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Permit (235) • • • n . CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 1111 I: C OMMUNITY DEVELOPMENT Permit #: ELR2012 -00253 T LGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/13/2012 Parcel: 2S115BA02500 ' Jurisdiction: Tigard Site address:, 16200 SW PAC IFIC HWY°S • Project: Gentle Dental Subdivision: 2004 -015 PARTITION PLAT Lot: 1 • ' Project Description: Low voltagefor voice/data /sound, as one system. • • Contractor: TELEDIGIT INC Owner: SN PROPERTIES PARTNERSHIP PO BOX 22287 1121 SW SALMON ST PORTLAND, OR 97269 PORTLAND, OR 97205 • • PHONE: 503 - 722 -8084 PHONE: - FAX: . 503- 722 -9914 FEES Description , Date Amount Specifics: • Restricted EnergyPermit 11/13/2012 $75.00 • 12 %State Surcharge - Electrical 11/13/2012 $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: Y 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: N 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 i - •r•an.- ' h 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. ; ENTION: Oregon ow re. =s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-1.1-0010 thr•ugh OAR 952 -01 ••90. ou - obtain a copy of the rules or direct questions to OUNC by calling 503.23 87 or 1.800.332.23 . sued By: I %i _� /� � i . 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. �'`'°�v~` °° Electrical Permit Application E L, e , 0/.-- 3 - .1 Current Planning ��� Washington County, 155 N. 1s AV, Suite 350, MS 12, Hillsboro, OR 97124, Approval �. °REGO," Phone: 503- 846 -3470, Fax: 503- 846 -3993, Project # Ins • ection Re. uests: 503 - 846 -3699, www.co.washington.or.us TYPE OF WORK PLAN REVIEW ❑ New construction ►2 Addition /alteration /replacement ❑ Other: Please check all that apply: ■ Service or feeder 400 amps El Hazardous or more where the available 0 Service or feeder 600 amps or more — CATEGORY OF CONSTRUCTION fault current exceeds I=1 ❑ I- and 2- family dwelling Commercial /industrial ❑ Accessory building 10,000 t Di Building Marinas and boatyards less to ground or exceeds ❑ Multi family ❑ Master builder ❑ Other: 14,000 , • ■ ' ' ' F Commercial agricultural - 1 C3 JOB SITE INFORMATION AND LOCATION installations. ■ buildings l 6 4) b O � (/1� �.-• ■ ■ • Job no.: Job address: � `� � �G 'I�yi , t KVA or larger QQ 11'a� 1 separately derived system ....,.. City /State /ZIP: j f -(�w ■ Addition of new . of t t ' . motor . ■ l Recreational vehicle parks Suite /bld /a S I ProJ ject name: 6-6 Fl ■ I g P t. no.: ■ ■ Supply voltage for more than 1/4 ■ facilities Cross street/directions to job site: S V V{ �r" 4 qq� I t volts nominal W V Description s N Subdivision: I Lot no.: Residential single- or multi-family dwelling unit. --..., Includes Tax map /parcel no.: 1,000 , ft. or DESCRIPTION OF WORK Ea. add'I 500 sq. ft. or portion ' Limited V o102_i b4 o s� t Limited energy, multi - family 105.00 2 residential (with above sq. ft.) ❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation, alteration, and /or relocation 200 amps or less 105.00 2 Name: 201 amps to 400 amps 158.00 2 Address: 401 amps to 600 amps 210.00 2 City /State /ZIP: 601 amps to 1,000 amps 315.00 2 Over 1,000 amps or volts 630.00 2 Phone: ( ) I Fax: ( ) Temporary services or feeders installation, alteration, and /or relocation Owner Installation: This installation is being made on residential or farm property owned by me or a member of 200 amps or less 105.00 2 my immediate family. This property is not intended for sale, exchange or rent. (ORS 479.540(1) and 479.560(1). 201 amps to 400 amps 158.00 2 Owner signature: Date: 401 amps to 599 amps 210.00 2 ❑ APPLICANT I ❑ CONTACT PERSON Branch circuits – new, alteration, or extension, per panel A. Fee for branch circuits with Business name: above service or feeder fee, 9.25 each branch circuit 2 Contact name: B. Fee for branch circuits Address: without service or feeder 105.00 fee, first branch circuit 2 City /State /ZIP: Each add'I branch circuit 9.25 Miscellaneous (service or feeder not included) Phone: ( ) I Fax: ( ) Each manufactured or modular 111.25 2 E -mail: dwelling, service, and/or feeder Reconnect only 105.00 1 CONTRACTOR Pump or irrigation circle 105.00 2 Business name: e �1 ! ' � �� _ !Flo 105.00 _© P. 0 - 8 a as T5 � Signal circuit(s) or limited Address: panel, alteration, 105.00 City /State /ZIP: p e }` i OR cr Describe: Phone: (57)3) as gOtSy F ((Z3) �a� l� 19 additional E-mail : 5 t'.; ( B lic. no.: ` `�� Per inspection 105.00 _- Electrical lic. no.: ~ l' ` a - Cit or metr lic.: Other: ELECTRICAL PERMIT FEES Supervising electrician _ signature, required: Subtotal 7�j Print name: , �(� �� as Plan review ( 25% of permit fee) r �yLJ�v1� (k p s Date: �, /1) Authorized State surcharge (12% of permit fee) � i r ■ signature: TOTAL PERMIT FEE gyi. Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete • Number of inspections allowed per permit. Revision 6/12 •