Permit CITY OF TIGARD ELECTRICAL PERMIT
114
I COMMUNITY DEVELOPMENT Permit #: ELC201000592
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2010
Parcel: 2S110AA00300
Jurisdiction: Tigard
Site address: 14145 SW 105TH AVE
Subdivision: Lot: 0
Project: Pacific Health & Rehabilitation Center
Project Description: TI
Owner: FEES
TIGARD INVESTMENT GROUP LLC Quantity Description Date Amount
BY EYRING REALTY INC, 1777 N CALIFORNIA •
BLVD #300 10 crt Branch Circuits 10/22/2010 $122.96
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/22/2010 $14.76
Electrical
Contractor:
GARNER ELECTRIC
2920 SE BROOKWOOD AVE A
HILLSBORO, OR 97123
PHONE: 503- 648 -4552
FAX: 503- 642 -7925
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $137.72
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 obtai the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344,
Issued By: - Permittee Signature: 4g 42 ' ::2- " Ze-AV-
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.
FROM :GARNER ELECTRIC FAX NO. :5036427925 Oct. 21 2010 11:32AM P2
°O
Electrical l'erit Applicatio lm `. 1' t OF�i�It::E 1ISE ON1. �'
City � �O Roccivdd
of Tigard r �,� , PermitNo.; ,
61 1 Date/By! jd �1; - n — r_Lc>$0 v 1 e)
■ 13125 SW Mall Blvd,, Tigard, OR 9723 v nnO Plan Review / 1 1 C ��
i Phone: 503.639.4171 Pax: 503.59K.1960 Q� P ` ` 1 .a,/g Other Permit
i ' + i ; ,� It I 1 Inspection Line; 503.639,4175 O ' \' t \ , Irate Ready/By; ri I ; ® See Page 2 for
Internet: www.tigard- or.gov r O N ' Notified/Method: "J7j Supplemental Information
�'N Nr a,tf,'f f'1 + q,�� J •,: 'ti `, i. ;T Rt:jL%ti 1f 1 �? " NM :, Y t� - Yr r,.
iill , !';p3, I +,,i 'i „ n $ ;l � > . " f si ..70 .1 ,1i)i+ i,3f • `f 4 ; !n Roar i)!I, VLJ -, 1!:-H- ' t C; .:r .i 2j�' +?; �M1Ai, r.
, e , ;' j4 ; a,, : r tr(1 1. t F,ll, r , 1 „ :1. , 11 I tr ) . , ..,�I( J o tri , ( I t E e 1,r- r „ r -,, .{ 1 ,,: i { ' (� __ 6 ? n _
. k, nlltiib :r,.:::��f.rnl�.�.�.t1�� 4." �ifl�. nd�1 .,6w'''^.bP-• . (.c`.*,rn:Ttr+r.,....;ftla,:a.� �' r_I114d � t t � Y`7d�}�t. _ ... ��9[�11�k{Ei��ltif,..:{ '!Yd:.1r�'tl'
❑ New construction P. 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.
0 Demolition ❑ Other: where lite available fault current ❑ Marinas and boatyards.
prl7 h ,+{'
, Fr , j r +l�iil� w ; WIli'1 tvgtins F 'Y t � �A ,
� fn'tWyt , • ;n 'qtr 7 �.7m. 'h � re,, �' '' `' r. Y,. ' 7 m'iir li∎let exceak 10,000 amps at ISO vnita nr ❑ Floating huadmgs,
t ilit:1 91'n J:,1:..U�:r` a t, ,∎:1 .1��2C`r.(`.'{ '10ii .n takfJils:>;rtiSlvt1!�t �i!hill 11111;4 e51 i 1 ?,{ i t i 1 ;fC; V 'IV y,
tins to ground, or exceeds 14,000 ❑ Cotmlxnial -ace agricultural
❑ 1- and 2- family dwelling if Commercial /industrial ❑ Accessory building amps Ibr all other installations. buildiaga•
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. f:1 inf aiiAtlen of 75 KVA or
4 ri" }
i +r " " ' „i 2i . , , r , , ' 1 , , n`''+ n?it! 1,9y nl v "auir.�a a bif l a:� r t nt•:ra:9r;ir r ,; , „t . , r{IJ tm•: c1 rr 7..., `1 " t , ❑ Erocrgency system. larger separately derived system.
i��,,1 p1 . ': l i . 11)) v', _ c, 1 ti .,dt :, e � �•�[1vt t+ ;j :+0 .40. 1 , j t y l l tor) %I ieor�l 1 , t f l • aia ,0tg, tS'� he
z t + .'H.:.tti ?;!:ii; ;;s;:hri,,., 1 e. (! t.41.87h 4.! ,g iiin it -A'ni i ksim :?Aemir3k >Ariethrat.^.tctikArtanc 11xi t %./' li '' s7.. 1 QAdditu
ni of I'M "HOT kud of CI - A" - P , r ••1 -2' "1 -3
�, /� 100HP or more. Oec tlpa0ry.
Job no.: Job site address: iii/ 7�? W �( ❑Six to rrmn rtxitleutia) unite. ❑ Recreational vehicle parks.
e 6
City/State/ZIP; -1 5./g_ q 7 z Zy aHlealth -tare facilities, ID Supply voltage for more than
y 1 ❑ Hazardous locations. 1500 volts nnminal.
Suite/bldg./apt no.: Project name: _� __ II ❑Service or feeder 600 amps 111' ,roue.
8" Pt J A(1 . AUt. OIL . % l +i; AIR i ` iiil � ' ' :s 1` i% o � r' 'rr" 1 '�j'z� i ' i:. '. t a 1'. �yj�J gi l t iii ' l` r (
Cross street/directions to job Site: rf %1rt' 1') t, „Die.:, ' L(,t,.,.,'A r` .,n r 1, ; Rea. 1<t.... ';,
Destt�doa .,, 1 StZ� Des. 1 Total
" — — New residential single- or multi - family dwelling unit
Includes attached garage.
Subdivision; l Lot no -: 1,000 sq. ft or less 145.15 4
�.. - no.. _ _ . ............... � __.
Tax map/pared
Ea. add'l 500 or 3340 __. ..... _._
rn r )nn� t:r ) J,r• ` �� t al .. tr1cl .1 r ; r . Limited energy, residential .
( igil ; i t 1 Vil t i j l t v i i i r 1'!1;' t'W 'll'IFk )s gi ')i (f� t �� e ; )15n') ,Tel U 1 1 !r ') N " ,�' n; t i . r .. (with above ft) 75.1x) 2
t vUUUn. .)!'41.1111 111gthi , ,✓ , ise�lk ∎Ai] ,. • . .... .. 'Lk.' .. it ∎..- Cltt_:h .''' R a9' )
Limited energy, multi - family 2
,Q,_.C, t rtu t4 "99 S r r Pr tp4 C 5 (with ahmve ::y. IL) _. - _ 75.00
Services or feeders In stallation and/or relocatio
• 200 amps or less 80.30 2
ds4li,Alll1. u i ., i`� i. L 3' fnWl t �' ' , + • "� � {� s EDT's tax r to f _..-- - -..,. ..., ........- --
fYI , V f'! r jl s art 'sc .t ` it 9ifht1(II � ; ` i 3 lug q ' E i , J ' , " 201 am to 400 am p s 85
106. 2
, l� ,i•�.,rni. {Ilr7.alt,1`(5�1•>a +er r7. �.�; 1..+ l tl H,o,{iliEd�l �G + k,.., .u - y.� 1 - . -__._
Name: ''� 401 amps to 600 amps 1 60.60 2
lY.s�l� emr y — 'Dot) 1) rr � - aK1' ! 14 ' AS 601 amps to 1,000 amps 240.60 2
Address: O ver 1,000 amps or volts 454.65 2
•
City / State/ZIP: Temporary s e ervic or feeders installation, alteration, and/or
..•..M- ... relocation - -. ,_.
Phone: ( ) Fax: ( ) 200 amps or less •
66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for salc, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 turps to 599 amps 133.75 2 _
Branch circuits - new, alteration, nr extension, per panel
Owner signature: _Date: A. Fee for branch circuits with
1 i+ iP n f ct r` t ) t kYurllut>Hll` '' 'iin1 .r t u +'t�t� rA ;yufar•n }qr',
:, • .i (1 ' , ' it U" ' t i nic o L 1/ +li ' ar '�+ , ° 1 t ) shove service ur feeder fee,
rt l lust. ( c, .:Li.1 ula �2an1'Stl� ' +fi1t, ! i 1 ilj1Oa t,t .. ', hA iMER 6.65 2
each
Business name: . ` - r .t.r1 L R. Fee for branch circuits
• r wilhoui service or feeder fee, 1
Contact name:
$ li &,./!... - _ tits _ first branch circuit 1 46.85 1.14 .2.5 2
Address: _2 D 5 0.10.0r2C�l re _ li4 Each add'1 branch circuit ! 6.65 I �'�8s „2
br► 114lstellaneous (service or feeder not ind
ud11
City / State/ZIP: ..,' . l���tl • / , 971Zy Each manufactured or modular —
u dwelling, service and/or feeder 90.90 2
Phone: e03) 6 g' i, mi Fax:: a , iz:1p 7 Reconnect only _.
_ _ 66.85 2
E -mail a 4 V Pump or irrigation circle 53.40 M1 _ 2 •
t+ J i 1 1 , T" 4 ,a TT t'z" "i + t t `�'y F o •:,t •
Pfx -4o�a 1'O r r' ( l�I' 1 �` _y '° ""+ ` ( • ' " I . f+�, Sign or ou tline lighting 53.40 2�
iri�, u1. 3;: ,r,1!�.l..ttos'lytlul,?1NL �,nt +�2+1.�,.:d�.i 1, -, i. IE .. - - -- . I
Business Dams: Signal circuit(s) or limited- i
GARNER 1 r._ T 1 � _ energy panel, alteration, nr
Address: 2g20 a RIr N/pCd /ZV•e,M -A_ extension. Describe: Page 2
City /State/ZIP: i O$ 1' ( a 3 Each additional inspection over allowable in any Of the ahove
Per inspection 02.50
Phone: t ) - 6 _ / Fax: ( (04a...792_5 investigation per hots (t hr min) 62.50
CCB I.ic.: 12_i (t pl Electrical Lic.: r ' ' M Su • . Lic.:3 •� i j-]— industrial plant hour 73.75
IR, 1r 1121E +rvt q,Ily 1�y tI II`tC1 . I' rh - 8! Mf it 4,-r'r' r {11 418!('
v� .�e�r>J'3i.1 � eL' 1, �7i ,�:Ln�.i»uhuaw.t.. � , •
.wS. 7r1, t IA i, a•�:=i1G�lw n^;1.H,1{l,.
Suprv. Electrician signature, regtrired: ,1 __ Subtotal: )04 - '�
VP' 1',,!/ ; � ' / Plan review (25% of permit fee)
Cr! ... .. • ''
Print name: ����r r '''' •
..._ State surcharge (12% of permit fee): /Z • it
Authorized signature: TOTAL PERMIT FEE:
/
Print Darns: Date: Thh permit applleatlon expires If a permit to not o 1 within ISO
days after It has boon accepted at eomple
• Number of inspections allowed Der permit. 1 Z 7 . -7)_