Permit CITY OF TIGARD ELECTRICAL PERMIT
IN COMMUNITY DEVELOPMENT Permit #: ELC2011 -00554
TLGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/13/2011
Parcel: 1 S126DC04900
Jurisdiction: Tigard
Site address: 9445 SW LOCUST ST
Project: Tigard Ortho & Fracture Subdivision: LEHMANN ACRE TRACT Lot: 3
Project Description: Electrical for X -ray machine.
Contractor: OREGON ELECTRIC CONSTRUCTION INC. Owner: LOCUST PROPERTIES LLC
1709 SE 3RD AVE 5632 SW EDGEMONT PL
PORTLAND, OR 97124 PORTLAND, OR 97239
PHONE 503 - 234 -9900 PHONE:
FAX: 503 - 234 -1001
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/07/2011 $100.70
Specifics: amps or less
7 crt Branch Circuits w /Purchase 10/07/2011 $51.94
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 10/13/2011 $18 32
Electrical
Type of Const: 1 ea Plan Review Electricial 10/13/2011 $38.16
Occupancy Grp:
Total $209.12
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 -0090 You may obtain a co• of the ru • direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: • - rmittee 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 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.
Electrical Permit Application OFFICE' USE ONLY
Cl of Tl and ,� Received // SS - y
g D ate /B /( t ar Permit No . V c �i (( _ tf
0 13125 SW Hall Blvd., Ti gard, OR7 r ` Plan Review
C V Phone . 503 718.2439 Fax: 503.598.19 Q J tj � it C. Other Permit.
U Date/By.
T LG A R D inspection Line 503.639,4175 O w � y Date Ready/By. tuns 63 See Page 2 for
Internet wwwtigard or.gov ■ + /Z �I ;G P � Q \v Notified /Method (0 Supplemental Information
V . _
TYPE' OF WO �j� .1 '' . t r J r '✓ PLAN `REVIEW
❑ New construction ® Addition /alteratid /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 ❑ Mannas 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 ® 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 denved system
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "1 -3 ",
Job no.: 80599 1 Job site address: 9445 SW Locust Street 100HP or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: Tigard Oregon 97223 El Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: I Project name: Tigard Ortho &Fracture ❑ Service or feeder 600 amps or more
, FEE SCHEDULE
Cross street/directions to job site: Description I QlY• 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 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft ) 75 00 2
Limited energy, multi - family 75 00 2
Electrical for X ray machine residential (with above sq ft )
Services or feeders installation, alteration, and /or relocation
200 amps or less 1 100 70 100 70 2
- - '❑ PROPERTY OWNER ' ❑ , TENANT ' 201 amps to 400 amps 133 56 2
Name:
401 amps to 600 amps 200 34 2
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
above service or feeder fee, �2Y2
® APPLICANT ' ❑ CONTACT PERSON' each branch circuit 7 42 Jt � f �[{ 2
Business name: Oregon Electric Construction, Inc.
�� �. B Fee for branch circuits without t
-
`�
—! service or feeder fee, first
Contact name: Kerry Davis ; ; / i A 4 e t �1 b, ( \Ndl branch circuit _ 56 18 2
l}l .}� J Ea 1 add'1 brunch circuit 7 42 2
Address: 1709 SE 3 Avenue V ► .4-1i �, ,�� re
� Ea h manufactured or modular
5' Mi cellaneous (service or feeder not included)
i
/ _ ,,
City/State /ZIP: Portland, OR 97214 V( . 7 1 d elling, service and/or feeder 67 84 2
Phone: (503) 849 - 2634 Fax: : (503) 5\35 - 2763 I V I'� I ( ' l 9
, V ` ,4 econnect only 67 84 2
/ Pump or irrigation circle 67 84 2
E - mail: h.bennett @oregon electric.com / Sign or outline lighting 67 84 2
CONTRACTOR ` -` Signal circuit(s) or limited - energy
Business name: Oregon Electric Construction, Inc. panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address: 1709 SE 3 Avenue Additional inspection (1 hr min) 66 25/ hr
'Investigation (I hr min) 66.25/ hr
City/State /ZIP. Portland, Oregon 97214
Industrial plant (1 hr min) 78 18/ hr
Phone: (503) 535 - 2652 Fax: (503) 535 - 2763 inspections for which no fee is 90.00 / hr
specifically listed (%z hr min)
CCB Lie.: 26 - 95C Electrical Lic.: 203 Suprv. Lie.: 4818S - ELECTRICAL PERMIT FEES
�j/��j j I(j (1 / Subtotal_ 1'224)6 1�1.i�`1
Suprv. Electrician signature, required: h �' Plan review (25% of permit fee): 3O '4 f
Print name: Mark Weinbender kg/ h b ,, i It . te: 9 - - State surcharge (12% of permit fee) 14-34 jj b'' IA
/ TOTAL PERMIT FEE. '1 tg
Authorized signature / This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Mark Weinbender Date: 9 -29 -11 * Number of inspections allowed per permit
1 \ Budd] g\Permas \ELC- PermnApp doe 07/01/10 440- 4615T(t I /05 /COM/WEB