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Permit • , CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2012 -00265 1 3125 S H all Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/08/2012 TIGARD g Parcel: 1 S136DCO2504 Jurisdiction: TIGARD. Site address: 7275 SW DARTMOUTH ST 160 Project: Benitoite Nail Subdivision: HUNTER POLLOCK NO.2 Lot: G Project Description: (6) branch circuits for TI 5/9/2012: REPRINT permit to add (1) phone line. Contractor: VAST ELECTRIC Owner: AMERICAN INDUSTRIES INC 1525 SEATTLE SLEW DR. SE 1750 NW FRONT AVE STE #106 SALEM, OR 97301 PORTLAND, OR 97209 PHONE: 503 - 566 -7274 PHONE. FAX: 503 - 585 -8828 FEES Quantity Description Date Amount 6 crt Branch Circuits wo /Purchase 05/08/2012 $93.28 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/08/2012 $11.19 Type of Use: COM Electrical Class of Work: ALT 1 ea Restricted Energy Permit 05/09/2012 $75.00 Type of Const: 1 ea 12% State Surcharge - 05/09/2012 $9.00 Electrical Occupancy Grp: Total $188.47 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 0; - 49 - 101 -00'0. You may obtain a copy of the rules or direct"questions to OUNC by 503.232:1987 or 1 :800.332.2344. DA/ /9"/ f _/ /C - '1 77O Issued By: Permittee 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' Date: LICENSE NO. Call 603.639.4176 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 1111 2 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00265 T I G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/08/2012 Parcel: 1S136DCO2504 Jurisdiction: TIGARD Site address: 7275 SW DARTMOUTH ST 160 Project: Benitoite Nail Subdivision: HUNTER POLLOCK NO.2 Lot: G Project Description: (6) branch circuits for TI Contractor: VAST ELECTRIC Owner: AMERICAN INDUSTRIES INC 1525 SEATTLE SLEW DR. SE 1750 NW FRONT AVE STE #106 SALEM, OR 97301 PORTLAND, OR 97209 PHONE: 503 - 566 -7274 PHONE: FAX: 503 - 585 -8828 FEES Quantity Description Date Amount 6 cR Branch Circuits wo /Purchase 05/08/2012 $93.28 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/08/2012 $11.19 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $104.47 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 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. AT' NTION: Oregon 'w e•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -00 1010 th • ugh OAR 95 %'s 1-00'0 ou may obtain a copy of the rules or direct questions to OUNC by calling 50 232.1987 or 1.800.332.2344. / Issue d By: � - ti /[■/.•. Permittee Signature: �1, . �\ t. . ��'• �_� 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 L ONLY SIGNATURE OF SUPR. ELEC' — *a02 - / B' Date: lai tg/ i LICENSE NO. Y 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 Applica I n roll orrlct: t. si: oy I., City of Tigard 1 CEIVED De/B 5/1 � . MI Permit No.: ek eao /a - co de. S 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.1I960. 8 2012 Dat ; • Other Permit: 1 . I �_ RD Inspection Line: 503.639.4175 Date Ready/By: turn: ® See Page 2 for Internet: www.tigard - or.gov C., TIGARD Notified/Method: Supplemental Information nrilittilEINWIDI VISION PLAN REVIEW ❑ New construction 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 stories. ❑ 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 ❑ 1- and 2- family dwelling eig Commercial/industrial ❑ 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 13 Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E", "l -2 ", "1 -3 ", - O' (k VA Y`O , 1 1001m more more. Recreational Job no.: Job site address: S & ISO u t �1'� ‘ 0 Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: -- \ . Q /\ . ` — /)� ❑ Health - care facilities. ❑ Supply voltage for more than J l 1� v ❑ Hazardous locations. 600 volts nominal. i u i ldg. /apt. no.: \U 0 Project name(Q -4.0 ik V c ` _ s ❑ Sennce or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description l Qty. I Fen l Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. 11. or less 168.54 4 Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. IL) /1 n .' L energy, multi - family 75.00 2 P V V∎12.AAt 0-Q Trot residential (with above sq. ft) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ 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: ( ) I Fax: ( ) 200 amps or less 59.36 I 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 ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first ( 56.18 4 • i4 2 Contact name: branch circuit Each add'I branch circuit 5 7.42 ''61, f 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2 E - mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 C C Signal circuit(s) or limited-energy Business name: \ V `� 0A-14N-it_ 1/\. k- T� panel, alteration, or extension. Paget 2 f Each additional inspection over allowable in any of the above Address: l 5 l� ( n,� _ 1/40 0 �� e Additional inspection (1 hr min) 66.25/ hr City/State/ZIP: (� / Q AM 0 ct77 , 0 Investigation (I hr min) 66.25/ hr ✓ Industrial plant (I hr min) 78.18/ hr Phone: ) 194 -� ,a 7 Fax: (, 5p3) s j _gga g Inspections for which no fee is t I 1 specifically listed ('h hr min) 00 hr CCB Lic.: 5 ( Electrical Lic.: .Z Su Irv. Lic.: Si , S ELECTRICAL PERMIT FEES Subtotal: • ; 2"g Suprv. Electrician signature, requi t i le, Plan review (25 %of permit fee): �—�— Print name: 1 , ' ► f' ' (, ►��,� Date: 5 �� State surcharge (12 %of permit fee): / 1 . / TOTAL PERMIT FEE: / D y . if Authorized signature: 7 This permit application expires if a permit is not obtained within 180 Print name: I Date: days after it has been accepted as complete. • Number of inspections allowed per permit. 1:\ Building \Pennits\ELC- PermitApp.doc 07/01/10 440- 4615T(t1105/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: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other I COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: p 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 I:I Building \Peimits\EL.C- PermitApp.doe 07/01110