Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00561
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/26/2012
Parcel: 1 S 135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST
Project: Plaza West Restrooms Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: (2) branch circuits for remodel restrooms 2nd floor
Contractor: DYNALECTRIC Owner: SUN LIFE ASSURANCE CO OF CANADA
5711 SW HOOD AVE BY NORRIS BEGGS & SIMPSON
PORTLAND, OR 97239 121 SW MORRISON ST #200
PORTLAND, OR 97204
PHONE: 503 - 226 -6771 PHONE:
FAX: 503 - 226 -7720
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 09/26/2012 $63.60
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 09/26/2012 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 O R 952 -00 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 4Pr or 1.800.332.2344. A r
Issued By: Permittee Signature: tl ues4 .Idyl.
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 503.639.4175 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.
Sep. 26. 2012 7:39AM No. 0601 P. 2
Electrical Permit Application FOR OFFICE USE ONLY
of Tigard
't 13125 SW 1441l Blvd., Tigard, OR 97223
`; PermitNo. ; aced a, -ma
t °
i Phouai 503.718.2439 Fox: 503.598.1960 Ot Pamir
SEP 2 6 20
TIC;nitO Inspection Line: 503.639.4175 +ate Ready/11y: IBM el See Page 2for
Intcmel: w'tvtv,tigard -or.gov
p, VOF TO t If oti0od/Method: _ Supplemental Information
E e PAN REVIEW .
I'1'h Or WOR ! 9 44 1. rI thttl r lilmr∎
El Ncw construction N Addition /alteration /replacement
muse died all nun apply (submit 2 sets of plans «iiloms checked below):
❑ Scrtice or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: • where the available fault current ❑ Marinas and boatyards.
'CATEGORY. OR CO ". , exceeds 10,000 amps at 150 volts or 0 Floating buildings.
• less so ground, or exceeds 14 000 ❑ Commercial -use agricultural
❑
I. and 2- family dwelling DitCoomtercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- fotnily ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
• . . . . Q Rm event y system. larger separately derived system.
JOU SITE _INFORMATION AND LOCATION:. ' • :.. .. ❑ Addition of new mayor load of ❑ ••A ••l: • ..1.2 .] ",
/ ciR qa 1001 II r Of mores occupancy.
Job ltO.: Job site address' Q�Q � (,(,� Q Recreational vehicle parks.
O� _ ! El Sic or more residential units. parks.
/Slate /ZIP: 4-,4g
❑ Ilcatth -cnre facilities. ❑ Supply voltato for mote than
y , � r ❑ i Ia ardour locations. 600 volts nominal.
Suite/bldg. /apt. Ito.: „ / r Projectname: g1/ a - � //r ❑ Scniceor lcder600 ampsormorc. • FEE SCHEDULE
Cross strcehfdircetions to job site: 0tudp I Qu•. 1 Fn. 1 'rota I •
New residentlnl single- or multi- family dwelling unit.
I Includes attached garage.
-
Subdivision: J Lot 00.: 1,000 sq. ft. or less 168.54 4
Ea. add' 1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCItII' PION Or .Vl'ORIC ; (with above sq. ft.)
75.00 2
•
)� ,) Limited n aovt q . I 75.00 2
y,� residential feeders above ��t Services or feeders Installation, alteration, and/or relocation
200 amps or less 100,70 2
❑ PROPERTY. OWNER : _ ' ; ❑. TENANT • •:. i
: 201 amps to 400 amps 133.56 • 2
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 services or feeders instnllalion, alteration, and/or
City /State/ZIP: relocation
Phone: ( ) l Fox; ( ) - 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation:'I'his installation is being made on property that I own which is not 401 amps to 599 amps I68.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. -
Branch circuits- new, alteration, or extension, Qer panel -
Owner signature: _ Date: A. fee for branch circuits with •
• ❑ "APPLICANT. jj '- CONTACT PERSON' : -• above service or loader fee. 7.42 2
I' '• each branch circuit
RU$indti, name: B. Fee for brooch circuits 11•ithour
ef J , 7 J� d'.M1A " service or feeder lie, first / 56.18 56,,/g 2
Contact Itante: .:) ( 507) branch circuit
Each add'h branch circuit / 7.42 j v4 2
Address: r ,MIscellaneous (service or feeder not included) / r
City/Slate/ZIP: ' /Stale/ %II': Each manufactured or modular 67.84 2
dwelling. service and/or feeder
Phone: (.136) O">'AZO,o' 77/ I Fax:: ( ) Reconnect only ` 67.84 2
Pump or irrigation circle 67,84 2
E-mail: Sign or outline lighting 67.84 2
Cn� \'1'j2AcTOR' , • Signal eircuit(s) or Iimilcd-cnergY
Address:
Business name: /lam 2 C �� ~ 1 panel, alteration. or extension. I'rvv 2_ 2
Hach additional Inspection over allowable In any of the abov
Add 57g t_Sil' 66%&/91A-,.._._. Additional inspection (1 hr min) 66.25/ Iir
City/State/ZIP: ,o �ka� li eW
97
Investigation Industrial plant (I mm) 78.18/ In
60.25/ hr
Industrial plant (I hr min) 74.1
Phone: � / / /_
Ol -- dig . 0, 77/ 1'm: L 3) a id' • 77v InS chions for which no (be is _
specifically listed (/, hr min) 90.00 / hr
CCB Lie.: &(, 793 Electrical Lira' - Suprv. Lic.a1 (g535 . • ELECTRICAL PERMIT FEES
/ Subtotal: 3„(
Suprv. Electrician signature, required: - -- a !l 1r h , °t ' _ , I .1 Plan review (25 %ofpermit fee):
9.4 Print name: ,5-4 jjajz a S , Date: ,R D � l� , _ State surcharge (12% of permit fee): 7.40 3
1 "^ TOTAI. PERMIT Pf_li: 7/,, 3
Authorized signature: , This permit implication expires Ira permit is nut obtained oidtin ISO
- � , ii. . Ai/ _ `✓ 1�
' - i ` da otter It has been accepted as complete.
Print name: �� „ Uate' : (� Nunnberof inspections allotced er permit.
nniL
t „0dinswermudla.C- rern,i,npp.dee anon /10 1a0.46I ST( l /05/COsIM'tin
Sep. 26. 2012 7:39AM No. 0601 P. 1
Dynalectrlc Company
Dynalectric 5711 SW Hood Avenue
Portland, OR 97239
An EMCOR Company Phone: 503.226.6771
Fax: 503.226.7818
ccb: 66793
Faxsit , ie
Number of pages including this cover sheet: 3
Date: 9/26/12
•
To: Electrical Permit Department Tel:
Company: City of Tigard Fax: 503 - 598 -1960 •
From: Lynne McEachern
Message:
Following is a Permit Application to be processed, once a number has been issued, please
Fax permit to 503- 226 -7720.
Also, a Credit Card Authorization Form.
Thank You.
•
Dyne -019 Rev. 02/17/04