Permit (22) 711 , CITY OF TIGARD ELECTRICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit ELC2016-00653
T[GA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/13/2016
Parcel: 1S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 400
Project: Everest Institute Subdivision: ASHBROOK FARM
Project Description: (17)branch circuits for new dental training lab. Lot: 5
Contractor: CAPITOL ELECTRIC CO INC Owner:
PLAZA WEST OWNER LLC
11401 NE MARX STREET BY CHIEF FINANCIAL OFFICER
PORTLAND, OR 97220 680 FIFTH AVE 20TH FL
NEW YORK, NY 10019
PHONE: 503-255-9488 PHONE:
FAX: 503-257-7121
FEES
Quantity Description Date Amount
Specifics: 17 crt Branch Circuits wo/Purchase 09/12/2016 $174.90
Service or Feeder
1 ea Plan Review Electricial 09/12/2016 $43.73
Type of Use: COM
1 ea 12%State Surcharge- 09/12/2016 $20.99
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $239.62
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� ttheeQ rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may of f the rules or direct questions to OUNC by calling 503.232.1987 or4
1.800.332.23 .
Issued By: c �f� Permittee Signature: r1C, ,
C/ 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 FOR OFFICE USE ONLY
City of Tigard Receive. g� ']
g974„1--,,,`t t yl t6`/IA, Permit no.: 0 t�(Q'_
'� 13125 SW Hall Blvd.,Tigard,OR . k Date/By: _
it Phone 5 Ball.4171 Fax: 503.$9 ° " s)4 Plan Review/IV (,�✓�)"�
,9 /ether Permit:
T t K:,A It I;) Inspection Line: 503.639.4175 ` T~` DateBy� (.?�J�"�7
Internet: w'ww.tigard-or.gov Date Ready/By: Juris: See Page 2 for
C1 ' n\b Notified/Method:Cr 1 1 /D 4 �3 rte+ 114)?d6,....
Supplemental Information
❑ New construction ❑ Addition/alteration/replacer>et4 s a '�g` t
❑ Demolition 0 Other: >- i t 3¢ i ,�4I 'N Please check all that apply(submit 2 sets of plans w/items checked below):
- � � air _ fi ;)1 0 Service or feeder 400 amps or more 0 Buildingover three stories
❑ I-and 2-familydwelling0 where the available fault current 0 Marinas and boatyards
Commercial/industrial • Accessory building exceeds 10,000 amps at 150 volts or
❑ Multi-family 0 Master Builder0 Floating buildings
044416`4445i,A;:i,Ile Other less to ground,or exceeds 14,000 0
fCommercial-use agricultural
amps for all other installations. buildings
Job no.: 161601 Job site address: 9600 SW Oak St ❑ Fire Pump ❑
Installation of 75 KVA or
❑ Emergency system larger separately derived system.
City/State/ZIP: Tigard,OR 97223 ❑ Addition of new motor load of
"A" "E" "1-2" "1-3"
•
100HP or more. 0 occupancy
Suite/bldg./apt.no.: 420 !Project name: Everest; I I-Cu 0 Six or more residential units
0 Recreational vehicle parks.
Cross Street/Directions to job site: ❑ Health-care facilities ❑ Supply voltage for more than
0 Hazardous locations 600 volts nominal.
0 Service or feeder 600 amps or more
Subdivision: I Lot no.:
Tax map/parcel no.: Description Qty. Fee. Total
New residential-single or multi-family dwelling unit.
a, ' ,: ;w Includes attached garage.
E and new dental training room -
1000 sq.ft.or less $ 168.54
4
� a; Y> , .F . J Ea.Add'l 500 sq.ft or portion
. a,,: i, . ;„y $ 33.92 1
Limited energy residential
Name: (with above sq.ft.)
Limited energy, $ 75.00 2
Address: multi-family
residential(with above sq.ft.) $ 75.00
Service or feeders installation,alteration,and/or relocation 2
City/State/ZIP: 200 amps or less
201 amps to 400 amps $ 100.70 2
Phone: $ 133.56 2
Fax: 401 amps to 600 amps $ 200.34
601 amps to 1000 amps 2
Owner installation: This installation is being made on property that I own which is not $ 551.26 2
intended for sale,lease,rent or exchange,according to ORS 447,449,670,and 701 Overm ora y amps or volts $ 552.26o
Temporary services or feeders installation,alteration,and/or 2
Owner signature: Date:
relocation
a: �.._$® 200 amps or less
0";,Q0';:7;,' ,! I $ 59.36 1
b � "§' ;�,e14;;-1 � 201 amps to 400 amps
Business Name: 401 amps to 599 amps $ 125.08 2
$ 168.54 I 2
c �: Branch circuits- I
new,alteration,or extension,per panel
Contact name. i,l A. Fee for branch circuits with
service or feeder fee,each
Address: branch circuit
$ 7.42 2
B. Fee for branch circuits
City/State/ZIP:
without service or feeder fee,
first branch circuit 1 $ 56.18 56.18 2
Phone: 3..,,k5-6.....1,11,-13.1Fax: Each additional branch circuit: 16 $ 7.42 118.72 2
E-mail: Miscellaneous(service or feeder not included)
Each manufactured or modular
e a. dwelling,service and or feeder
Business Name: CAPITOL ELECTRIC CO.,INC. Reconnect only $ 67.84 2
Pump or irrigation circle $ 67.84 2
Contact name: $ 67.84 2
Sign or outline lighting $ 67.84
Signal circuit(s)or limited-energy 2
Address: 11401 NE MARX ST. See
panel,alterations,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Additional inspection(1 hr min)
66.25/hr
City/State/ZIP: PORTLAND,OR 97220-1041
Investigation(1 hr min) 66.25/hr
Phone: 503-255-9488 Fax: 503-257-7121 Industrial plant(1 hr min)
Inspections for which no fee is 90 10/hr
CCB Lic.: 48748 Electrical Lie.: 26-496C �Suprv.Lie.: 3132-S 90.00/hr
`) specifically listed(1/2 hr min)
Suprv.Electrician signature,required:7D t///
7 0 6\,
Print Name: Darr Ie IcNeel Date: 08/23/16 Subtotal: $ 174.90
Authorized signature: % Plan review(25%of permit fee): $ 43,7tz.1 j
l-'/7 ' . �e� L State surcharge(12%of permit fee): $ 20.99
Name: Darrell McNee/ TOTAL PERMIT FEE: $ -209:61-
Print
This permit application expires if a permit is not obtained within 180 I9
days after it has been accepted as complete. `
*Number of inspections per permit allowed.
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