Permit CITY OF TIGARD ELECTRICAL PERMIT
, � COMMUNITY DEVELOPMENT Permit #: ELC2012 00484
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/16/2012
Parcel: 2S103DD00800
Jurisdiction: Tigard
Site address: 13815 SW PACIFIC HWY 50
Project: H&R Block Subdivision: MELROSE Lot: 7 -8
Project Description: (4) branch circuits for TI and low voltage for Data/Telecommunications
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Contractor: FIVE STAR ELECTRIC, INC. Owner: D W SIVERS CO
PO BOX 555 4730 SW MACADAM AVE #101
BANKS, OR 97106 PORTLAND, OR 97239
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PHONE: 503 - 324 -0948 PHONE:
FAX: 503 - 324 -0973
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 08/16/2012 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/16/2012 $18.41
Type of Use: COM Electrical
Class of Work: ALT 1 ea Signal circuit or Limited 08/16/2012 $75.00
Energy Panel
Type of Const:
Occupancy Grp:
Total $171.85
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 OA 9 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3332.23344. ( �
Issued By: Perm ittee Signature: vk Aeet ." ', 6 A ,
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:
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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.
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From:5 Star Electric 503 324 0973 08/14/2012 14:47 #006 P.002/003
Electrical Permit ApplicAE FOR OFFICE I: ONLY CI of Tigard Received Q�
g Date/By: 6 I � 12/ Permit No.6 POO — O0 y' ,94.
'11 - • 13125 SW Hall Blvd., Tigard, OR 97223'1 1 L 2012 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permits, _ — r
I' I t ;� r t Inspection Line: 503.639.417 n r+! f. Date Ready/By: 1u ® See Page 2 for 1
Internet: www.tigard Cam/ „ ., t �� Noutied/Method: I G Supplemental
l 7 ,; 7 ON PP emeatal Information
TYPE F K '�
- .. - � R . i -i ,�, n.,.JH ��' `;- � , -. , :_._, r v�,Ss Y pi:/�:`,l�,Vi�Ws�o= ��'<'�. -. ; "'�' i`.t±�
❑ New construction cgi Addition /alteration/replacement Please check all that apply (submit 3 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
El Demolition ❑ Other:
. .•. ?i '. ..,:,:ov -
where the available fault torten! Ma rinas and boatyar ds.
� ,.._s;- ; +':CATEGORY ; O�CONSTRUC'):'iON , - '?- ' ':; . exceeds 10,000 amps at 150 volts or 13 Floating buildings.
; y:" :`' l ess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ig Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder Other; Fire pump. ❑ Installation of75 KVA or
❑ y , .,: ❑ Emergeney system. larger tel derived system.
JOB�SITE INFORMATION AND ,LOTION Ea Y Y
" CA ❑ Addition of new motor load of ❑ "A ", "E", "1-2". "1 -3 ",
Job no.: )- 53o Job site address: 1 221 5 51./...3 Pct ' Cl• h e. tko ' ! l00HPormore• R c re atio n
❑Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: MCla yo C `' D D . 3 ❑ Health -care facilities. ❑ Supply voltage for more than
CI Hazardous locations. 600 vohs nominal.
Suite/bldg. /apt. no.: Project name: 14, I 1 ❑ Service or feeder 600 amps or more.
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Cross street/directions to job site: ip ioo I QtY•� E <SS'IiEU I Fe
I;E x Pee. T , o1a _, l
I
Description I e. ,7 � o1 � •
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'l 500 sq. R. or portion 33.92 1
Limited energy, residential
- .,`-- DE RIP9'JO)'r OF?W,ORK s NO; (with above sq. ft.) 75.00 2
Limited energy, muhi- family 7500 2
residential (with above sq. R.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
Q sPROPERTY :OWNER • „ 201 to 40 am
P ; �',: ` am Ps 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
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
i , ® a�;; :. ?:. .t = , °: f :.: ove or
.. ... AiPP1.IQA)VT, },,.> ..: � I , ��_�9�,�;_'C'�, CONTACT::,RF•1$O ME :t N ea bran service ch circuit feed ee, 742 2 er
Business name: B. Fee for branch circuits without
service or Contact name: branch circuit feeder fee, first 1 56.18 51j. 1 15 2
Each add'1 branch circuit 5 7.42 2'2.240 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
Sign or outline lighting 67.84 2
err .:,: i F.tt. "._. �...fg - C01.1TRA01'QYi > � ; °,r \_ ; M, Signal circuit(s) or limited-energy
Business name: Fj ve situ- e VeCkY.l C. I nG . panel, alteration, or extension. ( Page 2 ,--00 2
t Each additional inspection over allowable in any of the above
Address: -7 5 < ._ I mo' L vZ Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: Investigation (I hr min) 66.25/ hr
-- Industrial 7 , Industrial plant (I hr min) 78.18 / hr
Phone: ( ''rr �11 Q 2 s
`� `U9T__ � Fax: (�vJ _� / 7 Inspections a tions for which no fee is
tally listed (h hr min) 90.00 / hr
sp
B Lic. , 5c42,-. 6 c Lic.. - S ry Lic. : 1l'n ' t ;,: ;,
i i � � • �I 22 �� : k �,�� � «..inllr�c.�cw �� =, �k�.�:.:
Suprv. Electrician signature, required: r ` Subtotal: 1 53. q ` .
L) Plan review (25% of permit fee): 7
Print name: ' yL , ,-t eOi-✓'rl S Date: 3-14./-/, State surcharge (12 %ofpermit fee): I d, ti-
TOTAL PERMIT FEE: I ' R / ■ Authorized signature: This permit application expires if a permit is not obtained within 180 ✓
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1. Building \Permiu\F1.C- PermiiApp.doc 07/01/10 440- 4615T(i lros/COM/WEB
From:5 Star Electric 503 324 0973 06/14/2012 14:47 #006 P.001 /003
FIVE STAR ELECTRIC
COMMERCIAL/INDUSTRIAL/RESIDENTIAL
FACSIMILE TRANSMITTAL SHEET
TO: FROM:
City of Tigard Becca Sinner
COMPANY: DATE:
8/14/12
FAX NUMBER: TOTAL NO. OF PAGFS INCLUDING COVER:
503 - 598 -1960 3
PHONE NUMBER: SENDER'S REFERENCE NUMBER:
RE: YOUR REFERENCE NUMBER:
Electrical Permit
Thanks,
Becca Sinner
Administrative Assistant
Five Star Electric, Inc.
Phone: 503- 324 -0948
Fax: 503-324-0973
bsinner@fivestarelectric.org
756 SW Bailey Ave., Hillsboro, OR 97123 1t Phone: (503) 324 -0948, Fax (503) 324 -0973 * CCB# 158231
LICENSED • BONDED • INSURED