Permit y CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2015-00265
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Date Issued: 04/21/2015
Parcel: 1 S135DC00600
Jurisdiction: Tigard
Site address: 11765 SW GREENBURG RD
Project: Bodyfelt Subdivision: TIGARDVILLE PARK Lot: 8
Project Description: (1)branch circuit to rewire existing dental chair
Contractor: TIMBERLINE ELECTRICAL CONTRACTORS Owner: BODYFELT, SCOTT B
9414 SW BARBUR BLVD,#100 11765 SW GREENBURG RD
PORTLAND, OR 97219 TIGARD, OR 97223
PHONE: 503-459-4089 PHONE:
FAX: 503-254-4227
FEES
Quantity Description Date . Amount
1 crt Branch Circuits wo/Purchase 04/21/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/21/2015 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is -- .ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done accordance with :•proved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. • TENTION: Oregon la r you to follow the rules adopted by the Oregon Utility Notification Ce• T.•se rules are set forth in OAR
952-00 -0010 thrRugh OAR 952-00 090. o ay obttainnaa copy of the rules or direct questions to OUNC by calling 503.2 . 9: 2344.
Issue• By: • ����S�wq Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CQNTRACTOR INSTALLATION ONLY
•
SIGNATURE OF SUPR.ELEC' ,�� / Date: ' 16?/
LICENSE NO. / 9:37 O
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICL ITSE ONLY
City of Tigard RECEIVED Received
7 Permit No.: ��‘
11111
• 13125 SW Hall Blvd.,Tigard,OR 97223 2015 Plan Review
a Phone: 503.718.2439 Fax: 5O3. �9t$ 1 Date/B : Other Permit:
T I GAR D Inspection Line: 503.639.4175 Date Ready/By: Atria: Fa See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYBOttOtbat DIVISION 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 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2 ,°l-3",
Job no.: 13416 Job site address: 11765 SW Greenburg Road Six 100HP or more. occupancy.
. ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,Ore 0 Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Scott Bodyfelt ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description l 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'l 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 75.00 2
Rewire existing dental chair relocated for new headwall residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
Branch circuits—new,alteration,or ex_tension,per panel
Owner signature: Date: A.Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name:Timberline Electrical Contractors B.Fee for branch circuits without
service or feeder fee,first 56.18 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 _ 2
Address: Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
dwelling,service and/or feeder
Phone:( ) Fax: :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:Timberline Electrical Contracors panel,alteration or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address:9414 SW Barbur Blvd,Siute 100 Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
City/State/ZIP:Portland,Ore 97219
industrial plant(1 hr min) 78.18/hr
Phone:(503)459-4089 Fax:(503)254-4227 Inspections for which no fee is
90.00/hr
specifically listed(Y2 hr min)
CCB Lic.: 160037 Electrical Lie.: 26-1211C Suprv.Lic.: 4518S ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
,
Subtotal: ,---z,
/E.
Plan review(25%of permit fee): l
Print name: Craig Gossett Date: 4.21.2015 State surcharge(12%of permit fee): 4,,71
Zil TOTAL PERMIT FEE: /pa.. 9a
Authorized signature:
This permit application expires if a permit is not obtain within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I:\Building\Peemits\ELC-PermitApp.doc 07/01/10 440-4615T(I1/05/COM/WEB
NEW OPERATORY EQUIPMENT
AND LAYOUT FOR DR .
RECEIVE')
BODYFELT
APR 21205
CITY Of 1I6ARb
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Timberline Electrical
(N)_ I z z Mai , y aci E m r, Contractors, Inc.
I PO Box 918
I/ I \ Lake Oswego, OR 97034
\ Ph. 503-459-4089
Fax 503-254-4227
c-- CCB # 160037
ALL PATIENT CARE AREAS TO BE WIRED IN ACCORDANCE WITH NEC ARTICLE 517.13 (A)
Craig Gossett J S t '151 t,
EXISTING OPERATORY
RECEIVEp EQUIPMENT AND LAYOUT FOR
APR 2 j 2015
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Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11765 SW GREENBURG RD, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00265
Jeff Grove
Violation Summary:
Inspector Contractor