Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2018-00206
Date Issued: 04/04/2018
T f C.A li:I) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S101A603100
Jurisdiction:
Site address: 12115 SW 70TH AVE 102
Project: TVF&R-Occupational Health Subdivision: 2012-009 PARTITION PLAT Lot: 3
Project Description: Electrical for new tenant in vacant space.
Contractor: TEAM ELECTRIC CO Owner: TIGARD TRIANGLE PARTNERS LLC
9400 SE CLACKAMAS RD. 18187 SIERA DR
CLACKAMAS, OR 97015 LAKE OSWEGO, OR 97034
PHONE: 503-557-7180 PHONE:
FAX: 503-557-8201
FEES
Quantity Description Date Amount
2 ea Services or Feeders-200 04/04/2018 $201.40
Specifics: amps or less
37 crt Branch Circuits w/Purchase 04/04/2018 $274.54
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 04/04/2018 $57.11
Electrical
Type of Const:
Occupancy Grp:
Total $533.05
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 forth in OAR
952-001-0010 through OAR 954111-0090 You obtai a copy• the rules or direct questions to OUNC by calling 503.232.1987,o 1.800.332.2344.
Issued By: 7 Permittee Signature: X0411-/
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.
0 ,� ` i ."
Electrical Permit Application -0.-R '1'-.4 1-
FOR OFFICE USE ONLY
City of Tigard Received /y G
'I M r;I` C i 2 i Date/By: �7 /0 w`rRi ermit �j (// O1i �-s
13125 SW Hall Blvd.,Tigard,OR 97223 '
_ Plan Review r
Phone: 503.718.2439 Fax: 503.598 1960 Date/B :i'elated Pe G
Inspection Line: 503.639.4175
,-,t,l: t ,: i i, Y ���� 1 �a ^�����
I 1 G 1 RD_ ,i 1 r + , d 1 e."�i i s Ready Date/By: Juris: H See Page 2 for
Internet www.tigard-or.gov oti ethod
,1I P 4 a r �� Supplemental Information
� .� Ef ��'� s 5 • ��/�i�iA7Ili
t,,,<agr/,a<`. GV.•,' rr t x/,' T
at'.,i`a if ,.�;.rr r ,f,F r /f'' r r r rf t a tr�rvif, r ,r r ,.•.r ,t
.E F'„r/. ,:%,/r,r„ ,-,'�rr,,,r!•�/ f.1.�;v. .�f��l,' ,�1,.;,.tif�lr�f,'v'�F i�;"(rrr` � � 1 frr"fr fW7Y/ ,r,r/,'�'`„yi!✓;,
®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 Building over three stories.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
r,Ailio,^fi¢1!r °, 8 '. 1° f i r l r tr r f 1j
r!��-��- 1 �-r `��,r.0 ��<l, ,acJ rr, ?�,�p� �,,,, tri err a``r�fs�.r�rrJrfr/�, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑Mllltl famll amps for all other installations. buildings.
Y ❑Master builder ❑Other 0 Fire
rai� rFpump. ❑Installation of 150 KVA or
rr '�,,,,f,r ri 1'r 1 i Oil F t)atif:1#1 1,/r n#�r r , l ,,,,S 'r IS1 0 Emergency system. larger separately derived
Job#:9341 Job site address: 12115 SW 70th Ave 0 Addition of new motor load of system.
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97223 0 Six or more residential units. occupancy.
t3 Health-care facilities. CI Recreational vehicle parks.
Suite/bldg./apt.#: 102 I Project name:TVF&R Occupational Health ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW Baylor i "'% fClg i )B®i. ,."4/r1 irr
'
/
Description Qty. 1 Each
Total
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
#1 Meaa f r rEa.add'l 500 sq.ft.or portion 33.92
1
t / f! , 1Il� r 1i ifr rl{ Limited energy,residential
Build out of new Suite 102 with new 75KVA transformer&200amp panel (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Migg M.g:',!4:;: ',;;V!!'',t>,70 f es!`r;r ! 4r %,'� a 2
i Services orRenewable feedersEnergy installation,alteration,❑ SeePage and/or relocation
Name: 200 amps or less 2 100.70 201.40 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) I 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 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 Owner signature: Date: 401 amps to 599 amps 168.54 I. 22
o`f,omf 9° , f yy l rA ,, r/ BrancI:1:ircuits—new alteration or extension per panel
A.Fee branch circuits with
Business name: above service or feeder fee, 37 7 42 274.54 2
Contact name:
each branch circuit
B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone:( ) I Miscellaneous(service or feeder not included)
Fax: :( ) Each manufactured or modular
dwelling, 67.84 2
Email: service and/or feeder
Reconnect only 67.84
v1J{ rig fr1 iff ,i 7iffnaigff ?
Pump or irrigation circle 67.84
2
Business name:Team Electric Co Sign or outline lighting 67.84 2
Address:9400 SE Clackamas Rd Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:Clackamas/Oregon/97015
Additional inspection(1 hr min) 66.25/hr
Phone:(503)557-7180 Fax:(503)557-8271 Investigation(1 hr min) 90.00/hr
Email:BobS@TeamElectricCo.com .<"--- � y��� Industrial plant(1 hr min) 11. 78.18/hr
�- nspecttons for which no fee is
CCB Lic.: 173043 Electrical Lic.: 3-225C Suprv.Lic.: 4416S speclfical fisted(%hr mm) 90 00/hr
'2 fl kk%kk'gijr7.' "nlla' '1c 1 �T'y fr'f fffl ,r
Suprv.Electrician signature,required: ��� e t ref .rr,,,� �,rr 9,., �, �s f� �
l Subtotal: 475.94
Print name: Michael Trusheim Date: 3/26/18 0 Plan Review Required(25%of permit fee): 118.99
State surcharge(12%of permit fee): 57.11
v
Authorized signature: ecifel 0(7Z---.4,6"," TOTAL PERMIT FEE: 652.04
This permit application expires if a permit is not obtained within 180
Print name: Michael Trusheim Date: 3/26/18 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB
.
Commercial Application Checklist = t`
City of Tigardivl, H �; i 21J!3
:I : - 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439,Fax:503.598.1960
T1cARD Internet address: www.tigard-or.gov
PROJECT INFORMATION
Project name: TVF&R Occupational Health Clinic
Date: 3/26/18
Address:12115 SW 70th Ave I City:Tigard I State:OR I ZIP:97223
Scope of work: Build out of new TI space 102. Includes branch circuits, 200A panelboard & Xformer
Reference no.: 9341 Map and tax-lot no.:
Contact person name:Bob Swanson
Company: Team Electric Co
Phone: 503-557-7180
Fax: 503-557-8201
Cellular phone: 503-575-8271
E-mail: BobS@TeamElectricCo.com
NOTES AND INSTRUCTIONS
• The purpose of this checklist is to help define a complete submittal package for the scope of work. Plan
review will not take place until a complete package is submitted.
• This checklist can be used for all commercial construction projects, including new construction, additions,
alterations and tenant improvements.
• For complex projects, applicants should use the "location"space to note the item's location and page
number from the plans or the specification book.
• It is not necessary to duplicate submittal information, even if it is asked for in multiple sections.
• In the checklist, "Required"means that the applicant must provide this information for plan review.
• In the checklist, "P"means—
• if checked by the applicant—the information is provided for the plan review.
• if checked by the plans reviewer—this information is required for the plan review.
■ In the checklist, "NA"means that the information does not apply.
• Choose only those sections of the checklist that apply to your scope of work. Section 1.0, "General Project
Data "must be included with each .ro.ect submitted.
PRE-SUBMITTAL PROCESS
An applicant may request a pre-submittal meeting with representatives of the jurisdiction in which the project
will be built. The meeting may take place during the conceptual, schematic, or in-progress phase, or when the
applicant has completed plans.
INDEX OF CHECKLIST SECTIONS
1.0 General project data Page 2 7.0 Mechanical data(Types
2.0 Civil data Page 2 I and II
2.0 Architecturalvdata g kitchen-hood permits) Page 6
Page 3 8.0 Plumbing data Page 7
4.0 Structural data Page 4 9.0 Electrical data
5.0 Mechanical data(new construction, tenant 10Page 9.0 Fire-suppression data Page 9
improvement, gas-piping permits) Page 5 11.0 Fire-detection and fire-alarm data Page 9
6.0 Mechanical data(additional or replacement 12.0 Re-roof installation data
rooftop-equipment installation permits) Page 6 13.0 Jurisdictional requirements Page 10
q Page 10
This checklist is for building department jurisdictions in Clackamas,Multnomah, and Washington counties.
440-2734(8/01/WEB/COM)
I:ABuilding\Forms\COM-Checklist.doc 05/21/15
SECTION 9.0 — ELECTRICAL DATA
Construction documents Location(sheet number or spec section)
9.1 ® Required No. of sets of plans: 2 A150 & A250
9.2 ® Required Floor plan(s) A150 &A250
9.3 ® Required Electrical load calculations A150
9.4 ® Required One line diagram A150
9.5 ® Required Feeder riser diagram A150
9.6 ® Required Available fault current information A150 & PGE Calculation
9.7 ® Required Panel schedule(s) A150
9.8 ❑ P ® NA Site electrical plan
9.9 ❑ P ® NA Fire-rated construction details
9.10 ® P ❑ NA Lighting plan A250
9.11 ® P ❑ NA - - . :; .. - • _•• and iemergency lighting plan' A250
9.12 ❑ P ® NA Under-slab electrical plan
Supporting documents
9.20 Notes
® Required Structural calculations for vertical loads and lateral
loads for equipment weighing over 400 pounds
9.21 ❑ P ❑ NA Energy code compliance forms and calculations
for lighting
9.22 ❑ P ❑ NA Emergency power system specifications
9.23 ❑ P ❑ NA Feeder riser information
9.24 ❑ P ❑ NA Lighting equipment manufacturers' catalog
"cut sheets"or specifications
440-2734(8/01/WEB/COM) Tri-County Commercial Application Checklist 8
For use in building department jurisdictions in Clackamas, Multnomah, and Washington Counties
I:\Bui ldingTorms\COM-Ch eckli st.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12115 SW 70TH AVE 102, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2018-00206
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Breaker lock for range top
Bond for low voltage rack
Will check at building final
Violation Summary:
Inspector Contractor