Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00694
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/22/2011
Parcel: 2S101AB00100
Jurisdiction: TIGARD
Site address: 12005 SW 70TH AVE
Project: Acupuncture Clinic Subdivision: Lot:
Project Description: Electrical work for acupuncture clinic. 12/22/11, issued pending plan review.
Contractor: FIVE STAR ELECTRIC, INC. Owner: RED ROCK BUSINESS ASSOCIATES LLC
PO BOX 555 23077 SW NEWLAND RD
BANKS, OR 97106 WILSONVILLE, OR 97070
PHONE: 503 - 324 -0948 PHONE.
FAX: 503 - 324 -0973
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/22/2011 $100.70
Specifics: amps or less
28 crt Branch Circuits w /Purchase 12/22/2011 $207.76
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/22/2011 $37.02
Electrical
Type of Const: 1 ea Plan Review Electricial 12/22/2011 $77.12
Occupancy Grp:
Total $422.60
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: Ore... 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 la Ili-00 . ou ay obtain a copy of the rules or direct questions to OUNC by calling 503 • - .1987 or 1.800.332.2344.
Issued By: Permittee Signature: ! . • L1 - ____
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' "7"0-_—s–__. Date:
LICENSE NO. 96);.9- 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 Applicati 1; ECEIVED FOR OFFICE USE ONLY
City of Tigard Date/Bed /2 g �I �� e �J,�/ 70 /„7
8 'f� Permit No. L. Q(K w
a 13125 SW Hall Blvd., Tigard, OR 97220
- 8 2011 Plan Review � + A/
Phone: 503.718.2439 Fax: 503.598.1960 Date /B . / ' /Q'J (YZVy Other Permit: ka i// �ad 9
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: .iuns Et See Page 2 for
Internet: www.tigard- or.gov Notified/Method ) // / 4ri Supplemental Information
Please check all that apply (submit 2 sets of plans w /items checked below)
® New construction El Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
' C exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Ckfir tr:i5 OIF Ri -_ (? .y
"` ' 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
❑Emergency system. larger separately derived system.
$I -' A ItD , �14f t OC'�Ali Ol d ❑ Addition of new motor load of ❑ "A" "E", "1 -2" "1-3",
70th I00HP or mote. occupancy.
Job no.: FS2558 Job site address: 12005 SW 70 Ave
❑Six or more residential units. ❑ Recreahonal vehicle parks.
City /State /ZIP: Tigard, OR 97223 IEI Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
Suite /bldg. /apt. no.: Project name: Red Rock Acupuncture ❑Service or feeder 600 amps or more
Cross street/directions to job site: it . u t FEEOHI g I I
Descri tion Fee. Total
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 75.00 2
r
e' _ t -- :R O, O��, _ ,y (with above sq. ft.)
Limited energy, multi - family 75.00 2
Wire and install electrical per plans residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less ( 100 70 /00. 70 2
p C Z-0,:„: l T t 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
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
ty relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
� =� - s - ° - � � above service or feeder fee,
�P wk i - � O �Rb'O0� each branch circuit Zt 7.42 '
� ' 2
Business name: 6 � y �- � �i . �� c..-- B. Fee for branch circuits without
� service or feeder fee, first .1.. �-� �Q
Contact name: ` branch circuit 56.18 �7�� 2
e �' L'� Each add'I branch circuit —e41, 7.42 4,34,44, 2
Address: 0 t0\4 sus Miscellaneous (service or feeder not included)
City /State /ZIP: / ^ Each manufactured or modular
ate I (
Phone: ) � p( Fax: (&,43),3-- j � � (/ dwelling, service and/or feeder 67.84 2
3� I / Reconnect only 67.84 2
` � ( — � Pump or irrigation circle 67.84 2
E b,-> ir
v C- t o� --E—L I'J- --`.C_ s CW
'� k Sign or outline lighting 67.84 2
s. Y >. l iii CONTI2ACfiOR '. , OW .1 SSignal circu1t(s) or limited- energy
Business name: Five Star Electric, Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: PO Box 555 Additional inspection (1 hr mm) 66.25/ hr
City/State /ZIP: Banks, OR 97106 Investigation (1 hr mm) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 324 - 0948 Fax: (503) 324 - 0973 Inspections for which no fee is 90.00 / hr
specifically listed (A hr min)
: - ?a.
CCB Lic.: 158231 Electrical Lic.: 34 -665C Suprv. Lic.: 4622S � „ ��T EGT�2TC .. I'E11��EZS _, , � la y6
S ubtotal c .?4,7& ,
Suprv. Electrician signature, required: 7 `
'' ,./.4074: Plan review (25% of permit fee): 567'11 77./
Print name: Royal Stearns 1- Date: 0.- 2 - II , State surcharge (12% of permit fee): 3xel
TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 80
Print name: Date: * days after it has been accepted as complete.
Number of inspections allowed per permit �`.,:` �
�
I '\ Building \Permits\ELC- PermitApp.doc 07/01/10 440.46 15T( I l /05 /COM /WEB'