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Permit
• s.� CITY OF TIGARD ELECTRICAL PERMIT 2 - COMMUNITY DEVELOPMENT Permit #: ELC2009 -00511 T1CARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09!30/2009 . Parcel: 2S101AC01300 Jurisdiction: Tigard Site address: 7105 SW HAMPTON ST Subdivision: Lot: 0 Project: Kaiser Dental Project Description: Install (1) 60 amp and (1) 100 amp feeders, (10) branch circuits, and low voltage for data /telecom. Owner: FEES KAISER FOUNDATION HEALTH Quantity Description Date Amount PLAN OF THE NORTHWEST #838, ATTN: GENERAL ACCCOUNTING 11TH F, 500 NE 1 ea Limited Energy 09130/2009 $75.00 PHONE: 2 ea Services or Feeders - 200 09/30/2009 $160.60 amps or less 10 crt Branch Circuits w /Purchase 09/30/2009 $66.50 Service or Feeder Contractor: 1 ea 12% State Surcharge - 09/30/2009 $36.25 ELECTRICAL CONTRACTOR SERVICES N.W. Electrical 3335 NW ST HELENS RD, PO BOX 1233 ST. HELENS, OR 97051 PHONE: 503- 366 -6060 FAX: 503 - 296 -5518 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $338.35 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 160 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 throug• OAR 952- 001 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: N.-_-46 41. . • _ I L, Permittee Signature: � OWNER INSTALLATION ONLY 111 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. • Electrical Permit Applicatio 1, ° FOR Orr icl: l SE ONLY • ' City of Tigard ' ' CEIV DateReceived Permit No.: F (C Z004 d0 Sl I II _ • 13125 SW Halt Blvd., Tigard, OR 97223 CEP 2 9 PL�n Review Phone: 503.639.4171 Fax: 503.598.196 2009 DatelBy Other Permit: Inspection Line: 503.639.4175 Date Ready /By: Juri • ® See Page 2 for TIGARD Internet: www.tlgard- or.gov � Notttied /Method: ' � Supplemental Information TYPE OF ' (D ITYOF TIGARD NG DIVISION PLAN REVIEW ❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans winems checked below) 1 - ❑ Service or feeder 400 amps or more ❑ Building over three stories. IJ ❑ Demolition Other: where the available fault current ❑ Marinas 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 ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ['Addition of new motor toad of ❑ "A ", "E", "1 - ", "1 - ", 1001 - IP or more. occupancy. Job no.: C I 3 'D 73 Job site address: 9 1 0 5 S W AA gl m p I Q T� ❑ Six or more residential units. ❑ Recreational vehicle parks. q ❑ Health -care facilities. ❑ Supply voltage for more than City /State /ZIP:71 G,q� d _ Q 1R 9 `1'D D 3 ❑Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: {KA i S e ie. "�e.rti3 -.. ID Service or feeder 600 amps or more FEE SCHEDULE Cross street/directions to job site: s4_1Z s : c_C'tr $Qe r Description l Qty. I Fee. I Teat 1 .— `` New residential single- or multi - family dwelling unit. Tc r-y Q 4 ivelz, i o S3 3 . 1 9 ell Includes attached garage. _ Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'! 500 sq. fL or portion 33.40 . Tax map/parcel no.: Limited energy. residential 75 -00 2 DESCRIPTION OF WORK (with above sq. IL) Limited energy, multi- family 75.00 2 T. la. rz, csryl G1l c, t rt % to ti...}-1 11 ? . C.j \ 1 t=eea e 1R s 1 Ga Al ha Fd , residentiia1 ove sq. ft.) _ 1 CQ� e.k� S Ci t'i t Pzt4a C „ Services or(.feeders nstallation, alteration, and/or relocation ) L0411�t�1�T�CrP. (4 CChc b ”) tastplq 200 amps or less 4 dn r !dap a 80.30 160 40 ' 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 240.60 2 601 amps to 1,000 amps _ Address: Over 1,000 amps or volts 454.65 2 City /State/ZIP: relocation Temporary services or feeders instillation, alteration, and /or Phone: ( ) Fax: ( ) 200 amps or less 66.85 I Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits — new, alteration, or extension. per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ CON'T'ACT PERSON above service or feeder fee, S O each branch circuit 1 6.65 /_] - , 2 Business name: B. Fee for branch circuits C4�0 , without service or feeder fee, 46.85 2. Contact name: first branch circuit Each add'l branch circuit 6.65 , 2 Address: Miscellaneous (service or feeder not included) — City / State/ZIP: Each manufactured or modular 90.90 2 dwelling, service and /or feeder i l Phone: ( ) Fax: : ( ) Reconnect only i 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 ' .l Signal circuit(s) or limited - Business name: Elee }R► Crm- �'KC1C:1 R S, J�11 �t^:P N w energy panel, alteration, or — I extension. Describe: Page 2 n s6a 2 Address {IO I37( 1)33 •fitsle.cnt�, co. clo.,.�1-'. 1 I 1 Each additional inspection over allow able in any of the shove S j t City/State./ZIP: S u e r � . D R coo t Per inspection 62.50 Phone: (So ) ' 2_ + . Fax: (so ) .. ° . .s IR Investigation per hour (1 hr min) 62.50 CCB Lic.: ( s s y . I � ' _ Suprv. Lie.: 3 D � t . s Industrial plant per hour 73.75 , l - ' � � ELECTRICAL- PERMIT FEES j Suprv. Electrician signature, required: ' t fi` � �.a `, Subtotal: ?, C a _ 1 Q Plan review (25% of permit fee): p Print name: li7� Q '� e �� 0 Date: 9 • • State surcharge (12% of permit fee): -. i _ ( Authorized signature: Et•nr-"t" TOTAL PERMIT FEE: i / j,auld6•ECSrdtu A" This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. 'r Number of inspections allowed per permit. cl Icl t 1:\ Building \PermiutELC- PermrtApp.doc 05/23/06 • 440- 4615T(I1losmCOMIWEB 3 3 6. 35 L' 81.59 (£09) PQ ( 0 l ( I/ CA( (d Heaps ue>piS e!uuo8 dl-Z:£0 60 6Z de8 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm ❑ Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 -309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HYAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling C Other tt Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I: 1Building1Permitid3LC- PermitAgp.doc 9323/05 Z'd 8199 - 96Z (E09) Heuyog um{oNg eiuuo8 d LZ :£0 60 6Z deS