Permit CITY OF TIGARD ELECTRICAL PERMIT
N
:111111
1 '' COMMUNITY DEVELOPMENT Permit#: ELC2015-00286
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/07/2015
Parcel: 1 S134BC00300
Jurisdiction: Tigard
Site address: 12266 SW SCHOLLS FERRY RD
Project: Pacific Dental Services,LLC Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Electrical for a new dental office;(33)branch circuits and(2)limited energy systems for nurse calls and medical.
Contractor: KEC ELECTRIC INC Owner: FW OR-GREENWAY TOWN CENTER LLC
761 SW BAILEY AVE ONE INDEPENDENT DRIVE, SUITE 114
HILLSBORO, OR 97123 JACKSONVILLE, FL 32202
PHONE: 503-439-0904 PHONE: 503-603-4709
FAX: 503-640-3838
FEES
Quantity Description Date Amount
33 crt Branch Circuits wo/Purchase 07/06/2015 $293.62
Specifics: Service or Feeder
2 ea Signal circuit or Limited 07/06/2015 $150.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea Plan Review Electricial 07/06/2015 $110.91
1 ea 12%State Surcharge- 07/06/2015 $53.23
Type of Const: Electrical
Occupancy Grp:
Total $607.76
Required Items and Reports(Conditions)
This permit ' ' • • •'ect to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will
be don, in accordance wit' -pproved 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 I- re• ' - you to follow the rules adopted by the Oregon Utility Notification ter. Those rules are set forth in OAR
952-001-0010 th •ugh OAR 952-01 •r90. Y• , obtain a copy o the rules or direct questions to OUNC by calling 503. .1987 or 1.800 32�'4.
Is-ued By: Permittee Signature: ice! .
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
s-/
SIGNATURE OF SUPR.ELEC' Date: -7/7/75-
,
LICENSE NO. L.(e is
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.
E.R;ctr izal Permit Application.. �j j� FOR OFFICE I'SE ONLY
City of Tigard C I M EP Received
111111 • DateB Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ���
Phone: 503.718.2439 Fax: 503.598.l9 Date/B : ,A, M'... Other Permit: : , ♦15-- ii
I I i,A i;I Inspection Line: S 03.639.4175 PR 21 2015 Date Ready/By: �� Sec Page 2 for
Internet: www.ti and-or. ov Notified/Method: 15 Supplemental Information
TYPE OF
Vi .
o S PLAN REVIEW� —
['New construction ❑Addition/altefatir ION
ease 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:TI where the available fault current
❑Marinas and boatyards.
CATEGORY OF CONSTRUCT 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","I-3",
Job no.: I Job site address: 12266 SW SCHOLLS FERRY RD IoOHP rmore. occupancy.
❑S' or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:TIGARD,OR 97223 ealth-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project Ram !t6-k_ sa_,y}�,I ❑Service or feeder 600 amps or more
�/`�'V` FEE SCHEDULE
Cross street/directions to job site: _�I Ges
1 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 75.00 2
LIGHTS,OUTLETS,SWITCHES residential(with above sq.ft)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
0 PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:REGENCY CENTERS 401 amps to 600 amps 200.34 2
Address:5335 SW MEADOWS,SUITE 295 - 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:LAKE OSWEGO,OR 97035 Temporary services or feeders installation,alteration,and/or
Phone:(503)603-4709 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 1 25.08 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, er panel
® APPLICANT I 0 CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
1 Business name: PACIFIC DENTAL SERVICES each branch circuit 7.42 2
B.Fee for branch circuits without
4, Contact name: BRANDON WEBB service or feeder fee,first 1 56.18 54 LK 2
branch circuit
C-)., Address:2044 CALIFORNIA AVE Each add'I branch circuit 7.42 71st f 2
v City/State/ZIP:CORONA,CA 92881 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(951)5825758 I Fax: :(714)388-3951 dwelling,service and/or feeder
Reconnect only 67.84 2
W E-mail:webbB @pacden.com Pump or irrigation circle 67.84 2
.J CON K TACTOR Sign or outline lighting 67.84 2
w Business name: !y C Li"((6 /1 Signal circuit( )or limited-energy See
c `s panel,alteration,or extension. Page 2 1 • 2 44
Address: 74) ► o�w t I L€ 7 A V Each additional inspection over allowable in any of the above
r ' I Additional inspection(1 hr min) 66.25/hr
.... City/State/ZIP: 1'''f t L1_S o/ o k_ 7i 9. Investigation(1 hr min) 66.25/hr
Phone: 9��+'�T I Fax:( 3) �i(o 393 g Industrial plant(I hr min) 78.18/hr
UInspections for which no fee is
CCB Lic.: t O� � ElectrlCal :3F'7��Q ) S pry.Lie.: J specifically listed(%hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required �� � , / Subtotal: '24J.(0 2
Print name: l Date: /7/(�� Plan review(25%of permit fee):
�`"e't State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: BRANDON WEBB Date: 4-20-15 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:1Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440.4615T(II/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 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
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
I=1 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
Ill Heating,Ventilation and Air Conditioning OAR918-309-0040)
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 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('Y,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 2
*No licenses are required. Licenses are required
for all other installations
1.\Building'Permits\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
12266 SW SCHOLLS FERRY RD, TIGARD, OR,
97223
Commercial - Electrical
105 Underground/slab cover
PASS
ELC2015-00286
Herb Stabenow
Violation Summary:
Inspector Contractor