Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2015-00464
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/06/2015
Parcel: 2S101AB03000
Jurisdiction:
Site address: 7150 SW DARTMOUTH ST
Project: Pediatric Associates Northwest Subdivision: 2012-009 PARTITION PLAT Lot: 2
Project Description: Electrical for TI.
Contractor: CHERRY CITY ELECTRIC Owner: DF DEVELOPMENT LLC
1596 22ND ST SE 23077 SW NEWLAND RD
SALEM, OR 97302 WILSONVILLE, OR 97070
PHONE: 503-566-5600 PHONE:
FAX: 503-571-4410
FEES
Quantity Description Date Amount
2 ea Services or Feeders-201 to 07/06/2015 $267.12
Specifics: 400 amps
51 crt Branch Circuits w/Purchase 07/06/2015 $378.42
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Signal circuit or Limited 07/06/2015 $75.00
Energy Panel
Type of Const: 1 ea Plan Review Electricial 07/06/2015 $180.14
Occupancy Grp: 1 ea 12%State Surcharge- 07/06/2015 $86.46
Electrical
Total $987.14
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 nis adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You 'n a c,py of the rules o direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: L_ �� •ermittee Signature: - , y
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 Application l 1)1< O1 I( I 1 ',l 1)NI 1
City of TigarJACEIVEJ) �s 67® Permit No.: . D(5 LAY .�r,
111 13125 SW Hall Blvd.,Tigard,OR 9
Plan Review r
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : 7/Z /r��. other Permit: L /• / t
�` Inspection Line: 503.639.4175 JUN 15 2015 015 Notified/Method:7, Supplemental Information
Internet: www.tigard-or.gov er
TYPE °C PR*TIUAI 6.11 PLAN REVIEW
❑New construction ®Addition y (� Please check all that apply(submit l sets of plans w/items checked below):
"u1"111"- I II ®Service or feeder 400 amps or more ❑Building over three stories. t:
❑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 '
❑Emergency system. larger tely der system.
JOB SITE INFORMATION AND LOCATION ❑Addition o f new motor load of ❑"A","E","1-1","1-3",
o.,
100 or Job no.:3415133 Job site address:7150 SW Dartmouth more.
❑Six or more residential units. ❑Recreational vehicle parks. (,
City/State/ZIP:Tigard,OR.97223 ❑Supply voltage for more than
rj i dour locations. 600 volts nominal.
Suite/bldgJapt no.: Project name:Pediatrics-Gwap Acoc;>..-- ❑Vice or feeder 600 amps or more.
FEE SCHEDULE L
Cross street/directions to job site:72nd oe cr+pdsn I Qty. i Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage. ;
Subdivision: Lot no.: 1,000 sq.R.or less 168.54
Ea.add'I 500 sq.R or portion 33.92 1 11'
Tax map/parcel no.: Limited r
�'residential 75.00
DESCRIPTION OF WORK (with above sq.ft.) 2
Limited energy,multi-family 75.00 2
Tenant electrical residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,al don,and/or relocation
❑ PROPERTY OWNER I ® TENANT 200 amps or less p- t't t ,,
201 amps to 400 amps 133.56= , ,7,
Name:Pediatric Associates of the NW 401 amps to 600 amps 200.34
Address:2701 NW Vaughn st. Ste.360 601 amps to 1,000 amps �..,�� I 301.0 I
City/State/ZIP:Portland,OR. 97210 Over 1.000 amps or volts 552.26 2 1
ty Temporary services or feeders installation,alteration,and/or
Phone:(503)227-0671 Fax:( ) relocation ....r.mmuimsoma■mpimano as'.- -.-__ w
200 amps or less - imu..11Mlitier1111MINLtilhain■i
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 rI
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel hi
❑ APPLICANT I A.Fee for bcwsdh circuits with
❑ CONTACT PERSON above service or feeder fee, 51 7.42 378.42 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 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84
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
Business name:Cherry City Electric 3i@dciratil(NCar l t, T > See 75.00
panel,alteration,or exttseton. Page 2 2
Address:8100 NE St.Johns Rd Ste DO-101 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Vancoouver,WA...98665 Investigation(1 hr min) 66.25/hr
Phone:(360)5714411 Fax:(360)5714410 Industrial plant(1 hr min) 78.18/hr 1• „
Inspections for which no fee is 90.00/hr ,
CCB Lic.: 91668 Electrical Lic.: 37-620C Suprv.Lic.: 5621S i p'1 1�(r specifically listed('h hr min) _
I ELECTRICAL PERMIT FEES
Suprv.Electrician signature,requ�� e---- Subtotal: '' .., ,* ..
Print name: William F1 Date: 6-12-15 Plan review(25%of permit fee): _244.954 j, ,tk
State surcharge(12%of permit fee): --149:03-- -_x re. 4 6.
Authorized sign.,/� TOTAL PERMIT FEE: —4t5 f ill
+' / /�' This permit application expires if a permit is not obtained withi 180
Print name: f - Date6—a- /v-1 days after it has been accepted as complete.■
' Number of inspections allowed per permit.
1:\BuildingWsrmits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/201 440-4615T(11/05/COM/WEB
Electrjcal 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 l Qty. I Fee I Total 1 •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
nBurglar arm 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
n Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ O• ther: 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(h 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.
n B• oiler 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: I
*No licenses are required. Licenses are required
for all other installations
l:\Building\Pnmits\ELC_PermitApp ELR_ERE.doe Rev 05/21/2013
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
7150 SW DARTMOUTH ST, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00464
Jeff Grove
Violation Summary:
Inspector Contractor