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Permit
.� CITY OF TIGARD ELECTRICAL PERMIT ' -! g , COMMUNITY DEVELOPMENT Permit #: ELC2011 -00696 1 3125 S W Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/22/2011 T1GAR . 9 Parcel: 2S102AA00602 Jurisdiction: Tigard Site address: 11960 SW PACIFIC HWY Project: Tendercare Dental Subdivision: TIGARD HIGHWAY TRACTS Lot: 12 Project Description: Electrical for TI. Contractor: SUNLIGHT ELECTRIC INC Owner: AMAN, WALTER S CREDIT SHELTER TR 2800 NE 65TH AVE SUITE B 19217 SW 119TH AVE VANCOUVER, WA 98661 TUALATIN, OR 97062 PHONE: 360- 772 -3877 PHONE: FAX: 360 -694 -9728 FEES Quantity Description Date Amount 40 crt Branch Circuits wo /Purchase 12/22/2011 $345.56 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/22/2011 $41.47 Type of Use: COM Electrical Class of Work: ALT 1 ea Plan Review Electricial 12/22/2011 $86.39 Type of Const: Occupancy Grp: Total $473.42 Required Items and Reports (Conditions) This permit is • • to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done i• accordance with - , •roved - _ • . This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. TENTION. Oregon law -quires • o follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -00 -0010 thro. gh OAR 952 -00 • •90. Yo may 'obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Iss ed By: _ / • f Permittee Signature: 7 ,Y * 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' 4 ,i............... J °J Date: /7.0 LICENSE NO. / ( / 33 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 � �`v`O � Date/B \ � _ _.____. F o.FFICL_USL ONLY_ _ . ____.._ – ____ _�._ City of Tigard dzo\- \�'c3 \,, ed f O I � j Permi Oth er Pe rm No.: it: • / iL� "_ �� q II q 13125 SW Hall Blvd., Tigard, OR 9 NI �� Plan Review I Phone: 503.718.2439 Fax: 503.598.19'60 . Date/B : 12 2.1 1 1 G. L Zq /� ii T I G A RD Inspection Line: 503.639.4175 `\ l.J •1 rg� Date Ready/By: Juris. ® ee Page 2 for Internet: www.tigard - or.gov Notified/Method: !, // ', ` • Supplemental Information TYPE OF WO' ' ` S ✓� w PLAN REVIEW • ❑ New construction Addition /alteratlo .:cement 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. CATEGO Y 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 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 ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1.2 ", "I - ", Job no.: Job site address: / / 9 n w�] / 100HP or more. occupancy. I ! ✓ f� IV �V V p ❑ Six or more residential units. ❑ Recreational vehicle parks City /State /ZIP: ! I azar d ous l ocat i ons. care facilities. ❑ Hazardous ❑ Supply voltage for more than t�QC�� 600 volts nominal. Suite /bldg. /apt. no.: Project name: TP, 1, �ei„,.. Ca.,v_e_ Pelf ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I * New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: 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 DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi - family 75.00 2 residential (with above sq. ft.) Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 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 installation, alteration, and /or City /State /ZIP: relocation Phone: ( ) 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 Branch circuits – new, alteration, or extension, per panel Owner signature: Date: — tr. A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7 42 2 each branch circuit Business name: SCO 4, B. Fee for branch circuits without CO �` service or feeder fee, first Contact name: branch circuit 56.18 / 2 Each add'l branch circuit 2b9,3'3 3 9 7.42 2 Address: Miscellaneous (service or feeder not included) ) City /State /ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: 1 ii � �- l� , a rj - t J panel, alteration, or extension. Page 2 2 vL Each additional inspection over allowable in any of the above Address: 2 Roe /1/E [' E e ,4=-..e_ tt/ Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: V V) C o u V - e - 1, - IA/4 C�,/ 6/ Investigation (l hr min) 66.25/ hr ✓ fJ Industrial plant (1 hr min) 78.18/ hr Phone: (3 a 5/e. - --,57,9 Fax: ( s26- 966 p Inspections for which no fee is U ° specifically listed (%z hr min) 90.00 / hr CCB Lie.: 11-2 6 ,..9 Electrical Lie.: CZ 30 Suprv. Lie.: / rr 9s S ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: /"../7 j (25% Subtotal: 3 5, 51, ✓, b Pl an rev ( %of permit fee): t', • '?t q Print name:CA t= S.,t A 4l /la r i -f Date: / , © 3 , 7.0 / i State surcharge (12% of permit fee): AI. 4'7 Authorized signature: v L � % ` TOTAL PERMIT FEE: t v `' f ' J ` This permit application expires if a permit is not o •ned wit • 180 Print name: Date: days after it has been accepted co plete. Number of 1 inspections allowed per permit. ' -7 7,4 1: 1BuildinglPermits\ELC- PermitApp 07!01 /10 440- 4615TO 1 /05 /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* n 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: n A • udio and Stereo Systems ❑ Boiler Controls n Clock Systems ❑ D ata Telecommunication Installation ❑ Fire Alarm Installation n HVAC e Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ P rotective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I \Building'Permits\ELC- PermitApp doe 07/01/10 • This form is recognized by most Building Departments in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard 1111 Buildin g Division TIGARD TRANSMITTAL LETTER TO: lr G /Y�j� �'/ )1"/9 DATE RECEIVED: DEPT: BUILDING DIVISION R E C E IV ED �� 2 FROM: `,'� s tf �z �a �� £ CIT O 1 B UILD D VISIO COMPANY: � � / 1) 11 4 � G= l� GGr� 1 c PHONE: 3119 - 0 -- - 04 7 • RE: 1 d 9� � cci.J 7 � � t") C /r1 u� + 7 l 4 #) �% o�vt1- 00 (p � �(l ( " "ite Address) /. (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and /or lateral analysis. • Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): REMARKS: • FOR OFFICE USE ONLY Routed to Permit Technician: Date: Initials: Fees Due: ❑ Yes ❑ No Fee Description: Amount Due: Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: 1:\ Building\ Forms \TransmittalLetter - Revisions.doc 02/08/2011