Permit 4 CITY OF TIGARD ELECTRICAL PERMIT
II I 2 CO MMUNITY DEVELOPMENT P #: ELC2012 00280
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/15/2012
Parcel: 2S 115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY S
Project: Gentle Dental Subdivision: 2004 -015 PARTITION PLAT Lot: 1
Project Description: Electrical TI
Contractor: FIVE STAR ELECTRIC, INC. Owner: SN PROPERTIES PARTNERSHIP
756 SW BAILEY AVE 1121 SW SALMON ST
HILLSBORO, OR 97123 PORTLAND, OR 97205
PHONE: 503 - 324 -0948 PHONE:
FAX: 503 - 324 -0973
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 10/15/2012 $201.40
Specifics: amps or less
67 crt Branch Circuits w /Purchase 10/15/2012 $497.14
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 10/15/2012 $83.82
Electrical
Type of Const: 1 ea Plan Review Electricial 10/15/2012 $174.64
Occupancy Grp: 5 Misc Administration Fee 10/15/2012 $5.00
Total $962.00
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 ordance wi pproved 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. ENTION: Oregon I • .. • es ou to follow the rules adopted by the Oregon Utility Notificat • • - enter. Those rules are set forth in OAR
952 -00 -0010 th •ugh OAR 952 -1 -009'. • may obtain a copy of the rules or direct questions to OUNC • • , - ' • • 03.23 . • � 987 or 1 800.3 .2344.
�/ / / r
Issu By: =/` Permittee S gnature: �' _4(. < - '
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. .6? 4.5
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 Application E - - FO OFFICE O NLY =
City of Tigard E1 Date /B : 49I' Permit No.: "�I
Recet�ed
13125 SW Hall Blvd., Ti ard, O ' 91 t t'
Tigard, Plan Review
Phone: 503.718.2439 Fax: 503.598. q Date /B Other Permit
6]
T I GA +IfD ! Inspection Line: 503.639.4175 U 1 .5 202 Date Ready /By' loos: ® See Page 2 for
- Internet: www.tigard or.gov (T Notified /Method Supplemental Information IGARD
TYPE 0 - 1 4 t ■ " 1 PLAN REVIEW
1t '' Please check all that apply (submit 2 sets of plans w /items checked below):
X New construction III Addition /.R . . e I
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling NI 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 -3 ",
Job no.: Job site address: WZ 100HP or more. occupancy.
�313D Sh l�ec:( < i - I l � y ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: •- n t/x it^ g /cI / q -72 ❑ Health -care facilities. 12 Supply voltage for more than
t v'1 t ❑ Hazardous locations. 600 volts nominal.
Suite /bldg./apt. no.: Project name: , ID Service or feeder 600 amps or more.
�— �� /t — 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'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
n5-mi. .t 1 J YI o .aL -/ n Lo tb:Iri 1 residential (with above sq. ft.) 75.00 2
� ✓ t' Services or feeders installation, alteration, and /or relocation
200 amps or less a 100 70 1 I .4D 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 1 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 0 e /9 7 . 19
❑ APPLICANT' ❑ CONTACT PERSON above service or feeder fee 7.42 L 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56.18 2
Each add'I branch circuit 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: Five Star Electric, Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 756 SW Bailey Ave Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: Hillsboro, OR 97123 Investigation (I 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 (Y hr min)
CCB Lic.: 158231 Electrical Lic.: 34 -665C Suprv. Lic.: _ LL5 c ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: � • Subtotal Z W9/
Plan review (25 % of permit fee): r K 3j/ 4 1'
Print name: /1 J (�1 e ,, �� Date: ID/ i 2I 12_ State surcharge (12% of permit fee): ' #4 -F5* S3 V
-Co Y l TOTAL PERMIT FEE: 31 .R
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. 00
Print name: Date: * Number of inspections allowed per permit.
I \Building \Permits \ELC -Perm it App doe 07/01/10 440- 4615T(1I /05 /COM/WEB .1f 1I e9D — 4 K _/ _ _
Electrical Permit Application ,..).. FOR OFFICE USE.ONLY . •
•
City of Tigard RECEIVED Recei if Pe rmit No.: QQ
g RE Date /Bved y: 5 rI 1!. �� eg o - so
13125 SW Hall Blvd:, Tigard, OR 97223
C Phone: 503.718.2439 Fax: 503.598.1960 Date /By: Plan Review 00 9. . mod• Other Permit. 4K4 a -0007/
TIGARD Inspection Line: 503.639.4175 MAY 1 1 2012 Date Ready /By: kris. Pi See Page 2 for L
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
i
TYPE OF W0fi fYO HUARLD,. / 7 ( J/e,4,/. ! 0 PLAN REVIEW '
❑ New construction Addition /alteraM/te``p%arneril V ISIOIV 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.
El Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
'CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. •
f less to ground, or exceeds 14,000 ❑ Commercial -use agricultural t
11 I- and 2- family dwelling ,2 fommercial /industrial' 1:1 Accessory building amps for all other installations. buildings. J
1=1 Multi-family ❑ Master builder 12 Other: ❑ Fire pump. ❑ Installation of 75 KVA or II
JOB SITE INFORMATION AND LOCATION . ❑ Emergency system. larger separately derived system.;
❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "I - ",
Job no.: Job site address: ((p' LJ ( C.1 FI L, ' li„1 IOO or o more residential Recreational occupancy.
p 5 Y �� 0 or more residential units. ❑Recr
City /State /ZIP: %/6 , 6 (Z / 22 Health -care facilities. ❑Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg./apt. no.: l j Project name: G �.� b�• ❑Service or feeder 600 amps or more.
FEE SCHEDULE
•
q 4116 4116 oss street/directions to job site: Description I Qty. I Fee. 1 Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
4 ubdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
t Ea. add'I 500 sq. R. or portion 33.92 I
\` Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK . • - • (with above sq. R.)
Limited energy, multi - family
(tJQ 1 cE. ►at (
`r 7rt.ovc_wtc.ar ,g4„,,, �Cr,'TLt
cr_ residential (with above sq. ft.) 75.00 2
` � Services or feeders installation, alteration, and /or relocation
DeN r/4 - t ✓ ' r 200 amps or less 7. 100.70 g vo 2
❑ PROPERTY OWNER TENANT. , 201 amps to 400 amps 133.56 2
' Name: /�_ b 401 amps to 600 amps 200.34 2
GI_ 601 amps to 1,000 amps 301.04 2
�� Address: //6 / L� -ri a�i, , ' Over 1,000 amps or volts 552.26 2
►`\1 City /State /ZIP: r atico uvQe A 9 53 Temporary services or feeders installation, alteration, and /or
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
APPLICANT CONTACT PERSON, above service or feeder fee, 7 42 7 /y 2
.., ! each branch circuit
Business name: p
P `/ k C'e B. Fee for branch circuits without
service or feeder fee, first
/r
Contact name: 0,
ri s branch circuit 56.18 2
��l
Each add'I branch circuit X 7.42 2
. Address: Web 4 Ve g./4. - _, - D2 xe 2oz Miscellaneous (service or feeder not included)
City/State/ZIP: S � c3 15 9/ '2 3 Each manufactured or modular 67.84 2
li e c oriew dwe l ling, service and/or feeder
r
+lir. hone: ( 3/3 ) 7863 _8Q 6,0
Fax: : (
E 1. ` ) Reconnect only 67.84 2
/
n �� NS /a � ,2n/ rp G � c .GO Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR �� . Signal circuit(s) or limited - energy
Business name:
panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
Il City /State /ZIP: Industrial plant (I hr min) 78.18/ hr
s % Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (h hr min) 90.00/ hr
■
CCB Lie.: Electrical Lic.: Suprv. Lie.: . ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal: •S �
Plan review (25 /u of permit fee): / ei (pT _
Print name: Date: State surcharge (12% of permit fee): its • $ ,'„
TOTAL PERMIT FEE: 9x
Authorized signature: —
This permit application expires if a permit is not obtained within 1av
Print name: Date: days after it has been accepted as complete.
� • Number of inspections allowed per pennit.
1:t Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I1 /05 /COMAVEB
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Permit No.:
Date/
u 13125 SW Hall Blv Tigard, OR 97223 Plan Review
Phone: 503.7 (8.2439 Fax: 503.598.1960 Received
Date/B : Other Permit:
TI G A It D Inspection Line: 503.639.4175 Date Ready/By: Juris: 63 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 2 Addition /alteration/replacement 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.
CATEGORY 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 2 /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 ", "I -2 ", "I -3 ",
Job no.: Job site address: ((Q' // ' r 1, IOOHP or more. occupancy.
..i.3 ( -pttt I rl tY ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: % ).6760 , 6 (2 p /'7 22 9 ` .ErHealth -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: G , , ,e,„10( I ❑ 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: AVIIMI lW 1,000 sq. ft. or less 168.54 4
it Ea. add'( 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: a `, , Limited energy, residential 75.00 2
DESCRIPTION 0 WORK \ (with above sq. ft.)
Limited energy, multi - family 75.00 2
to cr1g(c.)0 ct"vv r 7 %rvt f (LC ✓Cc1ACror t 4 residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
DEN t.." 200 amps or less 2. 100.70 2
❑ PROPERTY OWNER I $TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: On P.6,1KC b ,44
-4 601 amps to 1,000 amps 301.04 2
Address: /to / ! 'Ttc.h Cafe r 'Dr. Over 1,000 amps or volts 552.26 2
City/State /ZIP: �iA�p� ' 8�0�3 Temporary services or feeders installation, alteration, and /or
U h 1 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
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
APPLICANT I ' CONTACT PERSON above service or feeder fee, 7 42 2
5E 1 - '4. each branch circuit 7
Business name: Pe ,' 14 M C f B. Fee for branch circuits without
// service or feeder fee, first �J^^ � 56.18 2
Contact name: �.i1�r / ®®"rQrri 5 . branch circuit / /
Each add'( branch circuit 7.42 2
Address: fge/ (/ UJg,/ D 2...c.)Z Miscellaneous (service or feeder not included)
City/State/ZIP: C 9� 3 Each manufactured or modular 67.84 2
ty / ef4YJ d 4 S dwelling, service and/or feeder
Phone: (6 /8 ) 786o -8g6 Fax: : ( ) Reconnect only 67.84 2
E -mail: 01 t / 7 rP�t • CO/14 Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR 1-11,517 Signal circuit(s) or limited- energy
Business name:
panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (%1 hr min) 90.00 / hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Q Subtotal: 9 8, S
Plan review (25 /o of permit fee): i i Li , G cf
Print name: Date: State surcharge (12% of permit fee): `-) L
TOTAL PERMIT FEE: / 5 z t)=
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete. lin
Num of �j
inspections allowed per permit: � rte` � � J
1:\BuildingWermitswLC- PermitApp.doc 07/01 /10 440- 4615T(II /05 /COWWEB i
From:5 Star Electric 503 324 0973 10/15/2012 14:18 #046 P.001/002
RYE STAR ELECTRIC
COMMERCIAL/INDUSTRIAL/RESIDENTIAL
FACSIMILE TRANSMITTAL SHEET
TO: FROM:
Debbie
•
Becca Sinner
COMPANY: DATE:
City of "Tigard 10/15/12
FAX NUMBER: TOTAL. NO. OF PAGES INCLUDING COVER:
503 -598 -1960 2
'BONE NUMBER: SENDER'S REFERENCE NUMBER:
RE: YOUR REFERENCE NUMBER:
Permit Payment
Thanks,
Becca Sinner
Administrative Assistant
Five Star Electric, Inc.
Phone: 503- 324 -0948
Fax: 503- 324 -0973
bsinner @fivestarelectric.org
756 SW Bailey Ave., Hillsboro, OR 97123 * Phone: (503) 324 -0948, Fax (503) 324 -0973 * CCB# 158231
LICENSED • BONDED • INSURED