Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2010 00655
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2010
Parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 202
Project: Scholls Ferry Rehab Subdivision: Lot: 0
Project Description: Electrical for TI. Fire alarm system included.
Contractor: COCHRAN INC Owner: PROVIDENCE HEALTH SYSTEM
7550 SW TECH CENTER DR. #220 4400 NE HALSEY BLDG 1 SUITE 160
TIGARD, OR 97223 PORTLAND, OR 97213
PHONE: 503 - 234 -6564
PHONE: 503 - 215 -6282
FAX: 503 - 238 -2098
FEES
Quantity Description Date Amount
1 ea Limited Energy 11/18/2010 $75.00
Specifics:
7 crt Branch Circuits wo /Purchase 11/18/2010 $100.70
Service or Feeder
Type of Use: COM 1 ea 12% State Surcharge - 11/18/2010 $21.08
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $196.78
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 Cent . Tho - ru -s are set forth in OAR
952 - 001 -0010 through OA; •52- 001 -0090. You may : '. - .,.,.i - . es or •erect questions to OUNC by calling 50 2.198 or 1.800 .2 44.
Issued By' . Perm ittee Signature: I� U
4971 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.
- � - CITY OF TIGARD ELECTRICAL PERMIT
Ip
g COMMUNITY DEVELOPMENT Permit #: ELC2010 -00655
- 1-iCARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2010
Parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 202
Project: Scholls Ferry Rehab Subdivision: Lot: 0
Project Description: Phase 1. Electrical for TI. Fire alarm system included.
Contractor: COCHRAN INC Owner: PROVIDENCE HEALTH SYSTEM
7550 SW TECH CENTER DR. #220 4400 NE HALSEY BLDG 1 SUITE 160
TIGARD, OR 97223 PORTLAND, OR 97213
PHONE: 503-234-6564
PHONE: 503 - 215 -6282
FAX: 503 - 238 -2098
FEES
Quantity Description Date Amount
1 ea Limited Energy 11/18/2010 $75.00
Specifics:
7 crt Branch Circuits wo /Purchase 11/18/2010 $100.70
Service or Feeder
Type of Use: COM 1 ea 12% State Surcharge - 11/18/2010 $21.08
Class of Work: ALT Electrical
Type of Const: 1 ea Plan Review Electricial 11/30/2010 $43.93
Occupancy Grp:
■
Total $240.71
Required Items and Reports (Conditions)
This permit ' 'ssued subl- • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done n accordance with appr• -d _ • s. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTIO : Oregon law - • ire you = follow the rules adopted by the Oregon Utility Notific- - Center. Those rules are set forth in OAR
952- 01 -0010 thro •h OAR 952 -01 -009:! Yo ' btain a copy of the rules or direct questions to OUNC by calli • - . .1987 or 1.800.332.2344.N
Iss ed By: / Permittee Signature: CAI ej e�Le X
OWNER INSTALLATION ONLY V
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 4r- ,■ " / 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 FOROFFICE USE ONLY
t
„ .
Received ,
City of Tigard
I D Date /B 1/ ig M7- .: _-, ----
II '1 13125 SW Hall Blvd., Tigard, OR 97 .... 610
Plan Review /0 Permit No 00 Ggs
'•-• Phone: 503.6394171 Fax: 503.5911., 'Mai Date/By: Other Permit: Va / d -
T 1 G A RD Inspection Line: 503.639.4175 rt.°'s Date Ready/By: turis: See Page 2 for
. - Internet: www.Supplemental d-or.gov Notified/Method: Tri Suppleental Information
0 \. ‘6
.4. 4v.oe di ,votik . .., i?1 • .
• f,, : --,-- :,. favv -. ,...' VIV . 4 ',.:,, 1 ',. • :., , f .,...'. ., ,,.'..,.. !`.. , . ,-,-,. '-', ..,., , .. ”.'" ' .11 '7. , ,..''' -, - ',' ' •
0 New construction f Addition/alteratiG iaMt" Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: OA where the available fault current ID Marinas and boatyards.
6Wrieiikii COisiz3iiitdriroW'! ;" '•,;',`,;:•;;;OA;n.' ':.‘,.' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
.• ' )ct . '': -t. '1' : :h.. l': .- .,.,.,,.
,-..--,, -1 ., ;. , ,,, ! ':.... - ?z::,.41N ..,:tlk less to ground, or exceeds 14,000 0 Coinmercial agricultural
111 1- and 2-family dwelling gg•Commercial/industrial 0 Accessory building amps for all other installations. buildings.
El Multi-family D Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
,, - , ,.. - ,-. 0 Emergency system. larger separately derived system.
..;;; SITEZ,INF9A LOCATION ;'.,.:-• !, Ei Addition of new motor load of
I 00HP or more. occupancy.
Job no.: a zzac , Job site address: / 7
it i_. ( Pfa ...S ,.91,6 0 Six or more residential units. . . - DI Recreational vehicle parks.
0 Health-care facilities. than
City/State/ZIP: -.7742/ 0 supply voltage for more sep ,vz 97Z.2- 5 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no: Z 0 7 Project name: R Z. 4 D S or feeder 600 amps or more.
:.:.... ' 1 r !, .; 'T' . 1 .4i NY.67:0r$ OliNVIC::'n Z :: ,-..-, .
Cross street/directions to job site: Description I Qty. I Fee. I Total 1 *
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. 0. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 . 1
Tax map/parcel no.:
Limited energy, residential
75.00
''6E§citittib: ,, •'.: ;•, ; • ' (with above sq. ft.) 2
Limited energy, multi-family
75.00 2
in 1 Ai till.. --r. 7_ 06,,,, "AA 4few1 - CA,,-- residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
t 7ti VA" j
) ,,.. _.S - yc : 12}7- , - t?y' V,, ,,.,, , 200 amPs or less
c_
) 100.70 2
,.p Op ERT y k,1 :.,4,:t:1; 7'M ' !....,,,,,"11:1 TENANT . 2 , ,, 1-7. 201 amps 10 400 amps 133.56 2
401 amps 10 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: ((' e .. zi ,,,, Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/Z! P:70,1444e/ eze 97Z/J relocation
200 amps or less 59.36 I
Phone: (543) z/sz. z417 ...... , Fax: (Say) zArr... 480
201 amps to 400 amps 125.08 2 _
Owner installation: This installation is being made on property that 1 own which is not
401 amps 10 599 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
OPLICA NT ::' ' '(1.....'' ' "' ';: iti eiti&fAeritii§bis1.:: .:,:::.;:.. above service or feeder fee,
7.42 2
each branch circuit
Business name: C3o_o - c...',.S Ci)("Nt(a. ci--0-<" 13. Fee for branch circuits without /,,
service or feeder fee, first
56.18 1/
2
Contact name: branch circuit
- Each add branch circuit 4 7.42 951 , 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP:
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
-
.,..;::';'''''':,. ',:,.: , :. ... .,„ ''''. . . ...' ,' : C.Q. N .t 11 0c.::(0 . , L' .. : ■ : ' ' Z ' ' ' ' . I '. % .:.. 1,, . ' A. . ' Signal circuit(s) or limited-energy /
panel, alteration, or extension. I Page 2 7 5 2
Business name: Clx0.- c \c
Each additional inspection over allowable in any of the above _
Address: - 1 5 50 51/44\1 ( e_ C (11) 4 2.2 0 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: - 7 - ;66(& 0K R 72 2- Industrial plant (1 hr min) 78.18/ hr
Phone: 503) 2_34__ / Fax: ( ) 2,3g - 2.09 '8" inspections for which no fee is
90.00/ hr
specifically listed (1/2 hr min) _
CCB Lic.: --- 2_ (...i2_ Electrical Lic.: 7 5z1-6, ei Suprv. Lic.: ` I S . *:5:-..'ib„;;;',,2,ELEFT12110:AE:ftliXIIVFEES_:
% Subtotal: .1 / 7s: 70
Suprv. Electrician signature, required: '\ Plan review (25% of pent , t fee):
Print name: KE f\Q Ct...\--0 Date: t w) . State surcharge (12% of pennit fee):
TOTAL PERMIT FEE: I C 1(.0 • 78
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
1:\Building Permits ELC-Pennit App.doc 07 I , 10 440-46 I 5T( 1 I '05 WEB