Permit CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: ELC2014-00054
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/18/2014
Parcel: 2S102AA00905
Jurisdiction: Tigard
Site address: 12000 SW MAIN ST
Project: Sierk Orthodontics Subdivision: PAYLESS SHOPPING CENTER Lot: 5
Project Description: (2)branch circuits in the area that was previously the drive-thru which is being enclosed.
Contractor: CONNECTIONS ELECTRIC INC Owner: HAAGEN, GARY L&CANDACE C TRS
PO BOX 7136 2514 SE 112TH AVE
SALEM, OR 97303-0026 VANCOUVER,WA 98664
PHONE: 503-390-7914 PHONE:
FAX: 503-463-6863
FEES
Quantity Description Data Amount
2 crt Branch Circuits wo/Purchase 02/18/2014 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/18/2014 $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 is- . or if w• • •en•-• for more the 180
days. 1 • Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi = on Cent.r. Tllose rules = = set forth in OAR
952 601-0010 through•'- 952-•; 1090. You may obtain a copy of the rules or direct questions to OUNC by calling•03.232.1987 or 1.800.332 4
/
Is-ued By: ism _�� 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' d2 Q1 < 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.
I
Electrical Permit Aim lic
EIVED 1 .1: l_til.()NIA
, i Permit No, E/410/ ...Zee 4 •
City of Tigard
. --- 13125 SW Nall Blvd.,Tiprd-REOR
1111
Plme: 503.7111.2430 Fu.: 503.5cF. 1 - 5 2014 __Bateibly: .;;arff/
Plan Review
DatelBy:
t abet Pintnii: 1-4_,,&,„ley4(-4e, • ,
,it;,,,,„„n Impaction Line: 503.639.4175 Dom Readyily: hes. -.1 FZ1 See Page 2 far
...
Internet: www.tigard-or.gov NitiliedMethod: Supplemental Information
; • i
,...,
LJ New construction
[
0 Demolition TYPE * • :T.
,,. . . . •
Add iti 411 !n i'll 2p 0, e',
0 Other: PLAN REVIEW
Please check all Mai apply(submo/sets of plans oroans.nhonk,a1 mow
0 Service or Feeder 4(10 amps or more 0 Building over three stories.
%here the available Auk current 0 Marinas and boatyards 11:
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
less In PAIIRI.01,3Xeee)s 14.001) 0 Cramtiervial-iist agricultural
0 1-and 2-Family dwelling eil Commercial/industrial 0 Accessory huilding amps lie all other inshillarions buildings
0 Multi-famiiy 0 Master builder 0 Other: . 0 Fire pump. Q Intaalltoion al 1 ili KVA or
0 litnerpency synlem. tar Lao separately den ved sysiem.
JOB SITE INFORMATION AND IAICATION _1 0 Addition of new motor(oat!or
_ . ....---
100118 or more. ns•ruponey.
--Job no.: Job sits utldress: acsab SW AAA,...) ‘3 0 SIX Of more rosidcniial ono, 0 litxmational whicie parks
-.--•
0!genial-ran:rat-attics. 0 Supply Whal.!C or mom than
• City/StalealP: 71 cs/1.n...0 la A- Ill vt-3 0 lizaanlous local ions. MO bobs nominal.
- _
SuiteibItIgiapt.no.: 1 p -
j. roved name:5 .rk.pc. 0 f.i.,...c.14.0 0 Service or feeder 600 smrs.or mow.
FEE SCHEDULE
Criss strceltdireetions to job site: peacciso., .I.-0n77:77,,,• L.___3.1...4.__I -
_ .._ .___...... --
New residential single--or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.11 or less 1-! 168.54
4
Ea.addl 500 sq.h.or ponion I
.13."2 i
- ---
-1.111(inaplparcel no Limited energy,residential
' i
- 75.00 -
DESCRIPTION Of WORK (with above ALI)_
- .- Limited energy,multi-firmily
75.00 2
'13 it.A.,-,caA__..c.....a (--‘117 5 residential(with above sq.II.)
Rettewshie Enemy 0 See Page 2
Servkes or feeders installation,al(eration,and/or relocation
......_____ _
0 PROPERTY OWNER -I 0 TENANT 200 amps or less 100.70
-I
201 amps tu 400 amps i 33.56 ........_
Name: _ 401 an to 600 amps 200.34 -.,
________ _ - -
_
Address: C on!amps to 1.000 amps 301.04 2
- -
Over 1.000 amps or volis 552.26 2
City/Slaie/ZiP: ' Temporary Tem .e vlees or feeders installation.alteration and/or
1 s r
Phone:( ) Fax:( I ' relocation
.._- 200 an,s or less 59.36 I 1 I
Owner installation:Illis installation is being made on property that l own which is not 201 amps to 400 amps 125.011 2
intended for sale.lease,rent,or exchange,according to ORS 447,449.670,and 701. _
401 amps to 599 amps 16.4.54
Owner signature: Date: ...._ _ Branch circuits-new,alteration,or extension.per panel
-......
la APPLICANT 1 0 CONTACT PERSON A.Foe fur broach circuits with
- , above service or feeder lee.
7,12 2
Business mune.
• s.)la__ ILZ.1 t Si e,..1 P...51.e,...-1____ Beach branch circuit
H.Fee for Nandi circuits mithow
Contact mine: --.
____________ service ur feeder fcc.find
branch circuit t 56.1X 5"..ei-•iI 2
Address: 2.24,,t, 5 c ,i c) _I io ti„t_s 7 c_,T Each add'I branch circuit 4
7.42 -•-119---:!
Miscellaneous service or feeder not included)
City/Stater/JP: 1 tilp A 0 4=5 6 0 I d- C11 L 49 Each manufactured or modular
67.84 -1721
durelli . service and. feeder -
Phone:(503 )4,vq- 4,14 4 Fax::( )
Recuninxt only 67.54 .1
- ---. - ---- _.-...- -.... .....
E-mail: Pump or irrigation circle r 67.84 2
__,..,.._.
- ................_ ._.__.___.-____ ______
CONTRACTOR _ Sign or outline lighting 67.84
Signal circuit(*)or I imi ied-energy Sec
Business name: C
...._ 1.P.,---1.0,1 E I c.1 TA ■( _punel.alteralkm,or extel isi on. _Eat.2 s
--i
A_d_re._ss:___a_i 1.5... 2ag.:11...
__ , above ....
Additional inspection(I hr min) 66.25;hr
- -
City/SlateiZIP: 4./1 i ,..-1,,,„. 0,/„.... -7 5.0 5 Investigation(1 hr min) 66.25;hr
.d... 4.{ _ - _.--...
Phone:t50 ) 3,1p _ 7 k Fax:( ) industrial plant(I hr min) 721.18:hr-
Inspections fur which no fcc is
MB Lie.: 4S i.1.4 I hieelrical Lie.: ,,4_204 Suprv.Lie.: 34115 szecifitml(y listedp:hr min) 90.00.;In
______.
F-LECTRICAL PERMIT FEES --1
Suprv.lika.-trician signature.require& •41/ 161111111111
iim........ Ji.„ „in.... Subtotal: (p.i.4,0 1
Print ------;;;- =%
narne.‘...ovvvisco 5.... •42.IL, - 4 t Date: Plan review(25%of permit fee). ---
State surcharge(12%of permit feel: 7. &..
Authorized signature: TOTAL PERMIT FEE: -7/ .
.
_ _..._......
Print name: I Date: Thls permit application evpirts if ti permit is not obtained oilhin 180
days after it has been accepted at complete. 410)r
_ - -'
• Number or inspections allowed per permit.
t'Italktairitssina;El 1 ProonApp 1.1 11 PRE tls•Rot tr5•21.201; 4.01-4n1t17111111$4:001 W811
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12000 SW MAIN ST, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
2014-03-10 00:00:00
ELC2014-00054
PASS - No C of O
Violation Summary:
Inspector Contractor