Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00316
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/06/2013
Parcel: 1 S135DD04400
Jurisdiction: Tigard
Site address: 11900 SW GREENBURG RD
Project: Southwest Family Physicians Subdivision: LOMITA TERRACE Lot: 9
Project Description: (1) branch circuit in lab.
Contractor: DEKORTE ELECTRIC INC. Owner: BC ASSOCIATES LLC
5331 SW MACADAM AVE #258 -113 1128 SW ENGLEWOOD DR
PORTLAND, OR 97239 LAKE OSWEGO, OR 97034
PHONE: 503 - 288 -2211 PHONE:
FAX: 503 - 292 -8237
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/06/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/06/2013 $6.74
Type of Use: SF 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 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 copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1 800 332 2344.
i
Issued By: Permittee Signature: -
411111No.
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 503.839.4175 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.
06/05/2013 10:43 FAX a002/003
Electrical Permit Aaalicatio 1• /12 OFI'ICE IISE CAIN
City of Tigard Received _
.� 13125 SW Hall Blvd„ Tigard, ermitNo.: Etc A , i ` i r
mod OR 97223 UN 0 5 2013 Review
�°
Phone: 503.718,2439 Fax: 503.598.19 0 Date/B : Other Pie
T 1 e; n K p Inspection Line: 503.639.417
,. ,_._.�_, me gard -or up en formation
Internet: www.tigard-or.gov od.
met• wars � S p�Pa
Date
Y•
0
. - Nei � ¢ tall r
�: � :' - " =r'•'a - - - - . a� : . : -V- W).:.:: 1 -� ?.: fir...-• ' _ . ::
New construction " - r. ;.:..:;; . , - e_� ,� - " ";�-.' '�- ,ti;�;, - ' t c; ^4•i'i:"'�'�`r;'� , ; .` '''''41."I'.:
�c- ddition/aiteration/replacemcnt e � au � apply (su 1 sits of plans w /items checked below):
❑ DcmolitiOn
['Service, or feeder 400 or
d Building over three atones.
N „ 1� - x : n. share the available Ault current CI Marinas and boatyards,
— .. : �.;.'.1 ;Q9g.?�c;nI•4. :i .
:•,; :'''�;:•ai;: _,ri r,. =cads 10 Bail
..::.. .. 2 - ..,..f . . � 150 voila
P or ❑ Floating buildings
® - sad 2-family sisal ' • mercia]/industrial [) Accessory building leas m ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Multi - find ❑ Master builder ` ter other installations. Installation
r .77' ❑ Other 0 pump, ❑ Installation of 1 SO KVA or
y l i. . 1- 5 I. r6 r i • i1 '; i r)� is , -; 1 :r- - • - D > oy ays� larger separately dived system,
. .. - - - - OMdx of ecw motor load of ❑ A, 'L ", "1- 2 "'•I.3 ^,
Job no I bt, Job site address: ( - I 10011P ormore. occupancy.
o `l1 f..• ❑ Six err mom residential unit& I] Recreational vehicle parka.
City /StateJZIP: — t -- ) Li 2_,7 •� ' El Health-care facilities. O Supply voltage for more than
i ❑ Haza dew locations, 600 volts nominal.
Suite/bldgJapt. tar,: 0 Project name: — r I O Se vice or lbeder 600 amps or mote.
Cross street/directions site: • 1 t - : 4.. .t ., 11,:_ 'ii r..i- ;:,.. .? , `'° •
s to job `'1 ``; ate ' ,.
New residential single- or multi - family dwelling unit.
Includes attacbed garage.
Subdivision: J Lot no.: 1.000 sq. it: or loss 168.54 4 ,
Tax map/parcel no,: Fis. add'! 500 sq. EL or portion 33.92 1
ti ' _ _ ,. tar =! _ • Limited energy, residential
cf ar:. ?bfs 7 • ii. t = ; - ;', i::i, ; .• ,. :, s.00
x �._� ..__.... _...,.- ._ ?`: — , _ Limited m ft.)
2
'T••.- rj�e` n Limi energy, mina- family 7s.00 2
..� D.�i�,4• ■ r _ , 91\2 a residential with above • . ft
_ 1Q: :,•r: Services or feeders lostalladon alteration, and/or relocation
.�..:._.., _.W ... .r _" _
:'i':W: - :__ - _ .,.-_, : . :i1 ,-; =_ : .200 snipsorleas 100,70 2
Name: — — -- 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: - _601 amps to 1,000 amps 301.04 2
—
City/State./ZIP: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, a n d/o r
Phone: ( ) I Fax: ( ) relocation
Owner Installation: This installation is bein made on r0 200 amps or 5 9.36 1
g p pettiy that I own which is not 201 to 400 125, 2
Intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. •
Owner signature: 401 unripe to 599 amps 168 2 • _ �` — ., - �, s .. _ w. i:_ ...... '..11;:_! D . _ .. Branch circuits - new or extension, Date: panel
' '
. -; - t d .r. A ! � 1 w
^J t - � < a :: - J >:Y_; !_;: 1;1- ' 1;1;,�1s: : � : :; : r '....
, v: -.. :, , A. Fee ibr branch above servi circuits with
ce or feeder fee,
Business name: each branch circuit 7 42 2
Contact name: B. Fee fbr branch circuits withow
service or feeder fee, first ` 563 8 c - , t y 2
branch circuit 4
Address:
Each add'1 broach circuit I 7,421 2
City/Stale/ZIP: Miscellaneous (service or feeder not Included)
Each menulaetor'ed Or modular
Phone: ( ) Fat :: ( )
dwelling, service and/or fbeder 67.84 2
Beoonoectonly • 67 84 2
•
E-mail:
Pump or irrigation circle 67.84 2
,
• ,.:. .... j T .. e'� 'Ffv ,1 G %�C" %' I' _ .r s' 4 • , ... . • ,: -..... �.... ..... i • .' : .. • ;, : lighting 67.83
Sign or outline 1 gh
'
Business name: - - Signal cireuit(s) or limited energy See
•
pant!, alteration, or extension. _ Page 2 2
Address: M A Each additional Ins . ctlon over allowable In an of the above
1 , I "� Af\ � ' TT z-$ — Additional inspection (1 hr min) im
Ciry /5ttltelZIP
1 11235 ` (( Investigati (I hr min) 66.25/hr
Phone: (54) 7_46 s .. Fax: (S 2: Z Industrial plant (1 hr min) 78i18/, hr -.
CCB Lie.: , S ectrical Lie,: Suprv. Lie.: Ej1 , ran
! I c El '5 Inspection for which no fee is 1.1 9000 hr
:, ,.
Suprv. Electrician signature, required: .I .4.. tt __... / 11k ,-
Subtotal: '
r` a
Print name: e Q . }
Date: .0 Plan review 5% of , - it fcc
Stale surcharge (12% ofpermit fee):
Authorized signature: TOTAL PERMIT FEE: 2
GL 7
Print name: This permit application expires if a permit is not obtained within 1
mays after It has been accepted as compteta.
• Number of inspections allowed per permit.
L•t&oldmgtRermitslm ..C_PomlzApp_euR_F ] t>:doe Rev 0321)2015 440.4615T(11/05/COMIW103
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11900 SW GREENBURG RD, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
2013-10-28 (null)
ELC2013-00316
PASS - No C of O
Violation Summary:
Inspector Contractor