Permit CITY OF TIGARD ELECTRICAL PERMIT
2 - COMMUNITY DEVELOPMENT Permit#: ELC2013-00549
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/18/2013
Parcel: 1 S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 201
Project: Providence Health Systems Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: (2)branch circuits to add desk at work station
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 09/18/2013 $63.60
Specifics: Service or Feeder•
1 ea 12%State Surcharge- 09/18/2013 $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 t ugh OA 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5 03,2,2,2.1987 or 1.800.332.2344.
Issued By: � � A/��t Permittee Signature: tyc�-��
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 Applica COR 0E, ICC use 0NLt " :
l"n u Received
/� i City of Tigard DaleBy. 7 lr _ Permit 1.4o.:e 46-415-4/9
i . ° 13125 SW Hall Blvd.,Tigard,OR 975 P 16 2013 Plan Review /^_
'',..' ;, Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: 'r
ti Inspection Line: 503.639.4175 Date Read/B saris:
TI'cARC?; CITY OFTIGARD y o I Supplemental See Page 2 for
nf
3; ^S� �* � Internet: www.tigard-or.gov Nohficd/Muhod: I Supplemental Iaformahon
B[JI[�� �[NUDWISION
. . .. TYPE,OF.IVO U<
PLAN REVIEW
❑New construction Ej Addition/alterationireplacement Please check all that apply(submit 2 sets of-plans w/items checked below):
❑Service or feeder 400 amps of wore El Building over three stones.
❑Demolition ❑Other.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 solo 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 o f t 50 KVA or
' .. .JOB STL`E•INFORMATION AND LOCATION - - 3 `rn
Emergency system larger separately derived system.
-- ❑Addibort of new motor load of 0"A","L". '•1-3".
Job no.g 5.7 01 Job site address: 12442 SW SCHOLLS FERRY RD 1001IP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:TIGARD OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:201 Project name:S ❑Service or feeder 600 amps or more.
..;;FEE SCHEDULE '
Cross street/directions to job site:SW NORTH DAKOTA er- C w1C E._ Description I otv. I Fee 1 Total I •
{�FfI t r/f �ySTf NS New residential single or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea add'150U sq.ti.or portion 33.92 1
Limited energy,residential
. ',DESCRIPTIONS OF,WORK = (with above sq.ft) 75.00 '-
Limited energy,multi-family 75.00 7
TENANT IMPROVEMENT OF WORK STATION ADDING DESK residential(with above sq.Ii.)
Renewable Energy -',.". , :.ti See Paget "..- -
Services or feeders installation,alteration,and/or relocation•PROPER T Y::O WNER _ 200 amps or less 100.70
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address' 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or leas 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: ______—`__�_�__Date:_ -_ Branch circuits-new alteration or extension •er .and
A.Fee for branch circuits with•❑:APPLICANT ';®;CONTACT`PERSON. :;- above.srrvseeorteederfee,
Business name:OREGON ELETRIC GROUP CONSTRUCTION each branch circuit 7.42 2
B.Fee for branch circuits without $6.18
Contact name: PATRICK TREPINA service or feeder fee,first 1 56.111 2
branch circuit
Address:1709 SE 3RD AVE Each add'lbranch circuit 1 7.42 7.42 2
City/State/ZIP:PORTLAND OR 97214 Miscellaneous(service or feeder not included)
Each manufactured or modular
67.84 2
dwelling,service and/or feeder —
Phone:(503)849-2096 Fax::( ) -- -----
Reconnect only 67.84 2
E-mail:P.TREPINA @OREGON-ELECTRIC.COM Pump or irrigation circle 67.84 2
CONTRACTOR, Sign or outline lighting 67,84 2
Business name:OREGON ELETRIC GROUP CONSTRUCTION Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: 1709 SE 3RD AVE Each additional inspection over allowable in any of the above
C' /State/ZIP:PORTLAND OR 97214 Additional inspection(I ter min) 66.25'hi
Investigation(1 hrmin) 66.25/hr
Phone:(503)849-2096 Fax:(503)234-1001 Industrial plant(1 hrmin) 78.15/hr
j Inspections for which no fee is 90.00/hr
CCl3 Lie.: 203 Electrical Lie.: ,..,16,-15c Suprv. Lie.: y J� specifically listed('/r hr min)
�4#40 .. • ELECTRICAL PERMIT<;BEES
Suprv. Electrician signature,require+ It X , AT If Subtotal: 63.6
rI '..r=o- i'� l%SAY
i tt C:� 3/f r ? Plan review(25%ofpelatit fee):
Print name:f-�. . /-14/ t i 1 , ti- - ' Date: 7
I '�.,4' t As_ ' I /�i . State surcharge(12%of permit fee): 7.632
Authorized signature�/�,�� / / /fftt f4�,__, TOTA.LPERMITFEE: 71.23
/ �f r �r 1 This permit application expires if a permit is not obtained within 180
Print name: l In ,/,� ,`� A� ! (p.,/-- Date: J Z / ( days after it has been accepted as complete.
f! j It t • Number of inspections allowed per permit. �j
I^1 3uildung'\Pu vuial.C._,PennilApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(1 Ii05/COM'WE.B �"
, (,,...._.___
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12442 SW SCHOLLS FERRY RD 201, TIGARD, 2013 -12 -03 00:00:00
OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2013 - 00549
Inspection Type: Result:
199 Electrical final PASS - No C of 0
Comments:
Violation Summary:
Inspector Contractor