Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 00401
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2013
Parcel: 1 S136DD03400
Jurisdiction: Tigard
Site address: 11740 SW 68TH PKWY 250
Project: Oregon Health Care Association Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: (1) branch circuit for ductless rooftop mini split.
Contractor: BEAR ELECTRIC Owner: HEALTH CARE ASSOCIATES LLC
PO BOX 389 11740 SW 68TH PKWY
DONALD, OR 97020 TIGARD, OR 97223
PHONE: 503 -678 -1355 PHONE:
FAX: 503 -678 -1108
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 07/17/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/17/2013 $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. 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 • 2 : ' 90. Y. u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:
•
Permlttee Signature: &A/ 67--/e).° / e 62-770 N
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 603.639.4175 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.
JUL- 15- 2013(MON) 12:13 Bear (FAX)5036781108 P. 001 /002
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City of Tigard
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I TYPE OF \ ISIO�! PLAN REVIEW •
1 ❑hie \\ sni i rut: 1ion •� ^ l) 111111 lletotnl{11ripIa Ctne111 — -- Plea.: chc,t sit that apply I ,,hln» 2.Sli 01 plans u urm.:h,•a,•.I Mon 1 y
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S.it• n. t.. • ,del .ton :111, olive ❑ thn1lllap •••e• dh.ee ••••••••" 1,'.
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„�, - ousts ilk. ma1L1h1: fatal etnaen ❑ h1:ng
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CATEC Y OF CONSTRUCTION - • • I. 10.11110 an at 1511 r»h. or ❑ �• i Inannp h,nldmp.
k.. lel round. or e t iI 1JJ111n 0 t -..ti• aplti,dnnll
COMIT11 rci;11 /itulllclr1 :ll ❑ Arcc-ssor\ buildin •
• 1 : Ind :dl PIINr nl +I:,llaln,n• h
❑ MI1111-1:1111ily ❑ Master builder ❑ Oilier: ❑Iiii: pump ❑kuOanar1141 III 7 kVA01 i
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JOB SITE INFORMATION AND LOCATION ❑ 1,,,1fI pCtWv c,.lhn ta11Yl {F»al.•t. delnra system i , l 1 A ❑ AJditam of mew motor load nl ❑ "A" '1 1 T ' ' 1 - ?",
J11h On,: : 1 lob sic addre- -I II Si k) (n(J V t n LT In(II'lh 0, Wrote occupancy
ich nti
�l (�v lJ''17 rj ❑ Stx t,r mitre residential 1111115 Reelean•vlal %chicle pall.
City/State/ZIP: ^D �('^Tj ❑ I Italth•n:ne facilluea 1I Ipp l! Ivhapr Im attic 11011 J �f tti 1 L �r ` J (] 1 tazaldou. In.miuni. t,tlO ,,111. nnrnmal
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Suilt:/hldgiapt. nn.: Prujcet name: (.!/ �/. ���� ❑Scrvuc Ti feeder non amps no —
/ I FEE SCHED
Lrl s Slrcet /dircctiun. 111 jnh Sill ; t y (� C f}� —ptun 1 o n. I te I ,m.I —
1 New residential single or multi - family dwelling uoit.
-- Includes attached garage.
SuhdiviSion: I,ol no.: 1,000 so II. or less 168 5.1 4
TON map /parcel no.:
— - Ea. add' I SOO sq. fl. w non ion 33 92 I
Limited gneiss, residential 7500 2
DESCRIPTION OF WORK Iw . il. . ilhaboves _
Limited energy. multi - family 75,00 2
‘10. `l 4 _ * : tik r .? residential (with above sq. (I 1
Services or feeders installation, alterati_o_n, and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER L 0 TENANT 201 amyl l0 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps 10 1,000 amps 301.04 1
Address; Over 1.000 amps or votes 552.76 2
City /51nIC!Ll P: Temporary services or feeders installation, Alteration, and/or
1 relocation
Phone: ( ) I Fax: ( ) 200 amps or Tess 59.36 1
1 201 amps to 400 amps 125.0B 7
Owner installation: This installation is being made on property that i own which is not
intended tor stile. lease rent, or exchange,- according to ORS 447.449.670, a 7Q 1, 401 amps to599 amps 168.54 2
Branch circuits - new alteration, or extension, r . n nel
Owner signature: Dote; A. Fee for branch circuits with
O APPLICANT I 0 CONTACT PERSON above service Or feeder fee.
each branch circuit 7.47 2
Business name; B. Fee for branch circuits without ' 1 C
el m Contact name:
B I NC, service or feeder fee, first I 56.18 C �'}' v 2
PO BOX 339 b ranch circuit _ _
, E Each odd'' branch circuit l 7.42 2
Address: DONALD, OR 97020 Miscellaneous (service or (ceder not included)
s C9# Each manufactured or modular r
City /Stute721i : dwellin_ service and/or feeder 67.84 2
Phone; ( ( ) Reconnect onl
67.84 2
Fax:: only
Pump or irrigation circle 67.84 2
E - mail: earele f:Lr.L.._ Sign or outline liP,hlin( 67.84 1
CONTRACTOR Signal circuity) ur limited - energy
attSi �_( me: Vrlr l n� •lmel. alteration orexteuyinn, Pa e2 2
�1 I „�� -� 1 Each additional inspection over allowable in any of the above
v
I. Address: Pb F s/�' Additional inspection (I hr min) 66.25/ hr
City /Slate /L1 P: j .,+ r 4-+ Iri . c 2 - 0 Investigation (I hr min) 66.25 / hr
U `� 4 ' 1 ` Industrial plant (1 hr min) 78.18/ hr
Phone: -- o , I Fax: 56i J 7 1 1 1 CA' inspections for which no fee is 90 00/ hr
t�l $) 1 JCl (%r . . -. •• -
shccificahy' lisi 3d hr min,
CCB Lie. : 1 ei Ele ctrical gt.,+ _ Suprv. Lic. 51 (Q >S ELECTRICAL PERMIT .FEES
Suprv- Electrician signature, required)( e , f _ Subtotal:
. � - Plan review (25% of permit fee): alt o
Print name. vu C Date: J! Slalcsurchargc (1 2%ofpermit fee): -14 � -
I TOTAL PERMIT FEE: �� L/
Authorized signature: '
V,-6-
This permit application tapir; if o permit is oat obtainer) within 180
P r i nt dame; t C « Date: �� 1 �— days after it bas been accepted as complete
.• - _ �. • Nurt,be of inspections allowed per permit. .
l'01.•1IJinpU'vm;Akt.C- Perm:t App.aoc 01 /00tu 140•.1015711 1l05,CUMnvka
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11740 SW 68TH PKWY 250, TIGARD, OR, 97223 2013 - 11 - 26 (null)
Record Type: Record ID:
Commercial - Electrical ELC2013 - 00401
Inspection Type: Result:
199 Electrical final PASS - No C of 0
Comments:
Violation Summary:
Inspector Contractor