Permit •
/ ,..
CITY OF TIGARD o ELECTRICAL PERMIT
s . COMMUNITY DEVELOPMENT °
illS/
Permit#: ELC2013 00597
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/08/2013
Parcel: 2S102CB03200
Jurisdiction: TIGARD
Site address: 9975 SW FREWING ST 110
Project: United Medical Group Subdivision: FREWING'S ORCHARD TRACTS Lot: 21
Project Description: Electrical for TI:(1)service,(6)branch circuits,and sign lighting for(1)sign. 10/30/13,adding(1)low voltage for
data -
Contractor: SURGE ELECTRIC Owner: MASSIH LLC
13617 NE 61ST AVE BY PIERROUZ YASAVOLIAN
VANCOUVER,WA 98686 8 BECKET ST
LAKE OSWEGO, OR 97035
PHONE: 360-772-1321 PHONE:
FAX: 866-929-4771
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/08/2013 $100.70
Specifics: amps or less
6 crt Branch Circuits w/Purchase 10/08/2013 $44.52
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Sign or Outline Lighting 10/08/2013 $67.84
Type of Const: 1 ea 12%State Surcharge- 10/08/2013 $25.57
Electrical
Occupancy Grp: 1 ea Signal circuit or Limited 10/30/2013 $75.00
Energy Panel
9 12%State Surcharge- 10/30/2013 $9.00
Electrical(manual)
Total $322.63
Required Items and Reports(Conditions)
This permit i '. •. . to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do = n accordance with ap• •ved •a s. This permit will expire if work is not started within 180 da s o ' .-- , or if work is suspended for more the 180
day- ATTENTION: Oregon law r-quires'you to follow the rules adopted by the •r-••n Utility •otificaio ent-r. Those rules are set forth in OAR
95 -001-0010 thr• gh OAR 952-00 Op=0. obtain a copy o/the rules or direct que ons to OUNC by-= '•,503.232.19:- or 1.800.332.2344.
I sued By: , / �/ Pe •••-e Signature: � ) /�C�r vy oa_..,_
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.
prittrofic
Electrical Permit Applicat><on- FOR OFFICE USE:ONLY
City of Tigard OCT 3 0 2 013 Date/By: (i /2j la I Permit No.: (..,d'e).e2/.5-GZ25---yyy
q 13125 SW Hall Blvd.,Tigard,OR 97223
,,a ,,,:� ) Plan Review Other Permit:
Illq
III ' Phone: 503.718.2439 Fax: 503.598;l96QJF flGA D
Date/By:
Inspection Line: 503.639.4175 pt +1 I r,_ 1`ii!ni it P Date Ready/By: luris: ® See Page 2 for
I'l G A I:a Internet: www.tigard-or.gov pH ii ,.+.`If t'�'L,'' Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW .
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑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 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","1-3",
Job no.: Job site address: 997 4/�.(xJl�cc IOOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ] ❑Health-care facilities. ❑Supply voltage for more than
/1 ^ ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: lam`°, II r(_��,J ❑Service or feeder 600 amps or more.
"/� FEE SCHEDULE
Cross street/directions to job site: -c.5ly Description I Qty. I Fee. I Total I •
0 New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential '
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
1 Jn� Limited energy,multi-family 75.00 2
t v,l residential(with above sq.ft.)
(� 6%1 Renewable Energy ❑ See Page 2
�. t-�7�4 Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT • 200 amps or less 100.70 2
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 less 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,per panel
❑,APPLICANT . I '❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'I branch circuit 1 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Signor outline lighting 67.84 2
Business name: 6 Signal circuit(s)or limited-energy ) See /�
panel,alteration,or extension. / Page 2 7 2-
Address: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: Investigation(I hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) . 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(A hr min) _
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 75-CP
Print name: Date:
Plan review(25%of permit fee):
C
State surcharge(12%of permit fee): /• -
Authorized signature: TOTAL PERMIT FEE: fe- • Od
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
1=1 Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr
• Inspections for which no fee is 90.00/hr
specifically listed(V5 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
ElAudio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC PermitApp_ELR_ERE.doc Rev 05/21/2013
CITY OF TIGARD ELECTRICAL PERMIT
'F ! COMMUNITY DEVELOPMENT Permit#: ELC2013-00597
T IC;AA O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/08/2013
Parcel: 2S102CB03200
Jurisdiction: TIGARD
Site address: 9975 SW FREWING ST 110
Project: United Medical Group Subdivision: FREWING'S ORCHARD TRACTS Lot: 21
Project Description: Electrical for TI:(1)service,(6)branch circuits,and sign lighting for(1)sign.
Contractor: SURGE ELECTRIC Owner: MASSIH LLC
13617 NE 61ST AVE BY PIERROUZ YASAVOLIAN
VANCOUVER,WA 98686 8 BECKET ST
LAKE OSWEGO,OR 97035
PHONE: 360-772-1321 PHONE:
FAX: 866-929-4771
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/08/2013 $100.70
Specifics: amps or less
6 crt Branch Circuits w/Purchase 10/08/2013 $44.52
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Sign or Outline Lighting 10/08/2013 $67.84
Type of Const: 1 ea 12%State Surcharge- 10/08/2013 $25.57
Electrical
Occupancy Grp:
Total $238.63
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 oft les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / �=
Issued By: Permittee Signature: C [—�
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 Ina 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 FOR OFFICE: USE ONLY
Received
City of Tigard DateBy: 1' 3113 @r Permit No.: E,e-av t 3--W ST+7
IN a 13125 SW Hall Blvd.,Tigard,OR 97vaiNIED
Plan Review
0 . . Phone: 503.718.2439 Fax: 503.598.1960 't0\3 Date/By: Other Permit:/�
y: G1P�13-�joaa-o
I'I G n K u Inspection Line: 503.639.4175 Os Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov Di 001" Notified/Method: ! - - Supplemental Information
TYPE OF WOO.- •1�C%St ' PLAN REVIEW
❑New construction in Addition/altera VI."VT ement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑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 g Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB'SITE INFORMATION.AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job site address: -�� -,,11 r 100HP or more. occupancy.
Job no.:
6 W e 0 1 n 4 y ❑Six or more residential units. ❑Recreational vehicle parks.
Clty/State/Z1P: /f ❑I lealth-care facilities. ❑Supply voltage for more than
1 O/'` 7-2, ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 1100"
0 Project name: On i /• ,dl�,` ❑Service or feeder 600 amps or more.
it_e_41/ / `�—+!' „ FEE SCHEDULE
Cross street/directions to job site: �� �1 n 6 TT , Description I Qty. I Fee. I Total I •
r / b New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
- - - Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.:_ Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
P IJ ^ n (i Limited energy,multi-family
`,11-'�', etfCJJ�I- � � �.��� ' residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
V `rE-RServices or feeders installation,alteration,and/or relocation
' , ❑ PROPERTY OWNER I ❑ TENANT 200 amps or less I 100.70 /O-lc, 2
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:( ) I Fax:( ) relocation
200 amps or less 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,per panel
❑ APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7.42 il/l 5-.1. 2
Business name: ke-t-k0 W F r C g_ each branch circuit
B.Fee for branch circuits without
Contact name: 0 �,tJ Y _2 service or feeder fee,first 56.18 2
—7 branch circuit
Address: /��)06 n,- fl-C- /n . Each add'I branch circuit 7.42 2
ty pa-f--k,,)7 OR /r 2-2 // 6 Miscellaneous(service or feeder not included)
City/State/ZIP: �l I G(� Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ���� Fax: :( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
' CONTRACTOR . Signor outline lighting ' 67.84 , (j 7,gf 2
Business name: a (C. C Signal circuit(s)or limited-energy See
-,1, panel,alteration,or extension. Page 2 2
Address: t?p.?;�/ 1J. , G 9 (�uk .fi lit . Each additional inspection over allowable in any of the above
n I > 1 T 1 Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: TO n L ) vC� Investigation(1 hr min) 66.25/hr
Phone:( 366 Z 192-2,.....� I Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: /1 Deco 0 I Electrical Lic.: Vj� I Suprv.Lic.: �S �fa specifically listed(vz hr min)
•Suprv.EleittCIatt si r ,required: 7Ji /�[' t Sh ELECTRICAL PERMIT'FEES
_ , Subtotal:
Print name: I ! /I / j Date: • a Plan review(25%of permit fee):
V •" + ! State surcharge(12%of permit fee):
Authorized signature: .- TOTAL PERMIT FEE: ' �. T. Co 3
This permit application expires if a permit is not obtained within 180
Print name: A 0(/ / 0n Z( _ r� Date: 1 Q frey j(`l, ,"` ►�`V�` I days after it has been accepted as complete.
" Number of inspections allowed per permit.
1:\Building'Permits\ELC_PermitAppLR_ERE.doc Rev 05/21/2013 440-4 T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
• >100 kva(fee in accordance with 552.26 2
❑ Heating,Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
❑ Each additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(V hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 05/21/2013
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9975 SW FREWING ST 110, TIGARD, OR, 97223 2013 - 12 - 03 00:00:00
Record Type: Record ID:
Commercial - Electrical ELC2013 - 00597
Inspection Type: Result:
199 Electrical final PASS - No C of 0
Comments:
Violation Summary:
Inspector Contractor