Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
!? COMMUNITY DEVELOPMENT Permit #: ELR2012 -00038
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2012
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: Burglar alarm.
Contractor: ACE SECURITY Owner: PFAFFLE OFFICE, LLC
5200 SW GREENWOOD CIRCLE PCCC LLC
TUALATIN, OR 97062 915 NW TORREYVIEW LN
PORTLAND, OR 97228
PHONE: 503 - 750 -9351 PHONE:
FAX: 503 - 692 -4547
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/28/2012 $75.00
12% State Surcharge - Electrical 02/28/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: y Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
•
Issued By: . Permittee Signature: _
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
2/27/2012 10:43 AM FROM: Rec Recore Inc. TO: 5035981960 PAGE: 004 OF 004
Electrical Permit Applicationr,
i i. FOR OFFICE USE ONLY
City of Tigard 1,. Received.
Permit No.:
cy g gy DaklBv. a �� ., 0,2 i / 61.34,9 i 13125 Halt Blvd., Tigard, 0 Plan Revie p
' Phonc:..503,71$.2439 Fax 503.598.1,% Y A {�O DatelRv: °lb I'dnig / DOa
Ins ciion Line: 503.639.4175 C` ` Date 8eady/By,: luris` ® - See Page 2 for •
Internet www'.tigard- or.gov' �� O N Q` �t \ % \J Notified/Method Supplemental Information
- - - TYR$ OF WO�. t, \ � PLA�i. ItEvIEw..
• • ❑ Nlew.constniction ❑ Addition/altisa p lacement Please check.au that apply(submit.j seta of plans w /Items checked below):
❑Service or feeder 400 ainps.or mole C,Building 'over 'three stories
D Demolition ® Other whert.the available fault current ❑ lvfarinas and boatyards
. .. CATEGORY O'F CONSTRUCTION . • • exceeds ib.000 amps at 150 volts or ❑ Floating buildings.
lm to ground, or exceeds 14,000 ❑ COUll,..reial - use dgricuhural
❑ I -and 2- family dwelling ® CotnntetbiaVini)iistrial ❑Accessory building gimps fvi ell other installations. ln+ildings
❑ Mu1ti- 4a111ily ❑ Master builder 0 Other: ❑ fire pump. O Installation of 75 KV A or
JOB SITE INFORMATION AND . ❑ Emergency system. larger separately derived system
. ... ❑ Addition of new motor loadof DA""[-2",
Job rio,` Job site address: 7910 SW Pfaffle 100111 or:more. occupancy,
❑.S;x or more:residential units. ❑ Recreational which, parks,
. City /State/ZIP: Tigard, OR ❑ Healthcare facilities. ❑ Supply voltage for more than
❑'Hazardous Locations. 600volts nominal.
Suite/bldg./apt. no_. Project name: l�/CNyi S/ I ��rr�L ❑. ce o r f 600 arnps.or more.
Cn s street/directions to job site: Off/ FEE: Sc I 'Pe 1 Total ' I •
• New. restdcntlal.eingle- ormulti- farmyy dwelling unit:
• Includes attached garage..
Subdivision: 'Lot no,: 1, 00 0_sq. it.orless ' 168.54 1 4
. . Ea., add'I 500 sq. ft. or portitat 53.92 • 1
Tax,map/parcel no.:
. . .. Limited
�titrd.ertergy, residential 1 7320 75:00 2
DESCRIPf ION OF- WORK.. . :: : • .: - (wilhabove sq: it) .
Limited e n e r g y ' , : multi- fondly. .. ' .. .
install alarm system residential (with above agfl.1 t 75.0(1 • 12
Sen'icca or feeders lnstaiation,alteration, and/or relocation
v
- 200 amps or less 100:70 • 1
❑ PROPERTI( OWNER .. . • -I- - . . 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 nr volts 552.26 2
City/State/ZIP: Temporary services.'or feeders installation. alteration, and/or
relocation
' ' Phone: ( ) • ::Fax: ( ) 200 amps ur less _ - 59:36 t
Owner installation: 'This installation is being made on that I own whichis not 201 amps 1.0400 amps 125.08 z
44 401 amps lo.599:amps 168.54 2
ORS
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Owner signature: Date:. Branch circuits - new, alteration, or extension, per panel
. .. A:Fee for branch circuits with •
above ae[vice or feeder fee,
❑ APPLICAN I. ❑CONTACT PERSON each ltrttnch circuit 7A2 2
l3usiness.nante: B. Fee for bram:h cirurits without .
- ---. — service:or feeder fee, rust 56:18 2
Contact, name: branch circuit
- • . • Each add'I brash circuit 7.42 I 2
• Address: Miscellaneous (service or feeder not Included)
.:CitS' /State/ZI . Eae dwel i n g , servi or a modular �- 6784 12
lling; service and/or feeder _ �
:Phone: ( ) Fax:: ( ) Retumreet only 67.84. 2 :
Pomp ur irrigation circle - 67.84 2
E- mail:: - .
.... - CONTRACTOR .. .. • Sign or outl)ne lighting 6724 2
.__� Signatcincait(e) or limited -energy
Business name: Ace Security , panel, alteration, or cxicnsion Page 2 . 2
Each additional inspection over allowable in any of the -above .
Address: 5200.sw Greenwood circle Additional:inspection (1 hr min) 66 -25 /ht
City /State/ZIP: Tualatin, OR 97062 Investigation (1 hr min) 65.25 / hr
r Industrial plant (1 hr min) 78.18/ hr _
Phone: (503) 750.9351 n f i' - F ax: ($03) 69 $ `6 i Inspections for w hich no fee is 90.00/ — � / specifically ('h hr'min),.
GCB Lie.; 48350 / O' / ' Electrical Lie.: 3- 226CLE 7 j / spx
upi tic.: 569LEA . ELECTRICAL PERMIT -FEES'
Subtotal: 75.00
Surrv. Electrician signature, tequi
Plan review (25% of permit. fee):
• Print name: Mark Recore Dater 2 -27 -2012 State.surcharge (12% of permit .fee); : 9,00
Authorized signature:_ /!, / n _ A TOTAL, PERMIT FEE: ' 84:00
1 �.�� This permit application erptres if a permit is not ohtaincd within 180
Print , • dame: Mark Recore. Dale: 2-27 =2012 • daysafter It has been accepted as complete.
.Number of irnpeetioaa allnwed perpermrt
iuowtd rglParmts\til.C.PenntAppdoo. 07/01110 440 I 105/C,04GWEa
2/27/2012 10:43 AM FROM: Recore Inc. Recore Inc. TO: 5035981960 PAGE: 002 OF 004
Electrical P 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:
0 Audio and Stereo. Systems*
Q Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning Systeni*
❑ Vacuum. Systems*
❑ Other:
COMMERCIAL WORK ONLY: .. , ... - •
Fee foregeh commercial $75.00.
system
(SEE - OAR 918- 309-Q000)-
Chec Type of Work Involved:
❑ Audio and Stereo.Systems
❑ Boiler Controls
❑ Clock Systems
❑ D ata Telecommunication Installation
❑ F ire Alarm Installation .
❑ .HVAC
❑ .Instrumentation
❑ Intercom and Paging Systems
❑ Landscape :Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
® Protective Signaling C, Sv,(L,(sA t)- ` -vv‘.
❑ Other
Total number of commercial systems: 1
*No licenses are required.. Licenses are required.
for all other installations
1•Anikdng.Pemnc∎6I -Peni WAPPQne 07/n1/10.