Permit Q_SE - S c G P- 0e
Nes- CITY OF TIGARD
ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00555
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2009
°T i GARD Parcel: 2S101 AC01300
Jurisdiction: Tigard
Site address: 7105 SW HAMPTON ST
Subdivision: Lot: 0
Project: Kaiser Dental
Project Description: Add /alter (1) branch circuit and 32 junction boxes. ADDED (2) branch circuits to permit 10/28/09.
Owner: FEES
KAISER FOUNDATION HEALTH Quantity Description Date Amount
PLAN OF THE NORTHWEST #838, ATTN:
GENERAL ACCCOUNTING 11TH F, 500 NE 1 crt Branch Circuits 10/21/2009 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/21/2009 $6.74
Electrical
Contractor: 199 da Investigation Fee (Equals 10/21/2009 $198.75
FIRST ELECTRIC CO Permit Fee)
19093 S BEAVERCREEK RD #305 1 ea Investigation 12% 10/21/2009 $23.85
OREGON CITY, OR 97045 Surcharge
PHONE: 503-632-8373 2 crt Branch Circuits w /Purchase 10/28/2009 $14.84
Service or Feeder
FAX: 503 - 632 -7989 0 ea 12% State Surcharge - 10/28/2009 $1.78
Electrical
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $302.14
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 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' C C ` O � � 1 Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
CITY OF TIGAR® ELECTRICAL PERMIT
n
Vi COMMUNITY DEVELOPMENT Permit #: ELC2009-00555
RT[G 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2009
Parcel: 2S 101 AC01300
Jurisdiction: Tigard
Site address: 7105 SW HAMPTON ST
Subdivision: Lot: 0
Project: Kaiser Dental
Project Description: Add /alter (1) branch circuit and 32 junction boxes.
Owner: FEES
KAISER FOUNDATION HEALTH Quantity Description Date Amount
PLAN OF THE NORTHWEST #838, ATTN:
GENERAL ACCCOUNTING 11TH F, 500 NE 1 crt Branch Circuits 10/21/2009 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/21/2009 $6.74
Electrical
Contractor: 199 da Investigation Fee (Equals 10/21/2009 $198.75
FIRST ELECTRIC CO Permit Fee)
19093 S BEAVERCREEK RD #305 1 ea Investigation 12% 10/21/2009 $23.85
OREGON CITY, OR 97045 Surcharge
PHONE: 503 - 632 -8373
FAX: 503 - 632 -7989
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $285.52
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �'Ll \iV.V ` 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 an inspection that business day.
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.
Elect c al Permit Application F C y � ° 1 0 12 0 I I U 7 , µ A ' f .. � , .. f4 F 4 ,r,, � .� � 1t t {
W# K 0....23.
riF y City of Tigard OCT 212009 Date/By: Received Permit No.: J — `� S' •
il
F' ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
&' 2 ' Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
DateBy:
a''' ' "` Inspection CITY OF TIGARD Date Ready/By: .runs: ® See Page 2 for
f l' D Ins ection Line: 503.639.
L fcT L Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: \ l Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction k 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 [X 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 - ", "I - ",
1 100HP or more. occupancy.
Job no.: i 8 - 7 09 Job site address: 7 1 5 ( - i 0, kS 1 0 C - \ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: p ❑ Health -care facilities. ❑ Supply voltage for more than
Tt �cLr� � J ��C� l Z-3 ❑Hazardous locations. 600 volts nominal.
�
Suite /bldg. /apt. no.: Project name: ( t S S - (, -} �� � t �A t f\ 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 1 Fee. 1 Total 1 *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 I
Limited energy, residential 67.84 2
' DESCRIPTION OF WORK (with above sq. ft.)
o Limited energy, multi - family
r esidential (with above sq. ft.) 67'84 2
Aacl o� rArc..>t� ra�J. 3 a „a�c.�.�� ��ke.s �r ( q.
S Services or feeders installation, alteration, and/or relocation
C.Z.‘_k_ * -% c. C) -5�kE"C' d..LS c SACS 200 amps or less 100.70 2
• ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State / "LIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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
❑ APPLICANT .0 CONTACT PERSON above service or feeder fee,
• each branch circuit 7.42 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, { 56.18 S�'? 2
first branch circuit 1
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
• CONTRACTOR Sign or outline lighting 67.84 2
Business name: Signal circuit(s) or limited -
I (r j� Fl e C .1 energy panel, alteration, or
Address: (� 45,6:, + extension. Describe: Page 2 2
City /State /ZIP: q - v � s Each additional inspection over allowable in any of the above
� C v� C O s e��� l Per inspection 3 66.25 (9 x 7 S
Phone: ($V ) (.o3a R yi 3 Fax: (s`)) 6. - a — 75 aC Investigation per hour (1 hr min) 66.25
CCB Lic.: I t - f r ( 6t, Electrical Lic.: Le _ sict L Suprv. Lic.: Li. i S Industrial plant per hour 78.18 {
l ELECTRICAL PERMIT FEES
pr. Electrician signature, required: 1 'M a..S2 Subtotal: a SLf —
Plan review (25% of permit fee):
Print name: f� Date: 3 57 Nt..... A�-i✓2T V a� v State surcharge (12%ofpermit fee): 0 —
Authorized signature: TOTAL PERMIT FEE: a 3 5 , -
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 10/01/09 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard A `
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK.ONLY: • -
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ H VAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n N • urse Calls
❑ O utdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Building'Permits\ELC- PermitApp.doc 10 /01/09
Ate_ •
Eleetilml Pernnit Application RECEIVE I-. -..::;,, .., -: ..,-. ,,,, , .i 0,14isiti .-.„,4. , „, • •.
•
111
, .
,-.''..":•':,-'--, Col of Tigard Received'
'1 " 13125 SW Hall Blvd,. Tigard. OR 97223 nc T 2 7 2009 D t4,:.,,,, - A Permit No.:i. 1.e2CCP (3ZSS
Phone 503.639.4171 Fax: 503.5983960 ' ' ' Dally : . Other Pernit;
Inspection Line: 503.639.4175 - - , Date Readyttly: :uric i r . _ EB See Page 2 for
Internet: www.tIgrd.or.gov CITY OF TIGAK 1 Natific „„ m ,,„,„, :
/ br Supplemental balbanation
i i - • AIM
.:::'-' ''''''..!' - .......- YYPE:olt sv! .‘,-'- . . - : . ' • . ' '.:...1-.;1':::::- 4 7 , 11 . :ri;: . Of:7- 4 1?:;;Wii:AW.
0 New construction TO Addition/alteration/replacement Please check all ilia apply (submit 2 sets cd plus atents chaired
0 Scrvisc ar react 400 AMP: Or mom 0 Building ova three stories.
0 Demolition 0 Othcr: where she available bah mama 0 Madras AM bomY=Tds•
7 '-': : :•-?;t: : ; 4 ';' , :'... - ' .-":'.:** • It .01F- CON imam groat meads 16.000 0 Comrnacial-ose agrialtlial
STRUCHION: - • • ; - • ''''. ',.... . :::' 'A :.... exceeds 10 m .000 snip /50 volts or 0 Floating buildings,
1 - and 2-family dwelling Commercial/industrial 0 Accessory building
C7011
a or
73
amps lbr all other butillations. buildings.
fulti 0 Master builder 0 Other. CI Fire pump. ClInstallation of 75 KVA or
larger seams* derived
".. ; -. ' . ;: ,•:.i .*; ;::: ; =: '' .A : . :
JOB tnII INTONMATION LOCATION . . . ' :: ' . :*/*"' '.'":,'''. (TA,Zrar.: .kmor a "1 "1 syaan. 3".
. . ,
Job no.: rill p Job site address: 7 1 135_ 1,„,,* .0 100HP or morc.
Six at MOM reuidential units. valiancy.
0 Recreational vehicle pada
City/State/ZIP: -RG ce _ 72:2. ' 0 Heith.aue fcilities.
0 ifaxardoos locations. 600 Supply voltage &sr more thn
a
600 'OM tuninat.
Suite/bIdgJapt no.; I Project name: KiMSEQ- CE14,s-rAL, • 0 Service or feeder 600 amps or more.
- ..::: P SCHEDULE:- `....:•7'.:: ::. '.-. • • • - ,•".. - •
Cross street/directions to job site: 72_ 1■\11:6 Ommimisi, I no. 1 I'm 1 It
New residential single- or malti-Gunily dwelling unit
Include) attached garage.
Subdivision: I Lot no.: 1.000 sq. R. or less 145.15 4
_ Ea. add" 500 sq. ft. or portion _ 33.40 1
- ----- -
- - Tax map/parcel ob.: - Limited energy, residential noo 2
''''''.:::: DESCRIPTION OF WODIC : t .:: .' • • '."-::' ' _11/ Above ra.11)
Limited energy. muhi-family
Nick 2 'C,1,trc,UTYS 1 4 tur. c_Vhh l t, ' T.,'V ' 5 +6 CA : residential (wit above so. rt) 75.00 2
Servicee or fteden installation, alteration, anchor relottation
i
LC &O--JcOs55 200 amps or less 80.30 2
::: .....;:f...: El iNitOliiEgirle oTiNEIR:: '-. • . ' :. ;: • •'-'..-: - -: :. 10 7fENANT ..-: ....•-• ::•.::i ''' 201 amps to 400 amps 106.85 2
401 amps 00 600 amps 160.60 2
Name:
601 runes to 1.000 araps 240.60 2
Address: Over 1,000 amps or voltq 454.65 2
City/State/ZIP: Temporary services or feeders humiliation, alteration. and/or
relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less 66.85 1
Owner instnilatiott: This installation is being made on pmperty that 1 own which is not 201 amps to 400 amps 100.30 2
intended for salc lease, rent, or exchange. according to ORS 447. 4.49, 670, and 701. 401 amps 00 599 amps 133.75 2
Branch *laths - new, alterullo or extension, per panel
°cater sigiaturc: Date: A. Pm for branch circuits with
.: : ;f 4 ' ,- -'•:: , •::: CFAPilifildANT-A ': '.'''. -; ''..- ' 1 7777 ' 0 *COlirlaCI PERSON •.. ',.--;: above service or feeder fee, q - 6.65
' each branch circuit
Business name: 8. Fec for branch eireni
without service or feeder Fee,
Ccmtazt name: 46.85 1
first branch circuit
Addrcss: Each addl branch circuit 645 2
hfroeellaneons (unAce or feeder not included)
City/State/ZIP Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Recommet only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
•:-.-* : .--: ..7.' ..-''.-; ••••':-.. • ::: z- coNTRACTINg:•(: ..• ' .. :.. .. • :. •:.••• •• .. ::•::.•-•:. • Sign or outline lighting 5340 2
Signal circuit(s) or limited-
Business name F (a ST FLECTIZA.c. (3;m-NAPAt'sJ Y energy panel, alteration. or
Address: Po ex CI tot,,, e(tension. Describe: Page 2 2
City/State/ZIP: (f) rics,e,‘J\ cirk‘,1 .Or c 1 C:4145 Each additional i - • ‘-. , on over allowable in , ,, of the above
Per inspo:tion 62.50
Phone: ) ! a,73 - Fax: (943 ) .... lk 2h, hw br estlgation pw hoot (1 m ho 62.50
tt
' C 1 o : 1 4
CCB Lic.: 14 Electrical Lic.: -SI - Suprv. Lie..: .. . e? , S' industrial plant per hour 73.75
: "; :-' ...... . ':::: • ELIECTRWAL PERMIT. nu %II a o.
T .,
Suprv. Electrician signature. requircd: - ''t e OP . ' Subtotal: 1
Print name: T q k A Rup,,c_cr---c Date: / 4, U - Plan review (25%6p:trait fee): 64,
State suvr.harge (12% of permit fee): / -"pis. ,
Authorized signztu ; . I i • A TOTAL. PERMIT FEE: /Lt
. -
Print name:A.1 . sz\bo, -
Date' le...../ f-eicit
, r---;, This pawn applicasoacwerai Ns pennit fp not obtained within 180
a? dare after ahns burn aecepad es earripseto.
/ • _Number of:inspection allowed par aon.
CultradlaPermitMELC mono 440.46137p umiteumeo
k I- e-r €4
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2009-00555
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2009
Parcel: 2S 101 AC01300
Jurisdiction: Tigard
Site address: 7105 SW HAMPTON ST
Subdivision: Lot: 0
Project: Kaiser Dental
Project Description: Add/alter (1) branch circuit and 32 junction boxes.
Owner: FEES
KAISER FOUNDATION HEALTH Quantity Description Date Amount
PLAN OF THE NORTHWEST #838, ATTN
GENERAL ACCCOUNTING 11TH F, 500 NE 1 crt Branch Circuits 10/21/2009 $56.18
wo/Purchase Service or
PHONE Feeder
1 ea 12% State Surcharge - 10/21/2009 $6.74
Electrical
Contractor: 199 da Investigation Fee (Equals 10/21/2009 $198.75
FIRST ELECTRIC CO Permit Fee)
19093 S BEAVERCREEK RD #305 1 ea Investigation 12% 10/21/2009 $23.85
OREGON CITY, OR 97045 Surcharge
PHONE 503-632-8373
FAX: 503-632-7989
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $28552
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 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1 800 332.2344
Issued By: j- P,/ 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 an inspection that business day.
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.
Icets"scal Permit Application + . PCEIV j
Ca of Ti rd Rectiwd
Data : Permit No.: C2
13125 SW Hall Blvd.. Tigard. OR 97223 2 7 )009 plan Review
Phone 503.639.4171 Fax: 303.599.1960 pig Other Permit;
InsKcdon Line: 503.639.4175 Dak Readylmr: b•t* ■ tine Paae r f•r
Internet: www.tiww.gov iii I"),' 0FTIGAR xotiftcWellved: 6 C~ s ppteatewlaromatian
•'9..:-..: TYFX-0* - a:YiTF '•'~7e,T.. s ~'.;raiRl{~•.i!~ir}~:, 7...nN~:
❑ New corn ruction Additionfaltaatitmhepiacement Plaaso check ali that apply (vAmst 2 acts of Plan w/items checked below):
D Drmolltitm ❑ Othtx: C3 Savicc or kvder 400.1mrs at *Km C3 Building over t1wue vories.
where the "low fitult current ❑ Manna and hnatrutis,
y' QF. SCILON i.t . exceeds 10.000 amps as 150 volts or O Flaming building.
-f . Ins to Commercial/industrial ❑ Accessory building RW Other ~ I i' . ❑ Com~*as;•1•we acricutruwt
1- and 2-family dwelling
amps 11ato+~. buildings.
lulti-family ❑ Master builder ❑ Other: O Fire pump. ❑ Itnullation of 75 KVA or
- JOB S n RGO1tMA7`M-AM LOCATTONi Ad y n~itaalmdof t'rRw sapmatoly
C3 dition of new ❑ 'A' . "B'. "1. -3".
Job
Job no.: Job site addrt 1(~ 17 Siix or awor more. e raddentrsl latices. C3 it aaeati ~onei vcmde Pak-
t-rx `7 ZZ 1 ❑ Hdhh.ute facilities. E3 Supply wnagc rnr more tlat,
R
❑ ytanrdous lomiorm 600 volm nominal.
SuiorlbldgJapt no.: Project name: r J~A ❑ sc-ice or ti:cdcr 600 naps er.nom.
':.FEE- S 'IMULIK `
Cross i2reet/directions to job site: ~ ve 7reer '
New residential "glie- or nafti-6mily dwdUng unit.
Indede s attached garage.
Subdivision: Lot tt0-: 1.000 sq. R. or less 145.15 4
Tax map/parcel no.: Ea. odd'i 500 sq. & or portion 33-40 1
Limited energy. residential 75.00 2
b M OF WORK wlthabove . A.
; Liraitad energy, multi-family
residential wilt above FL 75.00 2
Strvlea or /leedtro ie ta11a4N altteratloa and/or relocation
LC ~ zoo amps err laser 90.30 2
= (3 ' O!'Et[if OWh18R 0 T=ANir 201 amps to 400 amps 106.85 2
!Notice. 401 amps to 600 amps 160.60 2
601 amps to 1.000 amps 240.60 2
Address: Ova 1,000 amps or voltq 454.65 2
City/5tate/zIP: Temporary services or flttdem isalapation, alt raloa. and/or
relocation
Phi: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner itastallation: This installation is being made an property that I own which is not 201 amps to 400 ampe 100-30 2
intended for sale, lease, rcpt, or exchange, according to ORS 447.449, 670- and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: >smwA dreaib- acs or m[mmoioa reel
A. Fcc for brmb circuits with
s•: above service Or feeder f
C:-A!!'LICAIf'R • ` ' ❑ CONTACT PUU~ON ' p.
each branch circuit 6.65 l 3 - 2
Bugitles3 name- 8. Fee for branch eircuits
wirhow 9efvict or feeder Ike,
Contact name: first branch circuit 46.85 1
Addrm-. Each addl branch circuit 6.63 2
Mwellaneoaa servlee err feeder not indnde
City/State/LIP: Each manufactured Of madulu
dw Rip Rervicc arWer feeder 90.90 2
Phone: ( ) Fax:: ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign Or outline lighting 53.40 2
1-71 = y~ G yl Signal circuit(s) or limited.
Busint. name:
energy peed alteration, err
Address: X ciaetusion.Desertltc: Fage2 2
City/St2WzIP: Cy C ; S. ~L°t Each additiouai isapecMm am aNnwabk In am offte above
Per inspection 62.50
Phone: (~VI 0.1 ) Fax: ( sp)) -TIT 95 hwestigation per hour (I iR min) 62.50
CC$ Lic.: Electrical Lic.: 14, j ( Sum. Lie.: ' Ci ( ; Industrial plant per hour 73.75
EL6C1fRtCAtx; rzaIYIIT. FEE6'.: D.
Suprv. Electrician signature, roquirad: Subtnlal:
Print name: Date: V Plan review (25% of permit fee):
State surcharge (1291 of permit fcc): /
Authodnd signatu, TOTAL PERMIT FEE: f
[>!ie pandf applieattirw Cipirm a Fault is s-r owlew 'mum -so
Fatal name3J~~ C,,,'S dqa after it has been aceeped w e•wplate.
• Number of **pectim allowed per pamit.
t:uMriW6yvpntig5>~.C•pataiUpp.be ni43Ae aM.16ns1tttgy~plt~yrua
R€: CITY OF TIGARD ELECTRICAL PERMIT
n
COMMUNITY DEVELOPMENT Permit#: ELC2009-00555
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2009
Parcel: 2S101 AC01300
Jurisdiction: Tigard
Site address: 7105 SW HAMPTON ST
Subdivision: Lot: 0
Project: Kaiser Dental
Project Description: Add/alter (1) branch circuit and 32 junction boxes. ADDED (2) branch circuits to permit 10/28/09.
Owner: FEES
KAISER FOUNDATION HEALTH Quantity Description Date Amount
PLAN OF THE NORTHWEST #838, ATTN:
GENERAL ACCCOUNTING 11TH F, 500 NE 1 crt Branch Circuits 10/21/2009 $56.18
wo/Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/21/2009 $6.74
Electrical
Contractor: 199 da Investigation Fee (Equals 10/21/2009 $198.75
FIRST ELECTRIC CO Permit Fee)
19093 S BEAVERCREEK RD #305 1 ea Investigation 12% 10/21/2009 $23.85
OREGON CITY, OR 97045 Surcharge
PHONE: 503-632-8373 2 crt Branch Circuits w/Purchase 10/28/2009 $14.84
Service or Feeder
FAX: 503-632-7989 0 ea 12% State Surcharge - 10/28/2009 $1.78
Electrical
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Tota 1 $302.14
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 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 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' SL-0 C) ` 0 i 0 (2 Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Elect ><r cal Permit Application
CI`1 of Tigard Received
T DateB Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 I 1 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
i,
a Inspection Line: 503.639.4175 7;
Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: C; Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 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.
CA'T'EGORY 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 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", "1-3",
Job no.: p Job site address: 1 100HP or more. occupancy.
7S Q w. 1 O ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: -(e t a _ e ZZ, 3 ❑ Health-care facilities. ❑ Supply voltage for more than CA '3. ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: t r 1 1 El Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Deecri lion Fee. 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 67.84 2
DESCRIPTION OF WORK with above sq. ft.
11 Limited energy, multi-family 67.84 2
c~Cl e r v t v +~c ~~'~>ke j s residential (with above sq. ft.
Services or feeders installation, alteration, and/or relocation
r~ ov^ e Y~~"e~ c~.~ e+\~ 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
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
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 Sco' 2
first branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous service or feeder not included
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Signal circuit(s) or limited-
- - (<_i✓~ energy panel, alteration, or
Address: yc extension. Describe: Page 2 2
City/State/ZIP: C o C , Q U v• 5 Each additional inspection over allowable in an of the above
Per inspection 66.25
Phone: (S(23) 3 Investigation per hour (I hr min) 66.25
CCB Lic.: I Li-7,j L Electrical Lic.: t f _ S~ It L Suprv. Lic.: ' f Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES eV2
piv. Electrician signature, required: U~a/A GAW1 Subtotal: r f
Print name: n Date: Plan review (25% of permit fee):
TO PQ A~ ~~-T 1 V o State surcharge (12%ofpermit fee): O -
Authorized signature: TOTAL PERMIT FEE:
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 10/01/09 440-4615T(I 1/05/C0t.1/WEB