Permit 4
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
gi
Transmittal Letter
T I G A R D 1312525 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: fr:Cr DATE RECEIVED:
DEPT: BUILDING DIVISION
RECEiVr:D
FROM: s eG FEB 2 b 2020
COMPANY: Co84, GtJil c C f,. GI-I Y 01- ileARC1
9UILDING DIVISlov
PHONE: 9 7 l Z 5Z-) 1 Z-7 `- By:
RE: ---?(D5" Sw -1 .,P-r,vk Ct.-C.2oz0 — 0000
(Site Address) ( (Permit Number)
tj&t l -kt �44 4 �2.vCt-1
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: D cription: Copies: Description:
Additional set(s) of plans. ✓Revisions: akr,ti-.`-- o--k,.1D(�c:_u i01--,
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: u se.k \--T_A-- 0P St0G,!An; w/ 2 sQ'i-s c16 ela-o S
FOR OFFICE USE ONLY
Routed to Permit Technici ate: Initials:
Fees Due: ❑ Yes or" Fee Description: Amount Due: '—
$
$
$
$
Special
Instructions:
Reprint Permit(per PE): ❑ Yes ❑ No G Done
Applicant Notified: Date: �1 l?-- lz�-./ ,''`,•• s:
1:\Building\Forms\TiansmittalLetter-Revisions_061316.doc . i a /7_,_
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard i` r'" z , r.` Received J r
41 13125 SW Hall Blvd.,Tigard,OR 972/3[ L L.• . Date/By: a Permit#: C ZD.
Plan Revier�� IV
al Phone: 503.718.2439 Fax: 503598.1960 Date/By: 7 tzar ._ Related Permit#:
Inspection Line: 503.639.4175 FEB 2 b 2C/n Ready Date/B� ` ' tad:: I ® See Page 2 for
T I t .\It P Internet: www.ti d-or. ov Notifi-• i
gar g _1r,LSupplemental Information
❑New construction ®Addition/alte l 1M' : - '" • 1:16 ��I�� y. ease check all that apply(submit 2 sets of plans w/items checked):
a-\g II Service or feeder 400 amps or more ❑Building over three stories.
D Demolition El Other:
(R where the available fault current CI Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑Hooting buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
0 Multi-family ❑Master builder amps for all other installations. buildings.
❑Other: ❑Fire pump. 0 Installation of 150 KVA or
❑Emergency system. larger separately derived
['Addition of new motor load of system.
Job#: Job site address:7105 SW Hampton 100HPormore. ❑'°A",°E","I-z',"13",
City/State/ZIP:Ti gar d, OR 97223 ❑Six or more residential units. occupancy.
INHealth-care facilities. ❑Recreational vehicle parks.
Hazardous locations. ❑Supply voltage for more than
Suite/bldg./apt.#: Project name: T GD Sterilizers 0 600 volts nominal.
IDService or feeder 600 amps or more.
Cross street/directions to job site:
Description Otv. Each Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168• .54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
Limited energy,residential
(with above sq.ft.) 75.00 2
Add/Recircuit prep space in dental clinic Limited energy,multi-family •
for new sterilizers .
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
Services or feeders installationt_alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax: ( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Cochran Inc above service or feeder fee, 7.42 2
each branch circuit
Contact name: Gary Eade s B.Fee for branch circuits without •
service or feeder fee,first
Address: 7550 SW Tech Center Dr . Suite 220 branch circuit 1 56.18 56. 18 2
City/State/ZIPTigard, OR 97223 Eachadd'lbranchcircuit 15 7.42 11 . 30 2
Miscellaneous(service or feeder not included)
Phone:(971 ) 250-1273 I Fax: :( ) Each manufactured or modular 67 84 2
dwelling,service and/or feeder
EmailGEades@Cochraninc . com Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name: Cochran Inc Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
7550 SW Tech Center Dr . Suite 220 panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:Tigard, OR 97223
Additional inspection(1 hr min) 66.25/hr
Phone:( 9 71) 250-1273 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
EmeiLGEades@Cochraninc . com Inspections P 90.00/hr
CCB Lie.:72942 Electrical Lic.: 3 7—5,4 6 C Supr. Lic.: 6 2 7 7 S s.ecificall listed 'A hr min
Suprv.Electrician signature,required: / Subtotal: 1 6 7 . 4 S
Print name:Mi k e Grogan e 2/2 5/2 0 ❑Plan Review Required(25%of permit fee): 41 . 87
a/ State surcharge(12%of permit fee): 0 . 1 0
Authorized signature:, C/ TOTAL PERMIT FEE: 229 . 45
This permit application expires if a permit is not obtained within 180
Print name:Gary ades Date: 2/2 5/2 O days after it has been accepted as complete.
* Number of inspections allowed per permit.
lAuilding\Permits\ELC_Permit pp_ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/wEB
CITY OF TIGARD ELECTRICAL PERMIT
'. COMMUNITY DEVELOPMENT Permit It: ELC2020-00001
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/12/2020
TIG;\R - 9 Parcel: 2S101AC01300
Jurisdiction: Tigard
Site address: 7105 SW HAMPTON ST
Project: Kaiser Dental Subdivision: BEVELAND NO.2 Lot: 18-19,P
Project Description: Electrical work for TI.
Contractor: COCHRAN INC Owner: KAISER FOUNDATION HEALTH
7550 SW TECH CENTER DR#220 PLAN OF THE NORTHWEST#838
TIGARD, OR 97223 ATTN PROPERTY ACCOUNTING
500 NE MULTNOMAH ST
PORTLAND, OR 97232
PHONE: 503-234-6564 PHONE: 503-348-6291
FAX: 503-238-2098
FEES
Quantity Description Date Amount
16 crt Branch Circuits wo/Purchase 03/12/2020 $167.48
Specifics: Service or Feeder
1 ea Plan Review Electricial 03/12/2020 $41.87
Type of Use: COM 1 ea 12%State Surcharge- 03/12/2020 $20.10
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $229.45
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 rmit 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 How the s adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA -001-0090. You may in a cop the s or direct questions to OUNC by calling 503.232.198 00.3 2.'i'44.
f 1
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.
Electrical Permit Application FOR OFFICE USE ONLY
Received
IN City of Tigard RECEIV Datery Permit#: 1...,G097:d0 -did°I
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/Bir Related Permit#:
Inspection Line: 503.639.4175 MAR 12 2020 Ready Date/By. orris: Bt See Page 2 for
I t,:l It ll Internet: www.tigard-or.gov Notified/Method: Supplemental Information
1.4. R, . vw-�
t}s,
❑New construction El Addition/alteration/replacement Please check all that apply(submit 1 sets of plans w/items checked):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
ii: A where the available fault current ❑Marinas and boatyards.
"f" rr -ell rt; 'tJ �r ii' . ' exceeds 10,000 amps at 150 volts or ❑Floating buildings:
0 1-and 2-family dwelling ►1 ComnteIcial/industrial IN Ac -yyratat g less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑ Master builder • Other: 0 Fire pump. ❑Installation of 150 KVA or
'. s g"' ); -, ❑Emergency system. larger separately derived
0 Addition anew motor load of system
Job#: Job site address:7105 SW Hampton 100HPor more
. ❑"A","E","l-z","t-3
Six or more residential units. occupancy.
City/State/ZIP:T i ga rd, OR 97223 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: TGD Sterilizers 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder b00 amps or more. 600 volts nominal.
Cross street/directions to job site: .,: t _ 4' '
Desedptian et. IN5211M1
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add 500 sq.R.or portion 33.92 1
1 i;: ; ,L[iz r EF:Y f •; i a -a ' 'i ' Limited energy,residential
75.00 Z
(with above so.ft.)
Add/Recircuit re space in dental clinic gy,multi-family,prep p Limited ener 75.00 2
for r new W sterilizers . residential(with above sq.B.)
„ , rd)', s , ss •,l Renewable Energy ❑ See Page 2
B,s t►i's ° i t� n ;: services or feeders Installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax: ( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation: This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to400 amps 125.0B 2
Owner signature: _ Date: 401 amps to 599 amps 168.54 2
v .6 s BX Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Cochran Inc above service or feeder fee, 7.42 2
each branch circuit
Contact name: Gary Eade s B.Fee for branch circuits without
service or feeder fee,first 56.18 56. 18 2
Address: 7550 SW Tech Center Dr . Suite 220 branch circuit 1
City/State/ZIPTigard, OR 97223 Each add`Ibranchcircuit 15 7.42 11 .30 2
Miscellaneous(service or feeder not included)
Phone:(9 71 ) 2 5 0-12 7 3 I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:GEades@Cochraninc . cons Reconnect only 67.84 2
` t,4 ate` Ls - Pump or irrigation circle 67.84 2
Business name: Cochran Inc Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: 7550 SW Tech Center Dr . Suite 220 panel,alterarinn,nrextenaion.
Each additional inspection over allowable in any of the above
City/State/ZIP:Tigard, OR 97223 Additional inspection(1 hr min) 66.25/hr
Phone:( 9 7 1) 2 5 0-12 7 3 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Email: GE ade s @ C o ch r an i n c . corn Inspections for which no fee is
specifically listed('/z hr min) 90.00/hr
CCB Lie.:7 2 942 Electrical Lic.: 3 7—5 4 6 C Suprv.Lie.: 62 7 7 S , . 'Ill's liT
,a. ''
Suprv.Electrician signature,required: "' , iC(r/ram Subtotal: 167 . 48
Print name:Mi k e Grogan Date:2/2 5/2 0 0 Plan Review Required(25%of permit fee): 41 . 67
State surcharge(12%of permit fee): 2 0 . 10
TOTAL PERMIT FEE: 229 . 45
Authorized signature:
This permit application expires if a permit Is not obtained within 180
Print name:GaryE ade s Date: 2/2 5/2 0 days ener{t has been accepted es wmplete.
' Number of inspections allowed per permit.
I:Building Pemsits!ELC PermitApp ELR ERF..doc Rev0t1P2o15 440-46157(I1/o5/COMM/ER
n
Electrical Permit Application FOR OFFICE USEONiav
Jrr 1 2 L! Received If f
City Of Tigard Date/By: 0' 0 ,'1�; ' WO !
13125 SW Hall Blvd.,Tigard,OR 972°y� Ci(7 plan Review ) �I t w,
C Phony. 503,718.2439 Fax: 503.598.P9G0 " DateBy: i/�//. +�I Jll�D ,5,.�/�
Inspection Line: 503.639.4175 BUIL51rr is D)ViSION Ready Date/13y: / IX wu: ® See Page 2 for
'f 16 A It II Internet: www.tigard-or.gov Notified/Method! ' / 0./At Supplemental Information
TYPE OF WORK _ _ ? L-1 A,e g PLAN REVIEW
❑New construction fiS Addition/alteration/replacement Please check all that apply(submit 2 sets of plans ducked):
0 Service or feeder 400 amps or more 0 Building over three stories..
❑Demolition ❑Other: where the available fault currem 0 Marinas and boatyards,
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floaung buildings.
❑ 1-and 2-family dwelling ®Commerciaifndustria] Accessory building less o ground,nr exceeds I4,o00 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
1 I0 c iyx to „ t r" ❑Addition of new motor load of system
Job#: Jab site address: �I!W'3W! IOotIP nr more ❑"A","t 1-2","t-3",
City/State/ZIP: /�J� r� �^ ❑Siam tmre residential units. t1 1raiCy
—tl6,m2 ) ) o RP 91 as 3 G9iis Health-cue facilities. ❑Reerratn>nul vehicle parks.
ID Hazardous!nautilus 0 Supply voltage for mine than
Suite/bldg./apt.#: Project name: j�`(� ( i
p , v � ❑servt<c or feeder 600 ampsor 600 volts nominal.
Cross street/directions to job site: � - FEEE SCHEDULE
45.+ , /y ,, { -yA,,.,� y�-�- tteredpWn i on, I Each 1 'total 1 •
0 •'tom "I SWT 17Tt1'`csvb v ` J51 New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.R.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.R.or portion 33.92 I
DESCRIPTION OF WORK Limhed energy,residential.
i` � t'Op rl- .*V0001 c e Lin/41 01 (with above sq.t ti 75.00 2
1 t,Vti-'� t"' l"•--�CY s'V Vr V f•�-L 1vt' Limited energy,multi-family 75.00 2
4r O Ile r r, ll iO�j d1.•O e�/lP-. RR...,rive`S.e^s L t c /`I i tAtu`, residential With above sq.ft.)ig .
Cr i r C V v Ste.'- s Fes-'("i CUF-a CJ.4. 1 lT GrLf 1.. Renewable Energy ❑ See Page 2
PROPERTY OWNER '7 TENANT Services or feeders installation,alteration,and/or relocation
Name; t/, Sa� P'�i� tflAfet\y^�1�\'E _ 200 SOap_S or less 100.70 02.4 i2
Address: 4= $. lei r�7TDIM,Io S 201 amps to 400 amps ..fi'r 133.565GJa t
ry 1�1�/ r i O r�i ti �, 601 amps to 1,0 0 amps _ 301.04 2
Ci /Sta[e/ZJP: C 601 amps to 1,000 301.04 2
Phone:(503)348.6291 Fax:( ) Over 1,000 MPS or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: Jeremy.A.Morgan@kp.org relocation
Owner inWallgtlon: This itttallation is being:nyrde on property that i Own Whitt is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
o wa, r,�;Tgair-,.d..W.e.m...m..a.,.a. 401 amps to 599 amps 168.54 1 2
BOwner signature: Jeremy MOr�arl
SIAPPLICANT CONTACT PERSON A.Fee circuits s c new,alteration,or extension,per panel
'+4 N' .may �' A.Fee for branch circuits wilt
Business name:4 t` t4 C> �u,S ley..2 4 t t t7..i3 above service or feeder fee, "'/�i( 7.42'Z%.�2
T�� each branch circuit /pX„J
Contact name: T '� • t B.Foe for branch circuits without'.
�A✓U 55 '5 0 i service or feeder fee,first 56.18 2
Address: h"u" branch circuit
N l City/State/ZIP: i0 A� 0��.. O, 1•- _ Each add'I branch circuit 7.42 2
i L7✓� 'a x�' Each
fous(sery or no or feeder not inducted)
Phone: ) Cr.J 1 `1 FaX::( ) Each manufactured or modular 67 84 2
. � 1 ' I ss dwelling,service and/or feeder
i i Ernaii7 Gotei, v,� yin 1 Reconnect only 67.84
n -/Vl CONTRACTOR Pump or irrigation circle 67 84 2
i / Business name:"'r�� Sign or outline lighting 67.84 2
✓} r 1(Vc Signal circuit(s)or limited-en r ,. 2
Address: ?S �� ^ 1� �O/. # panel,alteration,m cxtensio. I� '-t "
City/Stale/ZIP: Each •additional)uspeettt v•• allowable in any of the above
�� die Additional inspcctimn(I hr min) 66.25!hr
Phone:(�,3) y�-,�%n,,,,(p�t) Fax:( ) Investigation Cl hr min) 90.001 br 1 i
I"1 1 Email: l 6 _! / Industrial plant(1 hr min) 78.18/hr �� `
Inspections for which no fee is 90-00/hr �•i!/
/"\ CCB Lie.: Electrical Lic.: I Suprv.Lie: specifically listed(..,4 hr nun)rl ELECTRICAL PERMIT FEES
Suprv:Electrician signature,required: Subtotal f L jy
Cili Print name: Date: 0 Plan Review Required(25"a of permit fee): -:a;> -
\�' State surcharge 1.12%of permit tee): : f'�+ . 1
\t\7ffi
. Authorized signatu TOTAL PERMIT FEE: .1(75"'7, t
This permit application expires if a permit is not obbined within 18d
Print name: 1 Dale: ' 30 y Q days after it has been accepted as complete.
+ * Number of inspections allowed per permit.
1:tnuilidngl-m8s1ELC-P-rn.CApp_ELR_ERE aloe Rev 06l51/5111i 440-1615T(I I105/COAIM'Ea Rif.
/
f dG4 f,J 1.71 0:410itii, ,c. ae,: ck.rc_-(` _ fl/A-,,-o l it-rail..
4.6,.3--7 . °e l'V^'.f `le/�, r,e 0?,'-w G•/i d/ rid; /Cp l�f .�'4s.! �d<sW / - ,. _. -
3v i .. R E C r j-v .may
Electrical Permit Application—City of Tigard J^` 2 r'''
Page 2—Supplemental Information C':�i'f ; -;)
BUILT.
Limited Energy Permit Fees: Renewable Energy Permit Fees:
._:, . _m...,_..._e. . . FEE-SCHEDULE._..,.
RESIDENTIAL WORK ONLY:—
nesariprran Vsx. Each I 'Total ] •
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s kva or lesa I 00.70 2
5.61 to 15 kva 133.56 2
❑ Audio and Stereo Systems* • 15.01 io 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25 01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 91 S-309-0040) 552.26 2
n Heating,Ventilatiori and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additio charge 0-0 3
Each addition nspection over allowable In any_of the above:
❑
Each additi inspection is Other: charged a hourly(I hr min) 66.25/hr
Inspcc' ns for which no fcc is 90,00/hr
spe 'molly listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Eater on pose 1):
(SEE OAR 9l -309-0000) • Number of inspections allowed per permit.
Check Type of Work Involved:
❑•Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
•
❑ Instrumentation
n Intercom and Paging Syste r
❑ Landscape Irrigation Co•'rol*
g Medical
❑ Nurse Calls
n Outdoor Lan',cape Lighting*
n Protective ignaling
❑ •the .
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
•
196aildine1Pemlits\ELC_PermitApp ELR_ERE.da:Rev Wit/2°15