Permit CITY OF TIGARD ELECTRICAL PERMIT
' 2 COMMUNITY DEVELOPMENT Permit #: ELC2011 00132
Date Issued: 03/11/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 100
Project: Amedisys Subdivision: Lot: 0
Project Description: Electrical for TI. 3/31/11, reprinted to add low voltage for fire alarm.
Contractor: LEAR ELECTRIC CO INC Owner: G &S FC LLC
PO BOX 573 516 SE MORRISON #100
GRESHAM, OR 97030 PORTLAND, OR 97214
PHONE: 503 -665 -9840 PHONE:
FAX: 503 - 661 -6389
FEES
Quantity Description Date Amount
15 crt Branch Circuits wo /Purchase 03/11/2011 $160.06
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/11/2011 $19.21
Type of Use: COM Electrical
Class of Work: ALT 1 ea Signal circuit or Limited 03/31/2011 $75.00
Energy Panel
Type of Const: 0 ea 12% State Surcharge - 03/31/2011 $9.00
Occupancy Grp: Electrical
Total $263.27
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 ' 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. TTENTION: Oregon 'law re uires ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 1 -0010 thr gh OAR 952 -0 -00 . ou ay obtain a copy of the rules or direct questions to OUNC by callin• % . 32.1987 or x.800.332.2344.
lss d By: Permittee Sig - ".' Qit '! i,
1
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.
CITY OF TIGARD ELECTRICAL PERMIT
1, g
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00132
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/11/2011
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 100
Project: Amedisys Subdivision: Lot: 0
Project Description: Electrical for TI.
Contractor: LEAR ELECTRIC CO INC Owner: G &S FC LLC
PO BOX 573 516 SE MORRISON #100
GRESHAM, OR 97030 PORTLAND, OR 97214
PHONE: 503 - 665 -9840 PHONE:
FAX: 503 - 661 -6389
FEES
Quantity Description Date Amount
15 crt Branch Circuits wo /Purchase 03/11/2011 $160.06
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/11/2011 $19.21
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $179.27
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 O 2-001-0090. You may obtain a copy of 'i e ru es or = t questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By• "' Permittee Signature:
v
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.
03/31/2011 13:50 5036616389 LEAR ELECTRIC CO INC PAGE 02
9
Electrical Permit Application FOR OFFICE 1. SL a\l.,
City of Tigard Received Permit No ,4. 4910//-DO 2-
13125 SW Sall Blvd, Tigard, OR 97223 Plan Review
' Phone: 503.639.4171 Fax: 503.5981960 Dapeaty, Giber Permit:
T I GA ., I) Inspection line: 503.639.4175 Date Ready/By: less: td Sex Page 2 for
Wand: www.bigaad - or.gov Notified/Method: Supplemental luformarlon
x fir. ;td^ 9' �`'Z c x _` CC" ' .>r "` a u `� ` 3i" : W� 3 � {,. A^M^ s + " '4 �- ,, 1 k . 't�t'Y s-'•t•- kt c
,.a `" " fffi yv. ' 4 1714 � ' '.t,, �A! � ,y� Cr ' ,,,,Z x C s � 4;.41c : r. `k ? I a .� 6:4, �'.. y i r y J ,,• `�- ti4L .. �.o...r.,, c • --• �... n `.. .
`•. :s.s..h,.�._ -k >.':rr3.e.. - -' ,. '' ..t.,'�+ "�Ht Y G�r� - S.. .. - � . . :a „r._
❑ New construction I i Addition /alteration/replaccin nt P e apPIY (submit j sets o mama C be iaev ):
Demolition ❑Offer ❑ Service or feed 400 amps or more ❑ Buriding over One stories.
Where the available fault current ❑ Mathias tad boatyards.
94' "`'' ''' ;" W a fir: w '.+ e a " 1 � wC`s` ^1 -�- � ,� a �v ' t �,a y � exceeds 10,000 amps at 150 volts or 0 F7oaio6 Amild'mEt•
. , ' ..11j5¢,.. -+s�t4 ,tsar v' -... ''' - i _ C a . t � . 4 '`:. n' Tail, �.2r' exceeds
" ' "�" � � � :$, •' less to Jtaoaa4 or eacceede 14,000 [] Commercial -user agricultural
❑ 1- and 2- family dwelling 11 Commercial/industrial 0 Accessory building augers for .0 other incmil fioss. buldinge.
❑ Multi- family ❑ Master builder 0 Other: Mire pump ❑ Installation of 73) VA or
e+ �#Il > ,. ^ la . a{ 7,,.; i ' � " rwT�' gar .)-17 rvi ❑ Diampeacy system. 17tH IY m
i a �§ .r�"' ?.+ +.+�e+ Q derived
,. '74 X1 1`. ''",... ,-- "iiI4a'�l :i a c, G QPetCIS2 "sCr-`_�`$a'.7i,
;; ❑Addltioua t' oew motorloadof [� A " ", "B"1- 2
,'; °1 -3 ",
Job no.: Job site address: l ' t _ I r look °r ID0' y
"
1 IR 2 1 4.t) Uri) C 't T� 11y( ['Six or more residential min 0 Recreational vehicle pn[ct.
Ctty/Staate7iP' �+ CC \ `p p J El Haza cng locations. 1:1
Supply voltage for mote than
600
*" :W ❑ Elarardoocl0codam volts mmmal
Suite/bldg./apt. no.: vv I Project name: O Service or feeder 600 amps or mom
Cross street /directions to job site: '�O �'•..; •"y1( e.,'!�v "�`...s`al ma :�-`�.�.i y z
- New residential single- or multi-fondly dwelling unit.
Includes attacked garage.
Subdivision: I L no.: 1,000 aq. e. or less 168.54 4
T Tax map/parcel no.: 13a. add'l500 eq. H. or portion 33.92 1
a x m .: limned amid: m816=11111 c}? v, y , vg- x r :. i Ham r y r r y ,. 75.00 2
E ;; . f to i•-iE`x• s' 11b=1........ s., y e i , i r . '. .. c . r.� s .,., �. 4i. ( e4 )
v _ � ) �. r P f � 1 i! e r i t " e i s �3 , J 4 •. + 1 y '°iii � win above tl.
h � ,t , I.united energy »xtlti�6ra is1y 75.00 2
LO C) \ l e 7' `� 1 - v--�c� residential &Mb abovese. 8.) .
Services or feeders InatalWbo and/or relocation
as e O l -do* 200amapsor less I00.70 2
CT`. '"'- �i'(+i. g hL'_'Y Ta .. '�'"at "'t.,. • .Ir,' -.e: y x t, ,.
• 7:7 , . F7', , Pei ; r` ' rli F i KIS ilF''�, , � r 4 , i h i / � . •11- f?5,S z 201= sto amps 133.56 2
• ....c ..3..�-.ae •`.aki' ..3's..asez ,x.1`3:.+ 4,..1Aa •�4 .i.a?' x. "-_Zs1. 5'
Nam 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps err volts 552.26 2
Temporary services or feeders Watallation, alteration, and/or
rdoeation
Phan= ( ) I Fax; ( ) 200 amps or less 59.36 1
Owner Iasi allatlon: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, 1 401 am to 599 ano I68.54 2
ease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, Per pane
Owner signature: Data A. Fee for breech (Awaits with
,a V y 5 ,,� " -=,�. s'3.,�t ! ,^' q .- .... - `fir - 'ygC�jry�+,�' • a :TZ'c., .T'au f..3"'w S s ;1 above service or feeder
L. - . r +4 4 l', � .6 .,P' . �. a_«.a;' .tfz........ s r- ' L,1 FA ii � z e rn,+ • f�.,-� .. each branch circuit 7A2 2 A.
Business nauna B. Fee for branch circuits wt7houa
service or feeder Lee, Scat 56.18 2
cb
Contact name: bran circuit
Each add`t branch chcoit 7.42 2
Address: M iat:ellaneons (service or feeder not included)
Each meonA educed antodular
IRteMP: dwelling, service and/or *odor 67.84 2
Phony ( ) i Fax:: ( ) Rocca:ectonly 67.84 2
1E - m81L' Pump or irrigation circle 67.84 2
,_ Sign or outline lighting 67.84 2
x _: J -, .< } s a ass- a..� ��`.J.Ji "...� '< : .� , :.:. , ..?.,.4� � . L, " Signal cimrid(a) or limited-energy �p
Business name Lear Electric Co., Inc . panel, alretatron or extension. P1( c 2 ,15 2
Each additional Inspection over allowable In any of the above
Address: PO Box 573 Additional inspection (1 by min) 66.25/ br
Y/S : Gresham, OR 97030 tm+enae+ an(Ibruau) ' 66251k
Industrial plant (1 brrain) 78.18/kr
P (503) 665 -9840 - I Fax: {503) 661 -6389 Inspections for which no fee is
90.00/k
lasted brmie
CCB Liu: 5 2 2 7 8 I Electrical Lic-:2 6 - 411 C I Suprv. lie 3 7 8 6 S y .z ;'' v"y_ A we , ate? .. f „ .i r . u:,, g.t.
Swum Electrician signature, required:
Ilan leview125 %ofpernaittee): `t om
Priintnaa= David Mumford Date: 3. - 11 State surcharge (12%of permit fee): 5, QC)
-*--..----N,,,,,....,„/ ;� ,, �J // TOTAL PERMIT FEE: ' n
Authorized ,/ r Jam./ ow.. / This permit application aspires if a permit h net obtained tt ISO
days after It km been accepted as complete.
Print aurae: David Mumford Date: • Number of inspections allowed per permit
1 tbc 07/01(10 440- etliT(1 LQ$/COM/W0n
03/11/2011 08:41 5036616389 LEAR ELECTRIC CO INC PAGE 02
Electrical Permit Application I sE ONIA
City of Tigard
11111 ■ . 1. f.>u orrlrl: TNI
13125 SW Hail Btvd., 75gand, OR 972 ' ' ' .f7 ramie No _ •! i . - • i
Phone: 503.639AI71 Fax: 503398/960 R ` y
Permit
T 1 c. ', f: r Inspection line: 503.639.4175 Date :
Ready/By: e' OtbOther ata
Internet: www tigazd -or gov d 1 i r
Iry n �S.. wv:w . .T
J` >� Y" ` �,� E "'�'� C � '? � ;a °�`h�-rQ * �' � .......a• -- , ?� a." �.Ir" "r'4.. "' - tf r,t rY �-t*r. -w� n _ �.
:.. kutgRo? x.+ f$ -_'.ttft: river �. e ,i4 A.. - cues ti ':41 wry ` A , -'. iP t` o . ,s f �' d i " ° ti �a + y , .
.'rE"� '�` c��y�..c, � ,V ..d,.•. �...�., ctki � :�J�. � .�� U.� ' C- •'- ��....�- ..
❑ New construction 1'd Addition/alteration/replacement Please meek an mat apply (submit I sets of plaits tv/itemts checked below):
0 Demolition ❑ Other: vile= the tender 400 amps or mt+re O Barran over Knee storisc
e y rA y vil ere e available fault current 0 Marina am boatyards.
it , h "'u-!H s N^ 4;: 1 q 7 77-."'v .uT s 31 a � a� c
- . i': , .,n> .lL:'^7:.�� dk. y � : r ins.,. = e moo am%.r Leo "its or ❑ Ft ba;td
❑ 1- and 2- family dwelling Comore cial/industrial 0 Accessory building am m promo, a exceeds
nstall s 000 O Comore u rQiwkurat
eagle fir all other installations buildings.
❑ Multi family 0 Master btil&- 0 Other O Fire pump. O Installation of 75 KVA or
i gic t- 0 5 ^ `"'n7T. ` W.4 7 ' 41 '�;� ,F i --- ) d H' 7-�:',r ,7,, . , "° aJ3F.F5' ,y s •:r �.. 0r?mageecyaysoem, large'separately derived system
.r ;:... ' " `.1 � _ . ? -_s_.; r 5r sa^, - ;f... .• t-E rs3x?- kF. a a,1✓a r 4%-;
�•...,, ;1 OAdditionof use clammiest! of O A ", "E", '"!- 2 ". "ll ".
Job n0.: Job site address: d s f , a e, r , ' w r o fk,' S OSix mar mare residential ar O Recreational vehicle pads.
City/Statc/ZIP: '�;nnark 9R- 5e.CC Rd. sit 100 Oath -care facilities. 13 Supply voltage for mote than
Suite/bldg./apt. tZO : ' �� " y � I l`/ y �� � O Hazatdoes locations. 600 volts nominal.
' �J name: 'TT1 &Ay S 0 Service or Seeder 600 amps or MOM
Cross sheet /direehons t0 b site: : c w 3.d3�� ;: 79Jia t� A4'�r w 5 s r•
1lesutadea Ow. Fee Tend •
New residential single- or multifamily dwelling unit.
Includes attached garage.
Subdivision: 1 lot no.: 1,000 sq. ft. or Less 168.34 4
Tax map/parcel arcel no.: Ea. sdd'I 500 sq. R m pork= 3392 l
+ST'^„a o-, =rcys limited
-
.,, �% - .�. "�' r<' "� , �- "�-Y�' yc •, .a-, z�� �e Qavr a� � �8Y> teaiidrnifal
S t
:�. s� ,., ,t, . tea1 �--? _ 17 .4 . w x,. a (with 75.00 2
..aaz _ .,. m: 1sF �.K�.'1' ;�d ( Ih above eq. ft.)
r Ad. • Limited energy, multi-fa ally
.111• Il ' 1a ".► � 11.6 residentiallwithaboveaq.it.) 75.00 2
Services or feeders lnstallationodter'ation, and/or relocation
E � . a' 3 4't , } ; 200 amps or less 100.70 2
f ``t L:- :.44: el 't1 of � ti " .., "S'' }- - . ;. c'�Q C w.' --j '' 0 : y F , � hi'. , 1,‘ , .".4. , " � .at - 4 ' l .s 4 k " r 1„ x2 � `--- 201 amps to 400 amps 133.56 2
Name. 401 maps to 600 amps 200.34 2
Address: 601 amps to 1,0O0 amps 301.04 ' 2
Over 1,000 sums or yobs 552.26 2
City/State/ZIP: Temporary services or feeders inatatladon, alteration, and/or
relocation
Phontx ( ) 1 Fax: ( ) 200 amps or less 5936 I 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to 404 amps 725.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 402 amps to 599 amps 168.54 2
Owner signature: *mach circuits - new, alteration, or extension, parcel
Oate
ti . : l �- : 4 , � A Fee for brands drain with
ri t :n zii7ti .y :
1�`��t rP' e r i s 4�^� a ir- w s sue. -..r 7 , � I'm above serviceer feeder
ar..9. ^f jy " kiN . u O . t4
' -i, 1 . l 3. -: �t,' each brand' circuit
i-e...s5w�.�1' Rn.�. :.R`..�;K.�c: =.�� 7.42 2
Business name: S. Fee for branch circuits without
Contact name service or feeder foG fast 56.18 18 2
branch circuit @Q�
Address: tech add'/ branch circuit ,y 7.42 1D3, D_ 2
NGsbellaneous (service or feeder not included)
City/Stat7elZ1P: Each manufactured or modular
dwelling, service and/or Seeder 67.84 2
PhoriC ( ) I Fax:: ( ) Rccaonxt only 67.84 2
E-mail: or i circle 67.84 2
r"'^"" trt -,T q cam t - r err ^� w �, .. - ,s or online lighting 2
PBy ?[i� ghting 67.84
tg,. ..;r.&M s �icti.lake..1.a4'x 4S I :: t s • ".1 . " ' W, ,a T R � Siali .
�:.� �c t.=.';1��d?3� Signal ararit(s) orlmtited- energy
Business name. Lear Electric CO. , Inc.
panel, altesation,orextensioo. Paget , 2
Each addldonal inspeedom over allowable 1st say of the above
Address: PO Box 5 73 Additional (1 lu n) 6625/hr
CitY/Stat nCP: Gresham, OR 97030 Invdsa (I min) 6625/'1
Industrial plant (1 br min) 78.18/ hr
Phener (5 0 3) 6 6 5 - 9 8 4 0 1 F ":(503) 661-6389 Inspections for which no fee is
S listed hr min 90.00i hr
CCB Lie.: 5 2 2 7 8 113lextricab Llc :2 6 411C Sap'rv. 1-10-: e cot'°., :. "+ .,_
7 8 6 5 �* E;:, .M113Ce? aarj:D ? m .>a . '� #').4
Suprv. Electrician sign: • . - i / Subtotal: kW.) Q
Aeo%. _ -. Plan review (25% ofpamit fee):
Print name: David Murnf o rd a,..
3 - kr) . (V State surcharge (12% of pdrmit fee): lQ . a
Authorized • t ,,../
TOTAL PERMIT Fly': 1'l a .07.-4,
7 � ar
This Pma appacadon expires if a permit Is not obtained within 1
Man= ' David Mumford 17mte j0 _ /� days alter It has been accepted as complete.
• Number of inspections allowed per permit.
lattediotWerwiesSL.C.Permiupp .dos 09/01/10 44 04515TOYDS/COM/ M
03/31/2011 13:50 5036616389 LEAR ELECTRIC CO INC PAGE 03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
ta'uli{'�� 6 A �,: �' F��u a �tm C � ' ..'
���t 4' "r�w'r� "ir x„ . � ' M�ifI t�i , Fa''fi . r SI T {t-u n {.�
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
E l Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
1: 1enaaieg Pen niis au- PennitApp.aa 07/01/to