Permit CITY OF TIGARD ELECTRICAL PERMIT
B COMMUNITY DEVELOPMENT Permit#: ELC201500820
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/27/2015
Parcel: 1 S126CA00100
Jurisdiction: Tigard
Site address: 9225 SW HALL BLVD G
Project: Ideal Image Subdivision: FAIRVIEW PLACE CONDO Lot: 20
Project Description: Adding outlets for inpatient care rooms.
Contractor: GARNER ELECTRIC Owner: GREENBURG CORNERS LLC
2920 SE BROOKWOOD AVE A 621 SW ALDER ST, STE 800
HILLSBORO, OR 97123 PORTLAND, OR 97205
PHONE: 503-648-4552 PHONE:
FAX: 503-642-7925
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 10/26/2015 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/26/2015 $10.30
Type of Use: COM Electrical
Class of Work: ALT 1 ea Plan Review Electricial 10/26/2015 $21.47
Type of Const:
Occupancy Grp:
Total $117.63
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. ATTE . • ,•n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0• 0 through OAR 9 •-001-109• You may obtain a copy of the rules or direct questions to OUNC .• - • .1987 or 1.800.332.2344.
Issu•• By: 1 A.. LL �� , Permittee Sig r ure: Fird r •
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' -
- Zrear fd--l_i Date: xo
LICENSE NO. �I�
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.
r ) _
Electrical Permit Application x FOR OFFICE USE ONLY
Receives
City of Tigard . - ; , /CIA) is— f / Permit No.: _`__ .)___m_,
'� 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review / W
Phone: 503.718.2439 Fax: 503.598.1960 ,` (� Date/By: l OS, l Other Permit:
TIGARD Inspection Line: 503.639.4175 GE V ��� Date Ready/B . 7uris: 0 See Page 2 for
Internet: www.tigard-or.gov � „ Notified/Method:`a/ J P� Supplemental Information
TYPE OF WOI \ x - 'OS PLAN REVIEW
❑New construction Addition/alteration/repla 6AAD Please check all that apply(submit 2 sets of plans w/items checked below):
❑ Demolition ❑ Other:
�Ni Or "1 ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF C " i exceeds 10,000 amps at 150 volts or Floating buildings.
��.' r�� i 12
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","1-2",
r� 1001-IP or more. occupancy.
Job no.: Job site address:_I 725 %/�/ ,y /1 'IJ`ry'
v It +++� Y(,( ❑Six ore residential units. ❑Recreational vehicle parks.
City/State/ZIP: / f� �f ealth-care facilities. ❑Supply voltage for more than
1 I G 1' 1 DE `�'1 7i/i3 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.:>1 Project name: :„/n / �Yy ❑Service or feeder 600 amps or more.
"`TTT7 �'+�-mot FEE SCHEDULE
Cross street/directions to job site: 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'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.:
Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
f Limited energy,multi-family 75.00 2
Ado )1rate,MC 1✓1 )0Chalt residential(with above sq.ft.)
t l l� 1 IU Renewable Energy ❑ See Page 2
' �, i . Services or feeders installation,alteration,and/or relocation
u» 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT ' t 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
n Over 1,000 amps or volts 552.26 2
City/State/ZIP: �f Temporary services or feeders installation,alteration,and/or
Phone:( ) 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 125.08 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,per panel
® APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name:Garner Electric each branch circuit 7.42 2
/� B.Fee for branch circuits without
Contact name: y he► +6 2 service or feeder fee,first t ;
yr ti�1 � v� branch circuit 56.18 ts1 l 2
Address: 2920 SE Brookwood Ave#A Each add'I branch circuit 7.42 ZQ, 2
City/State/ZIP:Hillsboro,OR 97123 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)648.4552 Fax: :(503)642.1LA 24✓ dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail•(" J(2,4 garnerelectric.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Garner Electric Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:2920 SE Brookwood Ave#A Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: Hillsboro,OR 97123 '
Investigation(1 hr min) 66.25/hr
Phone:(503)648.4552 ax:(503)642.lei Z,c Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCI3 Lic.: 121159 Electri•. c. 34-305C Suprv.Lic.: 3707S specifically listed('/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,req red: /, �/
Subtotal: eg,E i2
r' ° zfi: ,�' ^ /� Plan review(25%of permit fee):name: Charles Garner 1�' rte: I l/ S—I S ( p ): '�'I . H 7
State surcharge(12%of permit fee): IC, 3E
Authorized signature: TOTAL PERMIT FEE: -
Print name: Date: This permit application expires if a permit is not obtained withtin.180
days after it has been accept as corn lete. 2�,
* Number of inspections allowed per permi t i�, coJ
I:\BuildingWermits tELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(1 I/05/COM/wEB
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
9225 SW HALL BLVD G, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00820
Jeff Grove
Violation Summary:
Inspector Contractor