Permit „ CITY OF TIGARD ELECTRICAL PERMIT
111 11 2 ` - COMMUNITY DEVELOPMENT Permit #: ELC201200030
•T1GA -AD- 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2012
Parcel: 1 S136CD01002
Jurisdiction: Tigard
Site address: 7910 SW PFAFFLE ST
Project: Wenyi Jia Dental Office Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: TI for dental office.
2/15/2012: REPRINTED for additional work (1) 100 amp service added to permit.
Contractor: FIVE STAR ELECTRIC, INC. Owner: PFAFFLE OFFICE, LLC
PO BOX 555 PCCC LLC
BANKS, OR 97106 915 NW TORREYVIEW LN
PORTLAND, OR 97228
PHONE: 503 - 324 -0948 PHONE:
FAX: 503 - 324 -0973
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/15/2012 $100.70
Specifics: amps or less
31 crt Branch Circuits w /Purchase 01/26/2012 $230.02
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Plan Review Electricial 02/15/2012 $82.68
Type of Const: 3 ea Info Process /Archiving - Lg 01/26/2012 $6.00
$2.00 (over 11x17)
Occupancy Grp: 2 ea Info Process /Archiving - Sm 01/26/2012 $1.00
$0.50 (up to 11x17)
1 ea 12% State Surcharge - 02/15/2012 $39.69
Electrical
Total $460.09
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 OAR 2-11 •0. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
i / ,.moo iC el
Issued By: / ��� Permittee Signature: 40A/ /5
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.
rilP CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00030
13 125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2012
TI' i f�, g Parcel: 1S136CD01002
Jurisdiction: Tigard
Site address: 7910 SW PFAFFLE ST
Project: Wenyi Jia Dental Office Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: TI
Contractor: FIVE STAR ELECTRIC, INC. Owner: PFAFFLE OFFICE, LLC
PO BOX 555 PCCC LLC
BANKS, OR 97106 915 NW TORREYVIEW LN
PORTLAND, OR 97228
PHONE: 503 - 324 -0948 PHONE:
FAX: 503 - 324 -0973
FEES
Quantity Description Date Amount
31 crt Branch Circuits wo /Purchase 01/26/2012 $278.78
Specifics: Service or Feeder
1 ea Plan Review Electricial 01/26/2012 $69.70
Type of Use: COM 1 ea 12% State Surcharge - 01/26/2012 $33.45
Class of Work: ALT Electrical
Type of Const:
3 ea Info Process /Archiving - Lg 01/26/2012 $6.00
$2.00 (over 11x17)
Occupancy Grp: 2 ea Info Process /Archiving - Sm 01/26/2012 $1.00
$0.50 (up to 11x17)
Total $388.93
Required Items and Reports (Conditions)
This permi issued subje • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance with appr• ed 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 re you to follow the rules adopted by the Oregon Utility Notifi ion Cen r. Those rules are -et forth in OAR
952 -101 -0010 thro gh OAR 952 -00 0 0. Y ay obtain a copy of the rules or direct questions to OUNC by callin 503.232.19 1. 00.33 .2344 , ,
Is ed By: Permittee Signature: / `
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' , �,� u � — ( , Date: //a -) ,/.•
LICENSE NO. 2./6? a-2S
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.
. _ .
. . .,.
Fax; Feb 10 2012 03:23.m P001 002
Electrical Permit Application i. oR 01 1..S.4..ON IA
City of Tigard RECEIVED . :
Receid 21/ABINIE Permit No.; . . , • o c. 1 . .
Ili ..-- I I, 13125 SW Hall Blvd., Tigard, OR 91223 Plea Review
--. Phone: 503.639.4171 Fax. 503.598.1KB 1 0 2012 Dot: :,, Other Permit: i I
4 . __ ..: / , ,
r: '... • Inspection Lim: 503.639.4175 Date Ready/Sr rads: 1E1 ee Page 2 for
i' i.'.i7;
• Internet: www.tigard-orgov . ARD Notifiedayiethod: . ' SP• Saggpietnental Inicatibrieu
''' 1-4 .4. "PA •.4.- . • •
7 :' '..,V.W .. 0:dtrr,.."F - 1.'' , ';',7:1,44 ,1 2:' A ::•,":,„, , `. 5, , - ,; . .,: . : .- ,i , ..0 , 6 itvf,1014: iit wee ,..;:
: .,, ,, ,..1,6,-... v ,:,........., ,. .. ',, '''.' ' j , e . .‹ 0A.A ' , ....-. ,, - / ,,,, ..!.::::%•-:':':',..'. t ,,,,, ' ,.,i ve 04. •T, • • " . ,.-•••• ••• •- , - , t. -. •••, • 4.'' - • ..
1... ew construction 0 AdditiOrilalterationkcplacement Please cheek ell that apply (submit a sees orplans w/isems checked below):
0 Service Or feeder 400 amps or more 0 Building over three stories.
U Demolition 0 Other: where die available fault current 0 Marinas and boatyards.
'''•.: - .-1 . ,' ) 4 ,- gfp , _444;04S4(101*ii ***.tiraiikieg?':':' exceeds 10,000 amps at 150 volts or 0 Floating beildings.
less te pxouncl, or exceeds 14,000 0 Conenercial-use agricultural
L:I 1- and Maraily dwelling q2:Zornmercial/industrial 0 Accessory building attos for all other installations, beildings.
0 Multi-fatoy 0 Master builder 0 Other: ' El rim pump. 0 testellation of 95 KVA or
tAtrkzw.rwl.704`014:,"t: ; , 74, , ; ;: ...i, ,„.. 4 17 s ,. '. ,; '' ," Itfif 4':;'' '.■ 4 :**4. 0 ,-, 2Ine 5"32. larger larger separately derived system.
r":•'••''''"7 t:' i. f .).;'' .. '' ..,' '.:•-..: 7;4 • ;Ii • .i. f '' .. ' .::....::: ' .',.',.:.... ,17 R..'..... ''; ::: LJ A440100 of 06P/ motor load of El "A", "E", "1-2", "1-3",
11121 ° 1
3 b s'te address: 4 0
':11Y7*-rireirerffilWAII 1001-31 or more, °carpal:toy.
Six more residential asks.
0 or
In R,eoreutional vehicle packs.
City tate/ _ r : \ 9 0 a,- - q --1,0 /7 9 / 0 °a.m.,. facilities. 0 Supply voltasc for racso than
1 0 Hazardows locoltions. 600 volts 11/0/Di718.i.
Suite/bldg/apt no.: Project name: alb ,..... ..
.4. , 0 service or Seeder600 or more
-7.1 ak-a211.-da. -,.....- j.k , _
0 ' •*, .,L.W.:44:‘ . ' ' 'otapilltiarn:Zil '''.... 17: .
...1 40 II " A
Cross street/direc '
tions to job site: i- 4v ite-4" i Description 1 1 •
Pi8W single- or mulli-faudly dwelling unit.
. • ...
• •• .... ... . • • Includes a ftaelsed estrgge• ,
Subdivision: Lot no.: 1.000 sq. It or less 168.54 4
- Ea. addl 500 sq. ft. or portion 33,92 1
Tax map/parcel no.: .
Limited energy, residential • 75.00 .
2
(with above sq. ft.)
.....r a,..„arsig , ' - -AR . I. , ............. miewomilmmumagi W-.....,. z . _.4'*-"tv'''Ir-:z.,:..--::....",,-'.'e'',''. Limit.4 energy, immi-farnilY 75.00 2
10
41 111111 " m "" I Ya l fe r610 • - , - , - , Ak _ --'' - -_ _ .„,,, ,,
residential (with above sq. ft) -
,...... 14 :4 17 1li tz. TAIr iaricwrimmia j r4orgailiiir, ait.....„., .."... ja...... k 2 Servil i 1 , ca or I f e e s e s ders installation alteration and/or relocation
4 - _ 4 .,.. -
1123Mligeg4W77 ani l" t° " nmPa 133
Vill 100.70 ,
.56 2
201
2
• • 401 amps to 600 amps 111111 20034 2
Name:
NV/ do sal amps to 1,000 amps 301.04 . 2
Address: dr A over 1,000 amps or volts 552.26 2
Temporaryserrices or feeders installation, alteradon, and/or
CitylStaz/ZIP:
relocation
Phone; ( ) Fax: ( • ) 200 amps or less - 59.36 ' 1 2
p
Owner instal/010m This installation is being made on property that I own which is not 201 amps to 400 man 125.08
168.54
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: .
_Date: A. Fee for branch circuits with
taa - 0;' , AWE , 71':;IV:1. 11 .J" ;.'' ../..4 . ;),:: : 11".4 5; :teitkUte ,4:;.•*4','449110R. above senrice or feeder fe, 7.42 F2
ww 7 , " - -- - . ''''.* )...'.;..-, . k....a - . ..... ...... • -. ..........7. ..-..: . 4.... .4* •'....., ..r4;,•177.., each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, fast 56.18 2
Contact name: branch circuit
Each addl branch circuit 7.42 1 2
Address: .
Miscellaneous (senice or feeder not Included)
Each manufactured or modular
City/State/ZIP: 67,84 2
_dwelling, service and/or feeder
Pbetie! ( ) FalC. : ( ) _ Reconnect only 67.84 2
E-mail: Pump °rang:anon circle • 67.84 2
Sign or outline lighting 67.84 2
gatEWME5 tff=1.1.,r..ZW.:?=-4 t:; Signal circuit(s) or tinned-crier
23/
• extens 2
.
Business name: ri e - ors IC\ C FA el alterati
O additional Inspection over allowable is any of the above
Address: . -- Additional inspection (1 hr min) 56.25/ hr
' 1 ■ nr, • . -
Investigation (1 la min) 66.25/ hr
City/State/Z.1P; .- . g . 0 . `1110to ,
Industrial plan/ (1 ter min)
78,18/ In
Phone: ( - .6 • Inspections for which no fee is 90.00/ hr
ll - . . It. 1111 MM./ o • -.. . 4 listed 3 min .
CCB Lic.: -y . . Electrical Lie.: - SuPrv- Lie-: L. 2-7.. '', . ka1:: ak
I t 4
Suprv. Electrician , • t - required: .V.... A P'..- ......... Subtotal: . 0:9
AL._ AI Plan review (2$% Of permit fee): :7., ---.1
. _ .
Print name! - l .. ix,- curn Date: .- 1 0 cp„. State surcharge (12% of permit fee): ,/,,..4 , () '
Il ... ..
Authorized signature: . TOTAL PERMIT kEE:
- - - -Ths parent appllearimsecepirea if a is not otunined-witto
Print name: -
Date; days after it In, beeia eteepted 2"; C° i
c, .............,
• Number of inspections allowed per permit. /0.,--7.3"
,.‘BuiltliV.PerretitaX.C-NrmitApp.doc 07/01/10 440-4615TV yosicavrowss
_ _ .
Electrical Permit Application ��� .. m '". FOR OFFICE USE ONLY
City of Tigard C Date /By / / Permit No.: la_�o30
Tigard, SW Hall Blvd., Tid, OR 9 Q��- Plan Review n � y
Phone: 503.718.2439 Fax: 503.59 \ N Date /B : _ /A' �t / 6 � I Other Permit: ��0� /� v "
Ins Line: 503 N 1 R � � A Date Rea. /By I Juris. See Page 2 for
TIGARD Internet: www.tigard- or.gov "� r l ..,-. N ot ifi ed /Metho 20 i 1 G �' � H Supplemental Information
. XP Ol- WrQ. . ii -- ... r P Y,1>
® New construction ❑ Addition /dlterati 11 Please check all that apply (submit 2 sets of plans w /items checked below):
r V ❑Service or feeder 400 amps or more ❑Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
` ` 0 exceeds 10,000 amps at 150 volts or El 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
- .z ❑ Emergency system. larger separately derived system.
OBIS F 211) ; 4 ' D- IKVAT DN
. • � . - � � . ,� � gO ❑ Add ition of new motor load of ❑ "A", "E", "1-2", "1-3",
Job no.: FS2686 Job site address 7 p�u S W Pfaffle St
1001-11) or more. occupancy.
� - ❑Six er more residential units ❑Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 / 0 El Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Dr Wenyi Jia ❑Service or feeder 600 amps or more.
UPION*VI*450
Cross street/directions to job site: 78 Ave Descri I Qty. I Fee. I 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
(14k 7 a . l - at iii-OR (with above sq. ft .)
Limited energy, multi- family 75.00 2
Wire new office - ground up residential (with above sq. ft.)
;/ — Services or feeders installation, alteration, and /or relocation
R U,1 q- �t��.` � ` e � (� � 200 amps or less 100.70 2
= RU'ERT ® D ER _T 201 amps to 400 amps 133.56 2
401 amps to 600 amps 1200.34 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
y 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
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
� above service or feeder fee,
CE -- --T�PER each branch circuit 7 42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 30 X 7 42 -664& 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
Y 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
4 €49TRA2T92_ , Signal circurt(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 min) ' 66.25/ hr
City /State /ZIP: Banks, OR 97106 Investigation (1 hr min) 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 (% hr min)
CCB Lic.: 158231 Electrical Li: 34 -'6650 ° ' '� Su ■∎rv`Lic:"``4622S' `"' " `
°_� ELECTRICyAL,PR141tfi�FEES y
Suprv. Electrician signature, required:�** ! �' „ Subtotal 126
�/6 J -j Plan review (25% of permit fee): 30.54
Print name: Royal Stearns Date: 1/18/12 1 State surcharge (12% of permit fee): 1t-76
TOTAL PERMIT FEE: 1-68.46
Authorized signature:
This permit application expires if a permit is not obtained within 180
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- 46t5T(11 /05 /COM/WEB