Permit CITY OF TIGARD ELECTRICAL PERMIT
2 , n - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00259
IGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/18/2011
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Parcel: 1S 135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 308
Project: Westside Endodontics Subdivision: TIGARD MEDICAL MALL Lot:
Project Description: Reconnect RTU
Contractor: WILLAMETTE HVAC Owner: MCFADDEN, ARTHUR L
3075 SW 234TH AVE. #206 BY SKLARZ, ERIC
HILLSBORO, OR 97123 621 SW MORRISON ST, STE 800
PORTLAND, OR 97205
PHONE: 503 -628 -6841 PHONE:
FAX: 503 - 848 -2597
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 05/18/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/18/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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. ATTEN N: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -001 throu OAR 952- 1- 0. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By. Perm ittee 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 INSTALL; TION ONLY
SIGNATURE OF SUPR. ELEC' Date:
�,r y
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 Applicatio
7 Ci ' , . FOR OFFICE:USE ONLY
City of Tigard - 4 ti D Received ....11RIMIrli .
_ _ .:
14 " 13125 SW Hall Blvd., Tigard, OR 97223 MAY 18 2011 Date/B : Permit No Ei..._er Plan Review
1 - 11 ,., - ,• Phone: 503.718.2439 Fax: 503.598.1960 Date/By• Other Permit:
TIGARD
Inspection Line: 503.639.4175 CITY OF TIGARD n
Date Ready/By. Jus* 0 See Page 2 for
Internet: www.tigard Notified/Method: Supplemental Information
SUIT DNG NI ni,,..
tt* ,Ii'r. YVr,""k'm; yr770 48/,087,::
0 New construction N Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below)
12 Service or feeder 400 amps or more 0 Building over three stories
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
taittbi1 blOdCONSTRU6TIOIN - - :cg : ' Y: 1 ';' exceeds 10,000 amps at 150 volts or 0 Floating buildings .
less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 ll - and 2-family dwelling E] Commercial/industrial D Accessory building amps for all other installations, buildings.
0 Multi-family 0 Master builder 0 Other: ElFire pump. 0 Installation of 75 KVA or
I ''''' !',',4=- :''''''-'-' i6iegiiIi irgitriMhifoNIASIb% • . - 0 Emergency system
_ ., , larger separately derived system.
•'; '-.•• --, St - , •.,,, , ',; ' 0 Addition of new motor load of
100HP or more. occupancy.
Job no.: Job site address: 9735 SW Shady Ln
0 Six or more residential units I:Recreational vehicle parks.
City/State/ZIP: Tigard OR D Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal
Suite/bldg./apt. no.: 308 Project name: Westside endodontics 0 Service or feeder 600 amps or more.
FEE SCHEDUL 7 .:;',,..4i
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
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'l 500 sq. ft. or portion 33.92 I
Tax map/parcel no.: -
, Limited energy, residential
75.00 2
'---'; ",' - i in'''''filil (with above sq ft )
Limited energy, multi-family
75.00 2
Reconnect RTU residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
'
O keo OWNER , -1,,,,:,-- , --,,' ----- ':','T•': -- ,-: la
.0 201 amps to 400 amps 133.56 2
.„-si..,...,.., . -.—."4,.. : , - - t .. TENANT r -,-
401 amps to 600 amps 200 34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) 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
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
,,,,'„Vjk; gto'kfkerr„:, above service or feeder fee,
7.42 2
' ''''' ''''*' ''''''' '''''' ''''''&' ' 44 each branch circuit
Business name: same as below B. Fee for branch circuits without
service or feeder fee, first 1
56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E , Sign or outline lighting 67.84 • 2
iv::'w:lrgptwrRA-ot'ok ,V. ', ;-,.,, Signal circuit(s) or limited-energy
Business name: Willamette HVAC, LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 3075 SW 234 Ave Suite 206 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Hillsboro, OR 97123
Industrial plant (1 hr min) 78.18/hr
Phone: (503) 628.6841 Fax: (503) 848.2597 Inspections for which no fee is
90 00/ hr
specifically listed CA hr min)
CCB Lie.: 56950 Electrical Lie.: 34346CRE Suprv. Lie.: 4025 LEB TINV*geOgicAV.PERMIT:Fg1KSJ,,' ,,,,
Subtotal: 6 Ii* ( g
Suprv. Electrician signature, required:
Plan review (25% of permit fee): -----
Print name: Mike Sicard Date: 5/9/11 State surcharge (12% of permit fee): 6 -.7
Authorized signature: ''.4('d Date: 5/9/11
PERMIT FEE: 6 n 9
A.
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Michael Malstrom Date: 5/9/11 * Number of inspections allowed per permit.
t:\Building\PermitsLC-PermitApp doc 07/01/10 dea 2-1\-c 440-4615T(11/05/COM/WEB