Panel
Type of Const: 1 ea Plan Review Electricial 12/22/2011 $150.72
Occupancy Grp: 1 ea 12% State Surcharge - 12/22/2011 $72.35
Electrical
•
Total $825.95
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in ac . _ " - 'th approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT" 'TION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificati Center. Those rules are set forth in OAR
952-001-1.10 through OAR 952 -00 0. u may obtain a copy of the rules or direct questions to OUNC by callin 3.232.1987 or 1.800 32.2344..
Issue. By: PermiUee Signature: •
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' _ _ ✓ &SW. ,., Date:
LICENSE NO. fo, S
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. t,
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
From: 03/23/2012 14:08 #156 P.002/004
11 •
El ectrical Permit Applicati( w y , orl� lct_ l';1: O, I
• . City of Tigard M AR 2 3 2012 R Dat -2/47F i . % PamitN ELC2- OOX
0 UR
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598. }96Q. , Date/B : Other Permit:
Inspection Line: 503.639.4175 OF T G n3i �D Date Ready/By: 0 See Page 2 for
- I i c . I.JB i Y : 1 ■ I) p r ;13!': Notified/Method: Supplemental Information • Internet: www.tigard- or.gov BUILDING �,•bE 7$ _
�t� ^'- `+�`f?a!' yam -�� '``�I's'�..�:;i �. dX'.5�!�d'.hWORK:::. `�;, ., :„ • - .-`"L `ht�'.2 '�;,.',• iii li `�r:: '�'"i`gt .r.:. , FE ' /1�, ;;;+ :'r; `r:
❑ New constructionAdditiodalteration /replticement
Please check all that apply (submit 3 sets of plans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: where the available fault current ❑ Marinas and boatyards.
�...,� „ wa , gs' vo ❑ Floati buildings.
'
. <' l ° ` •n, rK ;« Aire TEGO)l LOY ON tUC 9k:, .. :' amps at 150
i...�,•%k'..- ..��.et;�.::,..: :1/a...., _. ..r >. .... ... . ... agric ultural
, , ` less to ground, m exceeds 14 lts or ❑ Comm erc ng i al -use
❑ 1- and 2 -family dwelling Zommercial/industrial ❑ Accessory building amps for all other installations_ Immune.
❑ Multi family ❑ Master builder 0 Other: Fin 75
� pump, Inrtallati of KVA or
- 1 -3" •
,.E derived tem.
;�a;��,� .. ,:� -,.. - - - - , :;. ❑ EmergeaeY system. larger DIY �
¢ �" � -JO . .X0.0010..:7 ;<� « . .
�.,.�,�� c58F.wtX<,._ : «: �. w- .xe.�n ��.'_,.,._ -_ �t._.. _ .., • . _ ...... .... ... ... ,..... ❑Addition of new motor toad of ❑
Job no.:�S2(¢ Job site address: 1 Z ) a -7 61 j kg, t0011Pormore. occupancy.
(�
ID Six or mom residential unite. ❑ Recreational vehicle parks.
city /$t3te/ZIP: ai�� (^ s l �Z O Hazardous localion. ❑ Supply far more than
i
J facilities. a 600 votes s norm ltage for
Suite/bldg. /apt no.: P roject name: � � q ❑ Service or feeder 600 amps or more.
L :7Y.,�,..�: _Y�Y, �l ` 5 ;3..C•� ° " ". $` °'' s's rF '•. i:�'
Cross street/directions to job site: f nrxrt °earn 1 Qtr. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. R or less 168.54 4
Ea add'1500 sq. ft. or portion 33.92 I
Tax map /parcel no.: - energy, residential 75.00 2
� 1t' aili- : r b 4:0 `~Y r s : ..:4 ::::';: ; •H (with above sq. ft.) "::
�h�. ���=`, �- �.' �' ��: ��' i:,' ��, �?'! ?�„DE ?`:r <::�,.w,,.
Limited energy, multi- family
l v 75.00 2
6 \ c 1 Da-�`� residential (with above sq. ft.) -
��� L O r N Services or feeders inatalletion and/or relocation
t y -IOC / 200 am m 100.70 less 100.70 2
�(.,} a. � }��rgp en, : _ - ia= r -x l _ �.4�:_ ,;. 400 amps 133.56 2
' 1° �' �• �". u �" �L�'.: t ± ���I�1Gh��. k: �M: sj ��. �.:::: ���-` ���'.'i� { : ?�`: =��:�� ". �'�.: "''`- ':' i s �.:�,�:`:_; �: 201 amps to
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary d services or feeders installation, alteration, and/or
City/State/ZIP:
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is 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, per panel
Owner signature: Date: A. Fee for branch circuits with
�m:::is } f' {tom:` "M y ! - ..�.:` y az+s::: {,e�r;: #z i'.i: �� 'i:':.ii;�� ..,... , :: above service or feeder fee, 7.42 2
± �r,; .` naF. 4.' Q #17- err. *' � =,,. x, r ..r • i5t1 OD.r AC , :� - ";' :- - i . is- each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included) modular
City/StatelZIP:
Each manufactured service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
4:fitaSg -ate'+' µ; : ,,,�: iXiS R*0_ ORtai.,'.; ,;< . si circa 8 or ii m ir o d. triergy Business name: panel, alteration, or extension. I' Page 2 7.' 2
Fl V e (. IKC:t Y 1 L t ► r1 L . -
Each additional inspection over allowable ble in any of the above
Address: - p d -?..0.4. 's - Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 6625/ hr
City/State/ZIP: (
'Earl 1--S c)$ 7 11D t o Industrial plant (I hr min) 78.18/ hr
Pho ( a1/+ _o q 41 Fax: (5�) 3 _ 7 ? 7 Inspections for which no fee is 90.00/ hr
/ specificail listed 444 hr min)
:, �.,, y ,. �. _ .rt • ;; - 31/ + 3fz•"2'i 5ii'd�..
CC Lic.: 1 e'SSZZ31 ✓Electric Lic.:3- 5 tiptyZi 25 :,.'�t%; ri g Cl;i:cP l$ ,Sx t�„f`l a : Tt
Subtotal: 75:
Suprv. Electrician signature, required: °7 7
e'e• ..s - ^ �' Plan review (25% of permit fee): / 7
Print name: ?otyki SteoUr-n State surcharge (12% of permit fee): 9. zit) s Date: � a'3 � ( -��
Authorized signature: TOTAL PERMIT FEE: /Oa 7S
This permit application expires Ka permit 1s not obtained within 180 'O
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
tABuddingwermiteELC- PermitApp.doe 07/01/10 40.4615Tptm5/COM/WEB
From: 03/23/2012 14:08 #156 P.003/004
Electrical Permit Applicatic • 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 gh commercial $75.00
system
(SEE OAR 918 - 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
2 g -1 - 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
1AuWtdi,gwenniu\Ecc- rcmtApp.d« 07ro1/10
Electrical Permit Application 9ECEII ONLY C ity of Tigard FOR OFFICE USE ON , ved �
13125 SW Hall Blvd., Tigard, OR 97223
. 11 1 4 4 Date/B : r� EM P Permit No.: &".".e.,940/ dO. ..- 1
0 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960
DEC 8 2011 1 12 c. Other Permit: / o / ∎ � . 2„/r
DateB 7
T l C A r 1:1 Inspection Line: 503.639.4175 Date Ready/By: luris: Fa See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: I V (0._ /rt+ Supplemental Information
TypE of Wo L fl - 1' ISIt�1� �i 777 ` PL
® New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more El Building over three stories.
Demolition where the available fault current El Marinas and boatyards.
CATEGORY OF CONSPRtcrIoN exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2 - family dwelling ®Commercial /industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑Other: 0 Fire pump. p ❑ Installation of 75 KVA or
3OB SHE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
. ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "I -3 ",
Job no.: F514,211 Job site address: Iai;2g' SW 70` Ave I OOHP or more. occupancy.
❑ 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.: Project name:
or.; � t e l ®� 0 Service or feeder 600 amps or more.
Cross street/directions to job site: Fly
Description I Qtr. 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
•
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
+_ Limited energy, residential
"" - % '. DESCRIPTI OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
Wire and install electrical per plans residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 2 100.70 20I, t}O 2
•5!..... mill • R
�''" I 1:1 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 volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fa ( ) 200 amps or less 59.36 1
Owner installation: This installation is 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, per panel
Owner signature: Date: A. Fee for branch circuits with
4 - APPLICANT I ❑ CONfA� PERSON above service or feeder fee, 459 ��
7.42 ' 2
each branch circuit
Business name: - J 3J- ( a ,n - B. Fee for branch circuits without
""L ` 1� service or feeder fee, first
Contact name: branch circuit 56.18 2
b
dd
Each Eac a'I branch circuit 7 .42 2
Address: b%.....s._-Q-- 144 `aYo
�� ( h t`� Miscellaneous (service or feeder not included)
City /State/ZIP: ',, (� Q Each manufactured or modular
r ��-- 6 !-J I1) dwelling, service and/or feeder 67.84 2
Phone: ` � J I.4.- • C ( Fax: (�� � ?,..i-1-.097 - � Reconnect only 67.84 2
(t Pump or irrigation circle 67.84 2
E - mail: ') \ 1(1(� -f-0— 1\{�.Q V1- -t_(` t. o1�
Sign or outline lighting 67.84 2
` CONS RACTOR Signal circuit(s) or limited- energy
Business name: Five Star Electric, Inc. panel, alteration, or extension. Page 2 t� 2
Each additional inspection over allowable in any of the above
Address: PO Box 555 Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Banks, OR 97106 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 324 - 0948 Fax: (503) 324 - 0973 Inspections for which no fee is 90.00 / hr
specifically listed (%z hr min)
CCB Lic.: 158231 I Electrical Lic.: 34 -665C Su . Lic.: 4622S ELECTRICAL PEOIIT FEES
Suprv. Electrician signature, required: t Subtotal: t ,
�,��� Plan review (25% of permit fee): , /e h . 72
Print name: Royal Stearns Date: 12 - U - 1 1 State surcharge (12% of permit fee): g g 74.
Authorized signature: U TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: • days after It has been accepted as complet� 9S
Number of inspections allowed per permit. ! �J / JJJ
I:\ Building \Pennits\ELC- PermltApp.doc 07/01 /10 440.4615T(11/05/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:
Q Audio and Stereo Systems*
El 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
. El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
•
for all other installations ,
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10
From: 03/23/2012 14:08 #156 P.001/004
RYE STAR ELECTRIC JY
COMMERCIAL/INDUSTRIAL/RESIDENTIAL
FACSIMILE TRANSMITTAL SHEET
FROM:
Community Development Becca Sinner
COMPANY: DATE:
City of Tigard 3/23/12
FAX NUMBER: 'POTAI. NO. OF PAGES INCLUDING COVER:
503 - 598 -1960 4 if-
I'FIONE7, NUMBER: SENDER'S REFERENCE NUMBER:
RE: YOUR REFERENCE NUMBER: _
Electrical Permit Adder f ( j j
Thanks, l• /
f
Becca Sinner
Administrative Assistant
Five Star Electric, Inc.
Phone: 503- 324 -0948
Fax: 503-324-0973
bsinner@fivestarelectric.org
•
P.O. Box 555, Banks, OR 97106 * Phone: (503) 324 -0948, Fax (503) 324 -0973 * CCB# 158231
LICENSED • BONDED • INSURED