Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00224
TIGAR 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05129(2012
Parcel: 1S136DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH ST 180
Project: Pacific Dental Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Electric for new dental office
Contractor: PRECISION ELECTRIC OF WA INC Owner: AMERICAN INDUSTRIES INC
PO BOX 2353 1750 NW NAITO PARKWAY
BATTLEGROUND, WA 98604 PORTLAND, OR 97209
PHONE: 360 - 260 -4544 PHONE: 503 - 478 -6603
FAX: 360 - 260 -4833
FEES
Quantity Description Date Amount
Specifics: 3 ea Info Process /Archiving - Lg 05/29/2012 $6.00
$2.00 (over 11x17)
342 Electrical Permit 05/29/2012 $342.38
Type of Use: COM 86 Plan Review - Electrical 05/29/2012 $85.60
Class of Work: ALT 41 12% State Surcharge - 05/29/2012 $41.09
Type of Const: Electrical
Occupancy Grp:
Total $475.07
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. AT ION: Ore!' law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 010 through OAR 9 - ' ) • - r. You may obtain a copy of the rules or direct questions to OUNC b >- - v .1987 or 1.800.332.2
Iss ed By: ! /' 0 ■ , Permittee Signet i � .r4.i��' pL--------
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' et" Date:
LICENSE NO. 3 PA 5
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 Application ,� FOR OFFICE USE ONLY �� y
O t. R I
City of Tigard ,�` ,���JJJ `� Re
Received v : jI Permit No.: �' ) (� ,\
II • 13125 SW Hall Blvd., Tigard, 0 � 3 1 � i ' 0 � Pl an Revie .1 �` CJ
C n Q► Date/ / /0- ' -.; Other Permit: ewe' O l o t -6mi 7
Phone: 503.718.2439 Fax: 503. 98.19688 G ` Date Ready/By. �GJ"�r Cam'
TIGARD
Inspection Line: 503.639.4175 Q.` 4N Date ^ , t _ ®See Page 2 for
it
,p,
www.tigard - or.gov Q 1 0\ Notif. . ethod: / /� /L t 1 , -- j Supplemental Information
TYPE OF WO � V iK4 A /el!
New construction ❑ Addition/alterati5 Pleas 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 41 ❑ 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 ",
--7 1001-IP or more. occupancy.
Job no.: Job site address:
/ (its / 7i',i (" \ ❑ Syr6r more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Air_ T G� ealth care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: A roject name: / e �� ) ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Oty. I Fee. I Total I
/ New residential single- or multi - family dwelling unit.
Qa 1 10 � T < i f /( ., 4)7 ', Includes attached garage.
Subdivision: — _ f f Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
A. Q �/ I U e Aka._ /I l�f � , I r ' C residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER El" TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: P/4),■ f ,F, c_. e GZ / 601 amps to 1,000 amps 301.04 2
Address: 72 2 C 5- �1rr�� a C/ C2" ` ( ) Over 1,000 amps or volts 552.26 2
^ City/State/ZIP: L �� �L �` Temporary services or feeders installation, alteration, and/or
/ tY , V 9� 2 relocation
Phone: ( ) I 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
Ia Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
,121 APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
' Business name: / c / ��y� /�� / � B. Fee for branch circuits without �S Of service or feeder fee, first rr 5
&, J 4 I N) branch circuit 56.18 2
ma c, Contact name: S `� ` L
Each add'I branch circuit 3 ..-111% 7.42 0-L�4r , 2
Address: / 7C> 6 p x'7 3 53 Miscellaneous (service or feeder not included) 2302D Z
� City/State/ZIP: « ry / . / � ` /t A.. �� / Each manufactured ee a or r modular
feeder 67.84 2
ty /� (� '�" "' � h � I dwelling, service and/or feeder
) 26 d d / /L/ / ( ) 4 Reconnect only 67.84 2
(
Phone: 36v / Fax : : 3Gd 2G /FI 3 �
Pump or irrigation circle 67.84 2
H E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
�� panel, alteration, or extension. Page 2 2
Business name: . ft/... e l c,_,....1_ t h ��Gl�'Lof 4,4....._ /° U J t�' Each additional inspection over allowable in any of the above
Address: , 0% . 6 „, .re V 2_ �. Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr —■
City/State /ZIP: j ! C, ti , 'Y� � ,,( w4 -'/' Industrial plant (1 hr min) 78.18/ hr
Phone: (i�� Z6 G�/s /G Fax.1 ZA 4/ Inspections for which no fee is 90.00/ hr
specifically listed (Y2 hr min)
CCB Lic.: J6 Ern Electrical Lic.: ---/ Suprv. Lic.$ 27/ c E LECTRICAL PERMIT FEES
b' i 77114 7j92 t Subtotal: — V 0
Suprv. Electrician signs e, e' wired: ^
– �..� ` Plan review (25% of permit fee): te 5
Print name: r l �� � f � Date: State surcharge (12% of permit fee): 411. O
' ` j TOTAL PERMIT FEE: 114 9, Q
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as comp) ,,,,# V 4 . av
Print name: - /76 r ./1-1 Date: • Number of inspections allowed per permit/WO rs _�
% I:\ i uilding \'ermits\EI.C- PcrmitApp.dot 07/01/10 440- 4615T(11/05/COM/wE8 �� �, ` V q 7 � O
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
ritESIDENTIAL 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 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
p 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
C \ Building \Permits\ELC- PcrmitApp. 07/01/10