Permit (50) CITY OF TIGARD ELECTRICAL PERMIT
INCOMMUNITY DEVELOPMENT Permit#: ELC2017-00336
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/25/2017
T t Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 150
Project: Sleep Medicine Subdivision: METZGER,TOWN OF Lot: 9
Project Description: (2)branch circuit alteration in patient care areas
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-255-9488 PHONE:
FAX: 503-257-7121
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 05/25/2017 $63.60
Specifics: Service or Feeder
1 ea Plan Review Electricial 05/25/2017 $15.90
Type of Use: COM 1 ea 12%State Surcharge- 05/25/2017 $7.63
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $87.13
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 - •rdance • 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. AT` NTION: Oregon I- -> ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 0010 through OAR 95 •. -009'. You may obtain a co•y of the rules or direct questions to OUNC by calling 503.232,1987 or 1,800.332.2344.
Y
Issu d By: 4( ��/�L At�-La# Permittee Signature: l am'
/ 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' 40.-, ,gif Date: I
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 ,A alpiieati CEIVEecee �n
City of Tigard Drvate/By. �J (D1 7` lj"l Permit no.: i.,_cd-01-7— Op 3
10 13125 SW Hall Blvd.,Tigard,OR 9722331�A�A� 0 Plan Review 0
Phone: 503.639.4171 Fax: 503.598.19i111)<{Y 1 2017 Date/By:�s/I81 Other Permit:
TIGARD Inspection Line: 503.639.4175 >��� "`"'"
Internet www.tigard-ar.gov Date Ready/By: Juris: 0 See Page 2 for
CITY OF TIGARD Notified/Method. �7 Supplemental Information
BUILDING DIVISION
y.
40 ,.. ;= , 1'�tP1:0"W R... , ° *.,,: PI'ANREVtlirv�
❑ New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑ Demolition 0 Other: 0 Service or feeder 400 amps or more 0 Building over three stories
1*. CATQR' C FON 'IRTJ T1pN y4HC=_:� where the available fault current 0 Marinas and boatyards
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building exceeds 10,000 amps at 150 volts or 0 Floating buildings
❑ Multi-family 0 Master Builder 0 Other less to ground,or exceeds 14,000 0 Commercial-use agricultural
,,.. ,TDB Sjfg INFO( ATt(M)LND LOCATION''' ' 3!.• amps for all other installations. buildings
Job no.: 170937 Job site address: 10220 SW Greenberg Rd ❑ Fire Pump 0 Installation of 75 KVA or
0 Emergency system larger separately derived system.
City/State/ZIP: Tigard,Oregon,97223 ❑ Addition of new motor load of 0 "A","E","1-2","1-3",
100HP or more. 0 occupancy
Suite/bldg./apt.no.: 150 Project name: Sleep Medicine ❑ Six or more residential units 0 Recreational vehicle parks.
0 Health-care facilities 0 Supply voltage for more than
Cross Street/Directions to job site: 0 Hazardous locations 600 volts nominal.
❑ Service or feeder 600 amps or more
Subdivision: Lot no.:
., S, FEgSCHEDULE. ? ;'ti-,
Description I Qtr. I Fee. I Total I **
Tax map/parcel no.: New residential-single or multi-family dwelling unit.
"'°''` '• DESCRIPTION OBAVOEW Includes attached garage.
Install(8)General purpose outlets 1000 sq.ft.or less $ 168.54 4
Ea.Add'500 sq.ft or portion $ 33.92 I
'U'' PROPERTY OWNER f,' " U `SAN - ra _ Vii:. ,' Limited energy residential
Name: (with above sq.ft.) $ 75.00 2
Limited energy,multi-family
Address: residential(with above sq.ft.) $ 75.00 2
Service or feeders installation,alteration,and/or relocation
City/State/ZIP: 200 amps or less $ 100.70 2
201 amps to 400 amps $ 133.56 2
Phone: Fax: 401 amps to 600 amps $ 200.34 2
601 amps to 1000 amps $ 301.04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 552.26 2
intended for sale,lease,rent or exchange,according to ORS 447,449,670,and 701 Temporary services or feeders installation,alteration,and/or
Owner signature: Date: relocation
200 amps or less $ 59.36 1
L,}:• APPLICAF`t, '4,.:.1 ' '' U,y=.CONTACr'PERSON ,'''''' 201 amps to 400 amps $ 125.08 2
Business Name: 401 amps to 599 amps $ 168.54 2
Branch circuits-new,alteration,or extension,per panel
Contact name: 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: Fax: Each additional branch circuit: 1 $ 7.42 7.42 2
Miscellaneous(service or feeder not included)
E-mail: Each manufactured or modular
,„..CONI AC1' Il ,,, -,1•4,t,,,,,, v,,,; dwelling,service and or feeder $ 67.84 2
Business Name: CAPITOL ELECTRIC CO.,INC. Reconnect only $ 67.84 2
Pump or irrigation circle $ 67.84 2
Contact name: Hillary Porter Sign or outline lighting g 67.84 2
Signal circuit(s)or limited-energy See
Address: 11401 NE MARX ST. panel,alterations,or extension. Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: PORTLAND,OR 97220-1041 Additional inspection(I hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone: 503-255-9488 Fax: 503-257-7121 Industrial plant(1 hr min) 78,1 g/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 48748 (Electrical Lie.: 26-496C ISuprv.Lie.: 3132-S specifically listed(1/2 hr min)
Suprv.Electrician signature,required: ,w.'',, II -- � „�� ECTRICAI'HERMIT F• '.
''..7:
l'%'�L /�' �� Subtotal $ 63.60^
Print Name: Darrell McNeel Date: 05/09/17 e Plan review(25%of permit fee): $ 15.90
Authorized signature: 7 y, State surcharge(12%of permit fee): $ 7.63
��ti /�Ilt TOTAL PERMIT FEE: $ 87.13
Print Name: Darrell McNeel This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
r Number of inspections per permit allowed.
I:\Building\Permits\ELC-PermitApp.doc 5/21/13 440-4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10220 SW GREENBURG RD 150, TIGARD, OR,
97223
Record Type: Record ID:
Commercial - Electrical ELC2017-00336
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor