Permit CITY OF TIGARD ELECTRICAL PERMIT
t; • • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00406
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/18/2013
Parcel: 1 S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Medical Group Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: (2) branch circuits for TI of workstation, computer /printer
Contractor: OREGON ELECTRIC GROUP Owner: PROVIDENCE HEALTH SYSTEM - OREGO
1709 SE 3RD AVE ATTN: REAL ESTATE & PROPERTY
PORTLAND, OR 97124 MANAGE
4400 NE HALSEY BLDG 1 STE 160
PORTLAND, OR 97213
PHONE: 503 - 234 -9900 PHONE:
FAX: 503 - 234 -1001
FEES •
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/18/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/18/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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- 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: Permittee 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 603.639.4176 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 RECEIVE
. Received
CIt• of Tigard nak,ii 2 /7 /3 4 lia Per No 43
„. _ _....,
.. .
.. ......
,.. ' •-• ' ■ 11 S W Hall .13/vd., Tigard, OR 97223 1 1
, . 1 S
. -'-. -;.. ' ,'::. Phone: :103.718.2439 Fax • 503.598.1960 u -- --• -- 7 2013 P Review
/ 14
Ill lan
..
Dat,tiliy: Other Permit.
Inspection Line: 503 63 Date R By. II-I
9.4175 ' eady/
T!,..1Gliltit). I r7. ! 0 Sec Page 2 for
vy
• ::' -:', '.:.,,..:,.-- Internet ww.tigard CITY OF TIGARD NotifiediliteMod Supplemental Information
TYPE D. IYISIQN ',- -.. -, : ". . .
. .
0 New construction (E) Addition/alterationireplacernent , PIcase chock all that apply (submit 2 see of plans ',tams checked below)
, Service or feeder inn amps or more ID Building th
g over ree stories
LI Demolition [:3 Other: where ale available fault oi--rcry. 0 Manna! and hodis.ards.
. . . . .
• !' ' - -I. . --;. .-. ,!! ICATEOCTY _ OF -CONSTRUCTION - .....;;' -: ; - ': exceeds I 0.0V0 amps at 150 volt: sr 0 Flaming he ildin:
less In p,Intild. or exceeds 14.000 0 Comnicrcial arEulialn I
El 1- and 2-family dwelling E commercialiindusrriai 11:1 Accessory building amps for al: other hist:dim:on,. bulIntrgs
0 Multi-family 0 Master builder 1=11 Other: 0 File pump, 0 Installation 01150 KVA or
El Emergency system . erive sy;•
JOB SITE INFORMATION , AND LOCATION • - .., _, . - ' . ..'_ El Addition of new motor load of urger separatel d d em
icth no.: 14486-169 Joh site address: 12442 SW SCHOLLS FERRY RD ' 1001-1P or more
0 Six (II more ressle7gral tsulS. 1:1 RCA.:fteliliJilili vehic'e parks.
City/State/ZIP: TIGARD OR 97223 ' 0 Healiii-caie ramtai..is. D Supply ,•oltage nix :sore Ilmss
..,.. ' . El Hazardous locallorts 600 stole norndia:
tV Suite/bldg..-'apt. no.. #100 Project name: SUITE 100 WORK STATION El Seri ice or Iteder GOD amps or more.
.
Cross strect:directions to joh site: H SW NORT DARO'FA P/201//6-&---mer .. . . . .
Liej.scrl Alan FEE 2 SCHEDULE, 1 I l'slat I
New residential single- or multi-family dwelling unit.
fri te.4-1- Includes attached garage.
Subdivision: ' Lot no.: I MOO sq ft or less , I 08.54 4
Ea. add'I 500 sq. II. or pon inn ! 11M2 I
Tax map/pared no.:
I .imiled res
energy,
5.00 o
..
,t DESCWFTION, OF WORK,.:' ',:- ._ ' : - - . .;_ -.-...; ''.-.: .. ,' ,-,..- ' mini aboy!s2. ft.)
. _ . .
TENANT IMPROVEMENT OF WORK STATION - ADDING (3) Limited energy. multi-fan:Ely
75.00 ! I
! residential (with aloovc SC.I. l
RECEPTICALS COUMPUTERJPRINTER
'Renexkible t1.) Enere'":: - See Page I - -"_ :-.',-,;-:,. • -- ,_
i Services or feeders installation, alteration, and/or relocation
. 200 amps sir kiss ! 00.70 I 2
0 PROPERTY OWNER - .- :. -' _ -. - . . ' . 0,-.4-4NANT - . . .., _
201 amps to 401' amps 133. 5 r I
Name: ' 401 amps to 600 amps 200.34 I 7
i
_
Address: ..._!_.:.:_.4
601 amps to 1,000 amps 301,04 ' 2
Over I .000 amps or volts 552.26 2
('ityiStateiZIP: ' Temporary services or feeders installation, alteration, arid/or
relocation
Phone. i ) Fax: ( ) : ' 200 amps o: less I 59.16 I
Owner installation: 'Ibis installation is being made on property that I own which is not ; 201 amps lc: 400 amps t 25.0 2
intended for sole, lease, rent, or exchange, according to ORS 447. 449, 670, and 701. mil snips its 5nn amps 168.54
Owner signature: Date: , Branch circuits - new, alteration, or extension, per panel
... . _. A. Fee for branch circuits twat !
-, 0 AP :-.; ' " ' ' : _ .-'..:: ,. -' alCONTACT : PERSON " ('. - above service or feeder fee.
- A2
' cach branch circull
Business name: OREGON ELETRIC GROUP GENN-S
B. roe thr branch circuits wit/lour 50 16' I
service or feeder fee, first 1 I
Contact name,: PA [‚RICK TREPINA 56.18 2
branch cirtuit .
Address: 1709 SE 3" AVE : . hach add branch circuit 7 4 7,42 2
Miscellaneous (service or feeder not included)
City/State/ZIP: PORTLAND OR 97214 1 Each manufactured or modular I
67.i34
cisvol.il: g. , service and/or feeder
Phone: (503) 849-2096 Fax: : ( ) • Reconnect only 67.34 1 . -
d
---- '
E P.TR_EPINA()tOREGON-F.:I,ECTR1C.L:OM : Pump Of ilTigatioss circle 67.84 -1 2
i s 1
CONTRACTOR ' ign or outline lighting 6734
----- ---
- Signal eircint(s) or litnikai-energy See
Business name: OREGON ELETRIC GROUP CONsT.RIJI-T-LLL-N__ _panel, alteration, Qr extension. l'ne 2 LL
Each additional inspection over allowable in any of the above
Address: 1709 SE 3RD .AVE,
Additional inspectinr. (I hr mini . I . 66.25! hr
City/Statel7AP: PORTLAND OR 97214 Inveslieatiort (I nr min) ; I 66.25/ hr
lndostrial plain r, I hr inin) i ' 7S.lbi it
Phone: 1:503) 849-2096 Fax (503) 234-1001
Inspections for which no fee is ; , ,.... . , l
CCB Lie.: 0 3 Electrical Lic.:A 95 C., Suprv. Lie.: It. 54c1 6 specificallv limed
,:. :: ....•,..Y1..: - -.: ELECTRICAL 'PERMIT-FEES..
• ' %la
Suprv, b:lectrician signature, required: t II■ . . %V 1 i ' *1° Subtotal: 63.6
1 ,... v a _._
. ) C , ,1 f-- / ,r,,,_, ._ Plan review (25% of permit feel
Print name: It) I ririld'k 71 (...,/;" I- ,11/1) l; Date...: ___ 7 // 7 4/ 5
State surcharge [ 12% of lee). 7.632
Authorized sitature: -.-
- — --1---'-'1."-- ' ' '1. \\\ . C '6.. ) •-n . / , TOTAL PERMIT FEE• 71 13
,
g `.1:',.),KL.,V.,,, ‘..., ' --
:+f-7---,-4 -- ----j- This permit application expires if a permit Is not obtained within 180
Print name
' t .i ' ' ' '" 11 /1 !--7.i- ,4:4.-- D be
ate: - 7 / / 7 / / tt ' di after it bas been nece com
pted as plete
—1.2. -"' i .
: yi t, 7,i 'fel , r.. 'i / / • 1 -,,) , i,./ $
, ;. 1....;,..; ... .A.,.-1,.. L,22 ?:..3.2.. ■ - --/- I-- -- --- ' Numbs, of raspectiong allowed per permit.
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