Permit (151) CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit#: ELC2017-00802
T R A:R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/16/2017
Parcel: 2S101AB03100
Jurisdiction: Tigard
Site address: 12115 SW 70TH AVE 201
Project: Advanced Endodontics Subdivision: 2012-009 PARTITION PLAT Lot: 3
Project Description: (2)panels and(41)branch circuits for TI.
Contractor: KEC ELECTRIC INC Owner: TIGARD TRIANGLE PARTNERS LLC
761 SW BAILEY AVE 18187 SIERA DR
HILLSBORO, OR 97123 LAKE OSWEGO, OR 97034
PHONE: 503-439-0904 PHONE:
FAX: 503-640-3838
FEES
Quantity Description Date Amount
2 ea Services or Feeders-200 11/16/2017 $201.40
Specifics: amps or less
41 crt Branch Circuits w/Purchase 11/16/2017 $304.22
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Plan Review Electricial 11/16/2017 $126.41
Type of Const: 1 ea 12%State Surcharge- 11/16/2017 $60.67
Electrical
Occupancy Grp: 1 ea Info Process/Archiving-Lg 11/16/2017 $2.00
$2.00(over 11x17)
Total $694.70
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a cop - - i - . •'rect questions to OUNC by calling 503.232.1987 00.332.2344.
Issued By: �. •• ii' ee Signature:
e%'
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applicata FOR OFFICE CSE OyLI
City of Tigard RECEIVED Received ) /� /�
Date/By: tin f�� �!" Permit#: i /Y/// 00��
1 n 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review / C/
Phone: 503.718.2439 Fax: 503.598.1 T 3 0 2017 Date/By: ( t // /,p ,4' Related Permit#: 1,�/7�Z� ,IC,
Inspection Line: 503.639.4175 ReadyDate/$y Jnris:
TIGARD Internet: www.ti ardor. ov C<a`rC* (tf.- I / Supplemental SeePage2fo
g g ;=1 Votified/Method: A �� Information
BU LD'ti\'G o1 v+.eooN t* !'f. /0-,m0,YPE OF WORK PLAN REVIEW
0 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current
0 Marinas and boatyards.
CATEGOF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ,L—t�,Commercial/industrial ❑Accessory building less to ground or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other:
El Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
j�l 6 sf_ 1 /l 70n Ur ❑Addition f new motor load of system.
Job#: Job site address: ( 100 or more. ❑°°A'°,°°E",°I-2' °°I-3
City/State/ZIP: 0 ' or more residential units. occupancy.
ealth-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: 0
( Project name: PJ/YfdV ‘i 0 Hazardous locations. 0 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 I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
�� (� iLimited energy,multi-family
residential(with above ft.) 75.00 2
_
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER 0 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
APP CANT CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: C /
f�G. t c/ ' /�� � above service or feeder fee, 7 42 2
each branch circuit (P
Contact name: &J `�'✓4.v>' / B.Fee for branch circuits without
/ c i
Address: 7 I /Ale
or feeder fee,first
6( J s 4/p- c7 4i(J' branch circuit 56.18 2
City/State/ZIP: 4/1 GCS ,e / c:) '2r-1 5 Each add'!branch circuit 7.42 2
/ Miscellaneous(service or feeder not included)
Phone:(r 5 ) ,i3 9 05 Cc{ Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:/k.,c e//.6-rceErrz`c .C6447
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 0/54 Electrical Lic.: et.-t{ArC Suprv.Lic.: < specifically listed('h hr min) 90.00/hr
Cat.„,.
�� l ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: �..r Ci7 Subtotal:
Print name: [t Cd � Date:400/,--7/,--7 ❑Plan Review Required(25%of permit fee): ,
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1.\Building\Permits\ELC_PermitApp_ELR ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB