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Permit
CITY OF TIGARD ELECTRICAL PERMIT o ' COMMUNITY DEVELOPMENT Permit #: ELC2010 -00476 T1 GA 1 D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/15/2010 Parcel: 2S 101 AC01300 Jurisdiction: Tigard Site address: 7105 SW HAMPTON ST Subdivision: Lot: 0 Project: Kaiser Dental Project Description: Electrical alterations for dental clinic. Owner: FEES KAISER FOUNDATION HEALTH Quantity Description Date Amount PLAN OF THE NORTHWEST #838, ATTN: GENERAL ACCCOUNTING 11TH F, 500 NE 1 ea Services or Feeders - 200 09/15/2010 $100.70 amps or less PHONE: 4 crt Branch Circuits w /Purchase 09/15/2010 $29.68 Service or Feeder 1 ea Plan Review Electricial 09/15/2010 $32.60 Contractor: 1 ea 12% State Surcharge - 09/15/2010 $15.65 OREGON ELECTRIC GROUP Electrical 1709 SE 3RD AVE PORTLAND, OR 97124 PHONE: 503 -234 -9900 FAX: 503 - 535 -2763 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $178.63 Required Items and Reports (Conditions) This permit i • • su•ie • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be don= ' accordance with approved plans. This permit will expire if work is not started within 180 days of is- - • ce, or if work is suspended for more the 180 day ATTENTION: Oregon I • req ires •u to follow the rules adopted by the Ore• • rtility Center. Those rules are set forth in OAR • 9 - 001 -0010 th ough OAR 9 -001-0,i. ou ay obtain a copy of the rules or direct questions to OUNC by ca mg•. • 6699 or 1.800.33 .2344. Issued By: � Permittek.Sigoature: � � • � � 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: !Alia) r LICENSE NO. i (0 - CaII 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. 1074/ -- loy Electrical Permit Applica CEIU ED I c)It ohFl<h, usH: ONLY Received © - 7 / City of Tigard P 0 7 9 0 Permit No.: EL c 2 2010 D ate /B v: ° 13125 SW Hall Blvd.. Tigard, OR 97 Plan Review : 0 Phone: 503.639.4171 Fax: 503.598.1960 DateBv: Other Permit: TIGARD Inspection Line: 503.639 CITY OF TIGARD Date Ready /By: Juns: 65 See Page 2 for Internet: ww'.v.tigard or.gov Notified /Method: Supplemental Information BUILDING DIVISION 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. 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 Ej 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.:1113-741- fto f Job site address: 7 /ot) .514) 3Dn C' Six or or more. R c re anry. JI ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: --r Z. 02 17E2.3 gef-(ealth -care facilities. ❑ Supply voltage for more than ty ar ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: AD g- I-, j ❑ Service or feeder 600 amps or more. 0 1 FEE SCHEDULE Cross street/directions to job site: Description 1 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 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.) � r Limited energy, multi - family 67.84 2 1, � -. ZisA // ,e . t�- / Z II a,►wtl1 de. ept %,.." 4" q.y.eot.k. residential (with above sq. ft.) A , 4t II Services or feeders installation, alteration, and /or relocation Ow p 1.0c o M c ('5 40 0.......), . r ,4 e4j'�,`4 elewf't I CCCo r+t), 200 amps or less 1 100.70 /00;70 2 Dir PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: Amer, 1 601 amps to 1,000 amps 301.04 2 Address: SOO AjJ /KNµMC.rtw 5 4. Over 1,000 amps or volts 552.26 2 ,� /I Temporary services or feeders installation, alteration, and /or City / State/ZIP: Yp Tl 4 1 0 C- 4 11Z57- relocation Phone: (• D3) g 3 _ 4/667 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 L) 23 APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, T 7.42 29. 6 8 2 each branch circuit Business name: OreOu, /Y ,_,r.,, �.. / �N s"�v c : b a , I ` • B. Fee for branch circuits without t1 �� service or feeder fee, first 56.18 2 Contact name: J%.') D,,„.4.5 branch circuit Each add'I branch circuit 7.42 2 Address: /log SA 5 re) Aj.r._ Miscellaneous (service or feeder not included) , H ` , Each manufactured or modular City/State /ZIP: �p rw.y C 9 7Z / '7 dwelling, service and/or feeder 67.84 2 ( 5) q - Jo 0 I Reconnect only 67.84 2 Phone: (5 ) Z 34/ _ 9q O� Fax. • �� L Pump or irrigation circle 67.84 2 E -mail: C.. not a.^SQO - e(ecfr c, .00t.tti Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy p anel, Business name: Q «Se.� /tCe4 c - � ONSTRQ 410I4 Co Each a l inspection extension. Page n 2 Each additi nspection over allowable in any of the above Address: 17 oq SE s A v.._ Additional inspection (1 hr min) 66.25/ hr City/State/ZIP: 19 b Q- 17 2 IL/ Investigation p n ( I r min) 66.25/ hr Industrial plant (1 hr min) 78.118/ hr Phone: ( 4 511) L511 0 Fax: (5 D ) zsq -10e / Inspections for which no fee is 90.00 / >u specifically listed (' /: hr min) CCB Lic.: ZO 3 Electrical Lic.:a,,p�� 5 G Suprv. Lic.: 4 81 % 5 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required:,, 4k._ Subtotal: /5 .3$ Plan review (25% of permit fee): 32. Go Print name: m Kt co N ' vb Date: 9/ State surcharge (12% of permit fee): /S 6S vI �^ v TOTAL PERMIT FEE: / 78 .. 4 ,3,_ Authorized signature permit application expires if a permit is not obtained within 180 Print name: 114 r'f 12 u ti N D9 Date: q [ l l o Nt anber o i ds ns p eci L s allowed d bee per ermit. a permit. d as complete. I:\ Building \Pemtits\ELC- PemutApp.doc 10 /01,09 440 4615T(11/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm • ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $67.84 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: n A udio and Stereo Systems ❑ B oiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC n Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ N urse Calls n Outdoor Landscape T »fighting* n Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\ Building \Permits\ELC- PermitApp.doc 10/01/09