Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2012 -00097
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/15/2012
Parcel: 1 S136DCO2504
Jurisdiction: TIGARD
Site address: 7275 SW DARTMOUTH ST 180
Project: Pacific Dental Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Voice /Data Cable
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Contractor: PRECISION ELECTRIC OF WA INC Owner: AMERICAN INDUSTRIES INC
PO BOX 2353 1750 NW FRONT AVE STE #106
BATTLEGROUND, WA 98604 PORTLAND, OR 97209
PHONE: 360 - 260 -4544 PHONE:
FAX: 360 - 260 -4833
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/15/2012 $75.00
12% State Surcharge - Electrical 05/15/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
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 0 R 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: Permittee Signature: D �P� cil / D' A
I
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OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNERS 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.
MAY- 15- 2012(TUE) 01:24 Rays Plumbing (FRX)3608929644 P.002/003 c r
Electrical Permit Applicatio IlEI FOR OFFICE USE ONLY' .
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City of Tigard MAY 15 2012 Flimmnic -
111 • 13125 SW Flail Blvd.. Tigard, OR 9722
Phone: 503,7182439 Fax 503.598.19 - � OF TiGARD Other Permit;
TI GA RD Inspection Line: 503.639.4175 BUILDING DIVISION Ze �r rd See Page for
Intoner; www.tigard.or,gov Natlled/Metttsd; M rturpteraantal infermatIan
iwa" F4 .in. . Ma.. 1'r:= 'OF ?.WC1 ?;LI ,= . ; i a� ir • 3,E.1f: m." rr.rsN -
❑ New construction 0 Addition/alteration/replacement MI.aec check all that apply (submit 1 sets of plans wlltens checked below):
Q Service or feeder .100 amps or more 11 Building over three stories,
❑ Demolition ❑ Other: where the avnilahle Omit current ❑ Marinas and hualyahle.
! ''-J 4 2 F 4 i , r 1 a v - P - . A.C O F . 1 - 0 , I c i $ T R U Q I O N . S . . . : - ' . ' -' ..,i' ` ' ' exceeds mono ammo' 150 volt■oR 0 Plumin81hui1dImp.
less to umd, or exceeds 14 nn
gro ,0 ❑ Commr:relal•ase agricultural
❑ 1 - and 2- family dwelling Commercia l/industrial 0 Accessory building amps for all other installations. building&
❑ Mulli•fumiiy ❑ Masterbuilder ❑Other: ❑ Fite pump. ❑ Installation of75KVAor
- Q Emergency system. larger separately derived system.
;;. :!. s '
'- '3B_} ;'1 EOit r "L_-7ON1A�YP;i.OA'170"
N" ice` .:; 9
� ••�' t ..� - ..._ 0 - . . C ❑ Additiohh of new tttotor Ionia ❑ "A " , ` E","l.. ", ". `I•
1
72 c(� /L•1 0 11urma ye rna, Run ii
Job no.: Job site addregs: / r! / � ( ,� i
: / ❑ S lx er more resldrnt units. ❑ Recteatlutud whiela parts
t~It O Hcaltb.csrc facilities. ❑ Supply voile h for mina than
0 Hasvdous'nations. 600 volts nominal,
SultabidgJapt no.: I Paojcct name: g j.2 I1l41 I _ , -- O Service or feeder 600 amps or more.
Cross street/directions to job site: n.�.t n " 1 Qr•. i p.. C Tulsa 1
New residential single. or molti•family dwelling unit
Includes attached garage.
Subdivision: [Lot no.: 1.001130. II. or le 16 5,54 4
Eu. add'1500 sq. IL or portion 33.92 I
Tax map/parccl no.:
Lt energy. ' '- `DFSCRiP730NaO. WOIUC. � °' (with bovc Rdl nital 75.00
—.. ..:. .... Limited encr�, multi- family —
` 75.00 ,
/
V O ! c'L / 1 t. 644.k.- rssident(ul (with above aq _ _ _ _ ._
f Se or feeders Indallatlun. ullerution. uarllur relutatlun
.... �, .2 0 /2_ — D Q2�� =00 amps or lens 100.70
: +' � 201 amts to 400 amps 133.56 2
, ::�r�: � iii ,,oPttir,3c��yi`!i��' �,� ":•T `D.� �?
401 amps to 600 amps 200.34 2
Name: -
601 amps to 1,000 gimps 301.44 2
Address: Over 1,000 amps or volts 55::6 12
Temporary services ur feeders inslallatloa. niterution. and/or
City/State/ZIP: relocation
Phone ( ) I Fax: ( ) 200 amps or leas 59.36 I
201 amps to 400 amps 125.08 2
Owner Installation: This insmilation is being made on properly that I own which is not - --
Intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701, a01 amps l0 599 amps 1611.54 2
Ranch circuits • new alteration, or extensin , jr e panel
Owner signature: Dote: A. lee fur branch circuits with
ii .., ;;i.: �, Cl tAPPLI , :' : . JI .': cl % 4O14t4 I' I._ almvo wrvlca nr feeder rim, 7.42
ku =7� �i t : rnch brace h cimutt
i3uciness name, , ezi.s. j 2 e c_ 2 •v.6 R, Fcc fur branch circuta wuhour
service ar feeder fee. that
56.13 2
Contact name: -cr �aw J•1 1 bnmch she'll
Elicit atit M ulish eucuit ___L_2,4:
Address go 0.30 x 2 c'''.2
Miscellaneous (service or feeder not included) _L
CI /State L / Each m g, service a or modular 67,84 2
ty / G: G • y dwelling, service and/or !ceder
Phone: ('JGo ) 65r) , Z/L/ - Fax:: (Y6 o) LG e/ ?33 Reconnectunit 67,114
Pump or irrigation circle 67.34 2
E - mail: Sign or outline lighting 67.84 2
:= ,;,K::�si`:. ii;>» 1gtr', ice:..: r .. HCONTRit t OR. "1 , - = ' • ,,; ��; ' 'signal clrcult(s) or llmited•enemy
Businr�nnnlc / '� f' / e� �anrl Itipen :
S Each addUlonal Inspection over allowable In any of the above
Addrm A /3 x 2 3 s Addltlanol inspection (1 hr Coln) 66.25 / hr
City/State/ZIP: 6, t i. J\ 1'� q' a in plum ttrndn) 66.2.5! hr
industrial plain (1 fu mm) 711.111/ hr
'140 / L Fa l ) G L pecifi ally fur which nu I'ee is
Phone;
(SCo) I( 5� �,� o Gera ���� 9o.00rl,r
r,� � ap��ci0cally listed i' /, hr mini
CB Li �,
, e: 4 ° s E1cctricnl Lie.: Cis; J 4uprv. Lic.:3 ` c� zr.. ,&.: ..,, ;ECT1t1Ci►C, rERma -TEES : .
Suprv. Electrician s l u'equireti: !G r 1 2 summit
fee):
, � . ��� - Plun review (_5% of penult fee):
Print name: 7 . Dare: S _ _ft state surcharge (I21u of permit fee); ` • ��•� : — r T'O'TAL FEE: � PERMIT F � �
Authorized signature: — This permit application expires If a permit Is oat obtnlnrdwitbin 180
l i days after It has been accepted as cnmplcte.
Print name: � /. 161,A I , I Date: 5"....../ S • Number (%f iempeClinns allowed put 1'mm
t: lnuJIdInp0 re,pdulZLCC•PmnnApp.dsc 07/01/10 l MM1•W17Tt11/fg(COANWtt
MRY- 15- 2012(TUE) 01:24 Rays Plumbing (FRX)3608929644 P.003/003
Electrical Permit Application - City of Tigard
Page 2 - Supplement it Information
LIMITED ENERGY PERMIT FEES:
sm aioK» oSti * "_ :1 . .
Fee for a ll residential systems combined $75.00
Check Type of Work Involve&
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
E l Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
t` COMMERGl}ii:SX/ORKrOIV LY_ N ,, :; ,A,
Fee for si h 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
... LA''' .
❑ Fire Alarm Instillation
❑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 arc required. Licenses arc required
for all other installations
1.ua1{1A0011I I ti.c.rarUUAr Me 07mui0