Permit (250) CITY OF TIGARD ELECTRICAL PERMIT
11: - COMMUNITY DEVELOPMENT Permit#: ELC2016-00881
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/28/2016
T[fes# g Parcel: 2S112DA01300
Jurisdiction: Tigard
Site address: 6640 SW REDWOOD LN 300
Project: Portland Clinic South Subdivision: 1996-048 PARTITION PLAT Lot: 1
Project Description: Phase II-(10)branch circuits&low voltage for data.Work is in patient care area.
Contractor: TEAM ELECTRIC CO Owner: PACIFIC REALTY ASSOCIATES
9400 SE CLACKAMAS RD. ATTN: N PIVEN
CLACKAMAS, OR 97015 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-557-7180 PHONE: 503-624-6300
FAX: 503-557-8201
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo/Purchase 12/28/2016 $122.96
Specifics: Service or Feeder
1 ea Signal circuit or Limited 12/28/2016 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12%State Surcharge- 12/28/2016 $23.76
Electrical
Type of Const: 1 ea Plan Review Electricial 12/28/2016 $49.49
Occupancy Grp:
Total $271.21
Required Items and Reports(Conditions)
This permit is issu-: •ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done accordance wit` 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 aw -;uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 001-0010 through OAR 952 s01-009 J. ou may obtain a copy of the rules or direct questions to OUNC by calling 503 800. .234'4.
/ / k .
I sued By: Permittee Signature: ��
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'
d,- --0— Date: /014.--/A
LICENSE NO. LIZ I//s
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 Applicati ...1 _ w .,, FOR OFFICE. t SF Oyl.v
City of Tigard 4 CEIV}
.. Received /, t
Date/By: ll I S/(� 4 Permit No.:Et 7n1�DD g /
,111111
• 13125 SW Hall Blvd.,Tigard,OR 97223 `-o'er
i Phone: 503.718.2439 Fax: 503.598.1 � Plan Review
V 1 r Date/By: Zc2 f Other Permit:
T 1( ,,p n Inspection Line: 503.639.4175 V 2(016 Date Ready/By: II runs: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method:/ /27/ 4�,a P__. `� Supplemental Information
TYPEO�T�x���+ 'TgIpGA 14,_ //y)161,24,/ c%✓ PLAN REEVIEw
❑New construction ®Addititl /Itld#alii r IhE¢Ip(g 3{.: Please check all that apply(submit 2 sets of plans w/items checked below):
0 Demolition 0 Other: ❑Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 17 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder
0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB STtE INFORMATION AND LOCATION
IIUN ❑Emergency system. larger separately derived system.
0 Addition of new motor load of 0"A","E","1-2","1-3",
Job no.:10824 Job site address:6640 SW Redwood Ln. 1001W or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Portland,OR 97224 ®Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:300 Project name:The Portland Clinic South 0 Service or feeder 600 amps or more.
Cross street/directions to job site:SW Sequoia Pkway FEE SCHEDULE
Description I Qty. I Fee. 7 Total I '
aro Floor New residential single-or multi-family dwelling unit.
Includes attached garage.
1,000 sq.ft.or less 168.54 4
Subdivision: Lot no.:
Tax map/parcel no.: Ea.add'1500 sq.ft.or portion 33.92 i
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
Tenant improvement of space — ped—,,,,jr, ,, residential(with above sq.ft.) 75.00 2
(� ^ _ Renewable Energy 0 See Page 2
1�ti-+ti ✓L�l/L-Q..t t.H b5) 61h taj2 etAfut \ Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER 0 TENANT 200 amps or less 100.70 2
Name: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
City/State/ZIP: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
0 APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name: each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name: service or feeder fee,first 1 56.18
branch circuit 56.18 2
Address: Each add'l branch circuit 9 7.42 66.78 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular
67.84 2
Phone:( ) Fax: :( ) dwelling,service and/or feeder
E-mail:
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Team Electric Company Signal circuit(s)or limited-energySee
panel,alteration,or extension. 1 Page 2 75.00 2
Address:9400 SE Clackamas Rd Each additional inspection over allowable in any of the above
City/State/ZIP:Clackamas Or.97015 Additional inspection(I hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:(503)557-7180 Fax:(503)557-8201 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 173043 1�� V Electrical Lic.: 3-225C Suprv.Lic.: 4416S specifically listed C=hr min) 90.00/hr
Suprv.Electrician signature,required: Mice`,/,7:4 ELECTRICAL PERMIT FEES
K"'C Subtotal: 197.96
Print name: Michael Trusheim Date: 11/9/16 Plan review(25%of permit fee): 49A9
- State surcharge(12%of permit fee): 23.75
Authorized signature: M k_h_. /f 7_- / ® TOTAL PERMIT FEE: 271.2$ipt,
Print name: Michael Trusheim G1�-� /�� Date: 11/9/16 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
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 1 Qty. I Fee I Total I *
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01to15kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
❑ 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
❑ 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
❑ 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 mm)
Inspections for which no fee is 90.00/hr
specifically listed(%3 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
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
6640 SW REDWOOD LN 300, TIGARD, OR,
97224
Record Type: Record ID:
Commercial - Electrical ELC2016-00881
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
6640 SW REDWOOD LN 300, TIGARD, OR,
97224
Record Type:
Commercial - Electrical
Inspection Type:
130 Ceiling cover
Result:
PART
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
ELC2016-00881
Inspector:
Jeff Grove
Contractor