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Permit CITY OF TIGARD ELECTRICAL PERMIT 1111 • COMMUNITY DEVELOPMENT Permit#: ELC2015-00618 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/20/2015 Parcel: 1S134BC00401 Jurisdiction: Tigard Site address: 12442 SW SCHOLLS FERRY RD 100 Project: Providence Medical Group Subdivision: GREENWOOD TERRACE CONDO Lot: 17 Project Description: Installing(15)branch circuits for this healthcare facility remodel&low voltage for fire alarm. Contractor: COCHRAN INC Owner: PROVIDENCE HEALTH SYSTEM-OREGO 7550 SW TECH CENTER DR#220 ATTN: REAL ESTATE&CONSTRUCTION TIGARD, OR 97223 4400 NE HALSEY BLDG 2 STE 190 PORTLAND, OR 97213 PHONE: 503-234-6564 PHONE: FAX: 503-238-2098 FEES Quantity Description Date Amount 15 crt Branch Circuits wo/Purchase 08/19/2015 $160.06 Specifics: Service or Feeder 1 ea Signal circuit or Limited 08/19/2015 $75.00 Type of Use: COM Energy Panel Class of Work: ALT 1 ea Plan Review Electricial 08/19/2015 $58.77 1 ea 12%State Surcharge- 08/19/2015 $28.21 Type of Const: Electrical Occupancy Grp: 5 Misc Administration Fee 08/20/2015 $5.00 Total $327.04 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 - - -- -- 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. • NTION: Oreg•• la equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0• -0010 through OAR 95 •01-0•••. You may obtain a copy of the rules or direct questions to OUNC by - • 232.1987 or 1.800.332 344. Iss ed By: /� �/ / Permittee Signa • `i ' / �/1( (�� - 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: �/'/ /5— LICENSE NO. �j Sj/ 7 5 ((( 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 ecms�++ 1vE� ,(„R t 11 I ( 1 l \l I ICI , City of Tigard RG�-/ Reteivsd • 13125 SW Halt Blvd.,Tigard,OR 97223 Pp: ' t 2�� C Plan R ' IN Phone: 503.718.2439 Fax: 503.598.1960 AuCj 5 L pp�g : ,� M Related Permit a: Inspection Line: 503.639.4175 flciA1c1) Ready Y: B11 See Page 2for Internet: www.tigard-0r.gov C� OF 1 't- , caified/Method•,1I�� %14 Supplemetal Information _ .TYPE OF W li t[��NG:. •. LIA 'IAN REVIEW ❑New construction ®Addition/alter 1ion/replacement Please chec all that apply(submit I sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition 0 Other: where the available fault current ❑Marinas and boatyards CATEGORY OF CONSTRUCTION . ' exceeds 10,000 amps al 150 volts or ❑Floating buildings. ❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building leas to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations- buildings. ID Multi-family ❑Master builder ❑Other: ❑Fin pump. . ❑Installation of 150 KVA or JOB SITE'INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: I Job site address: 12442 SW Scholls Ferry Rd ❑Addition of new motor load of system. IOOHP or more. ❑"A”"E"'•I-2"•,I-3" City/StalelZlP;97223 / ❑Six tore residential units. occupancy. 47/71. t.0 e 1 r t Lis%7 ealth-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: 100 Project name:Ste.100-Scholls Med Home 7 ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total f •_ New residential single-or multl-family dwelling unit. Subdivision: rLot#: Includes attached garage. 1,000 sq.ft.or Less 168.54 4 Tax map/parcel#: Ea.add'(500 sq.R.or portion 33.92 I .:• " DESCRIPTION OF WORK Limited energy,residential - (with above n. 75.00 2 Install receptacles,lighting,and fire alarm Limited energy sq. residential(with above sq.R.) 75.00 2 Renewable Energy ❑ See Page 2 .0 PROPERTY OWNER [ . . ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168 54 2 APPLICANT Branch circuits-new,alteration,or extension, er panel �' I ❑`CONTACT-PERSON, A.Fee for branch circuits with Business name:Cochran Inc above service or feeder fee, 7.42 2 each branch circuit Contact name:Larry Warren B.Fee for branch circuits without Address:7550 SW Tech Center Dr. Suite 220 branch it feeder fee,first I 56.18 56 I S 2 branch circuit City/State/ZIP:Tigard,OR 97223 Each add'(branch circuit 14 7.42 103.88 2 Phone:(503)718-6001 f Fax::(971)205-4268 Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email:lwarren@cochraninc.com l Reconnect only 67.84 2 CONTRACTOR • Pump or irrigation circle 67.84 2 Business name:Cochran Inc Sign or outline lighting 67.84 2 Address:7550 SW Tech Center Dr. Suite 220 panellalteration,orextennssion.-energy IN See Page 2 75 2 City/State/ZIP:Tigard,OR 97223 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(971)205-4242 Fax:(971)205-4268 Investigation(I hr min) _ 90.0W hr Email:sswenson @cochraninc.com ,,i)17 Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lie.: 72942 Electrical Lic.: 37-546C Suprv.Lic.:,83178— specifically listed(ti hr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: S6/9-172764 re(72 Si6n/ I'..."-' ' Subtotal: 235.06 Print name: Richard Smith Date: 7/14/15 ®Plan Review Required(25%of permit fee): 58.77 /7 Slate surcharge(12%of permit fee): 28.21 Authorized signature: / L TOTAL PERMIT FEE: J�1419"- 7 Y - �- ��_ This permit application expires if a permit is not obtained within 180 Print name: `j 4 . ,, Date: 7//01 days after It has been accepted as complete. ,,2.2 - 0 • Number of inspections allowed per permit. a L/ t 1 t uiWing\PermitstEl.0 PermitApp ELR ERE.doe Rev 06/17/2015 440.461 ST(I I/OS/COM/wEB XQ/ — — Electrical Permit Application—City of Tigard t'age 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined: $75.00 Renewable �y : Each 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 Wind generation systems In excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* 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: ❑ Other: Each additional inspection is charged at an hourly(I hr min) 6615/hr Inspections for which no fee is specifically listed(.4 hr min) 90.00/hr COMMERCIAL:WORK ONLY: . ELECTRICAL PERMIT FEES . Fee for each commercial system: $75.00 Subtotal(Enter on Page I): • Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ® Fire Alarm Installation ❑ HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n 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 I\auildie6\Permits\ELC_PermitApp ELR ERE.doc Rev 06/17/2015 Electrical Permit Application t ""fl City of Tigard rA c.'--'t"` ; Received III • 13125 SW Hall Blvd.,Ti r Plan Oate/By: Pe°mt�r ZG �j7 ', ff* Bard,OR 97223 r 7 rl i C Plan Review �r? G{ ! Phone: 503.718,2439 Fax: 503.598.1960 l i i " `U DateBy. Related Permit M: ■ Inspection line. 503.634.4175 j r� Ready Dalusy: rum ® Sec Page 2 for t 1 c;n It 1) Internet: www.Ugard•or.gov fe 1'`{ `;, Supplemental information i TYPE OF WORK ')`, = 4 • PLAIN REVIEW ❑New construction ®Addition/altera`tion/replacement Please check all that apply(submit I sets of plans w/items checked): Q�5 ❑Service or feeder 400 amps or more ❑Building over three stales ❑Demolition ❑Other: AUG 6 . CATEGORY OF CONSTRUCTION where the�available fault current ❑marinas and boatyards exceeds 10,000 atnps at 150 volts or ❑Floating buildings. { ❑ 1-and 2-family dwelling ®Commercial/industrial 0 T ARD, 4 lass to ground,or exceeds 14,000 CI Commercial use agricultural V i� amps for all other installations buildin ❑ Multi-family ❑Master builder gat• A,rDINC DIVISiO ❑Fire pang. ❑Ms:anauon of 150 KVA or T ❑ JOB SITE INFORMATION AND LO Emergency system larger separately denied Job#: ]ob site address: 12442 SW Scholls Ferry Rd ❑Addition of new motor load of system, 100HP or more. ❑"A','E" "1.2""1.3 City/State/ZIP:97223 ❑Six tore residential units occupancy ealth•care facilities. ❑Recreational vehicle parks Suite/bldg./apt.#: 100 Project name:Ste. 100-Scholls Med Home ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal Cross street/directions to job site: FEE SCHEDULE Description rich 7etar I • - _ New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.R.or less 168 54 4 Ea.add'l 500 sq.R.or portion 33.92 1 i', '' - DESCRIPTION OF WORK Limited energy,residential - install receptacles,lighting,and lire alarm a (with above sq.it) 75 2 } Limited energy,multi-family residential(with above sq R) 75.00- 2 ❑ PROPERTY OWNER ❑ TENANT Renewable Eger: ❑ See Page 2 Services or feeders.installation,alteration,and/or relocation i Name: 200 amps or less 100 70 2 Address: 201 amps to 400 amps 133.56 F. 401 amps to 600 amps 200 34 2 City/State/ZIP: 601 amps s to 100.0 amps 301.04 2 i ?hone:( ) Fax:( ) Over 1,000 amps or volts 552.26 -21 Email Temporary services or feeders installation,alteration,and/or , relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 0 iniended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 7C 1. 201 amps to 400 amps - 125.08 2 Owlet sIL:.�...n,. Date._ 401 amps to S99 amps 168 54 2 ®`APPLICANT..- •- I - ❑ CONTACT PERSON Branch circuits-new,alteration,or extension, er .and A.above bo for branch or feeder w e, Business name:Cochran Inc_ a service or feeder fee, -- each branch circuit 7.42 , 2 Contact name:Larry Warren B Fee for branch circuit,srufwrir Address:7550 SW Tech Center Dr. Suite 220 service or feeder fee.first 1 56 I S 5618 2 branch circuit City/State/ZIP:Tigard,OR 97223 Each add'/branch circuit 14 7 42 103.831 2 Miscellaneous(service or feeder not included) LPhone:(503)718-6001 Fax::(971)205-4268 Each manufactured or modular dwelling,service and/or feeder I 67 84 2 Email: lwarren @cochraninc.com Reconnect only 1 67 ey 2 CONTRACTOR Pump or irrigation circle 67 84 2 Business name:Cochran Inc Sign or outline lighting 67 84 2 Address:7550 SW Tech Center Dr. Suite 220 Signal circuit(s)or limited-energy panel alteration,or extension. ® See Page 2 75 2 City/Slate/ZIP:Tigard,OR 97223 Each additional inspection over allowable in any of the above Phone: 9?I 205-4242 Additional inspection(I hr min) 66.25/hr , ( ) Fax:(971)205-4268 Investigation(1 hr min) 90.00/hr Email:sswenson@cochraninc.com Industrial plant(I hr min) 78.18/hr Inspections for which no fee is —� CCB Lic.: 72942 Electrical iltk 37-546C` Suprv.Lic.: 8317S specifically listed(Yi hr mini 90.00/hr Suprv. Electrician signature,required: i / ELECTRICAL PERMIT FFFS- -- `"`...ZA`.�nt�. Subtotal: 235.06 • Print name: Richard Smith Dai 7/14/15 ®Plan Review Required(2S%of permit fee): 58.77 — Slate surcharge(12%ofpemtitRc) 28.21 Authorized signature: �. - TOTAL PERMIT FEE: 219.29 i �_ This permit application espires if a permit is ant obtained within 180 Print name: 4",. ,% Date: 7//y /S-- j days after it has been accepted as complete. " 1L'G • Number of inspections allowed per permit I UluildingwermiU'ELC PrrmnApp_ELR ERE doc Rev 06/17,1015 440-4013111 Ir05KOWWEa 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 12442 SW SCHOLLS FERRY RD 100, TIGARD, OR, 97223 Commercial - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2015-00618 Jeff Grove Violation Summary: Inspector Contractor