Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2013-00633
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24!2013
Parcel: 2S102AA00905
Jurisdiction: Tigard
Site address: 12000 SW MAIN ST
Project: Sierk Orthodontics Subdivision: PAYLESS SHOPPING CENTER Lot: 5
Project Description: (28)branch circuits for dental office TI
Contractor: TIMBERLINE ELECTRICAL CONTRACTORS Owner: HAAGEN,GARY L&CANDACE C TRS
9414 SW BARBUR BLVD,#100 2514 SE 112TH AVE
PORTLAND, OR 97219 VANCOUVER,WA 98664
PHONE: 503-459-4089 PHONE:
FAX: 503-254-4227
FEES
Quantity Description Date Amount
28 crt Branch Circuits wo/Purchase 10/24/2013 $256.52
Specifics: Service or Feeder
1 ea Plan Review Electricial 10/24/2013 $64.13
Type of Use: COM 1 ea 12%State Surcharge- 10/24/2013 $30.78
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $351.43
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 rdance with proved plans. This permit will expire if work is not started within 180 days of issuance, or if work i suspended for more the 180
days. NTION: Oregon la re s you to follow the rules adopted by the Oregon Utility Notification Center. Th• rules are set forth in OAR
952-0 -0010 through OAR 952-00 090. may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 • 1.`(332.2344.
I ued By: _ Permittee Signature: ear'
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' • . l� 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 Applicatio i � j,,, fl ir, FOR OFFICE ( SF ()y1.1
�1 ,,
City of Tigard b ll it l l s ,f ;L___, J, Received �y
III DateB 0 p 3 Permit No.: ,A /3 r /5
• 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review J/� / /
Phone: 503.718.2439 Fax: 503.598.1 I 6 d Z t1;j Date/B : }9/'� Ao A'4//.3 Other Permit: �i p9„,5,0 4
T l c n 1.n Inspection Line: 503.639.4175 Date Ready/By: // �3 / Juris: ® See Page 2 for
Internet: www.tigard-or.gov U i V i I d iii- r, Notified/Method: Supplemental Information
1 od
TYPE OF X 4!O R 1 ';" ' ,: ,,,, ', • 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.
❑ I-and 2-family dwelling less to ground,or exceeds 14,000 ❑Commercial-use agricultural
y 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 no.: Job site address: 1200tSW Main Street 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,Oregon 97223 0 Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Dr Sierk ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. i Fee. I Total I •
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.)
Limited energy,multi-family 7500 2
Coplete T.I Remodel residential(with above sq.ft.)
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 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:See Below each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first 1 56.18 56.18 2
branch circuit
Address: Each add'I branch circuit 27 7.42 200.34 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 Sign or outline lighting 67.84 2
Business name:Timberline Electrical Contractors Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:9414 SW Barbur Blvd Each additional inspection over allowable in any of the above
City/State/ZIP:Portland,Ore.97219 Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:(503)459-4089 Fax:(503)254;14227 id, Ili Industrial plant(1 hr min) 78.18/hr
5' 11`19 Inspections for which no fee is 90.00/hr
CCB Lic.: 160037 hi Electrical Li 2- f uprv.Lic.: l i q yi t specifically listed(Vs hr min)
Suprv.Electric' signature,required: 1. � f ELECTRICAL PERMIT FEES
"V Subtotal: 256.52
-Print name: (1 t V J t � Date: Plan review(25%of permit fee): 64.13
— . /b ' /3 State surcharge(12%of permit fee): 30.'71,Z if
Authorized signature: TOTAL PERMIT FEE: 351.94'rt 3
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\EL,C_PermitApp_ELR_ERE.doc Rev 05/21/2013 440.46151(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
r RESIDENTIAL WORK ONLY - . -. • 1 FEE'SCHEDULE
Fee for all residential systems combined ... $75.00 Descripf1on 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
El 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
Inspections for which no fee is 90.00/hr
specifically listed(1/2 hr min)
1.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
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