Permit (214) CITY OF TIGARD ELECTRICAL PERMIT
'. - �.�' COMMUNITY DEVELOPMENT :itAs i Permit#: ELC2018-00416
Tigard � Date Issued: 07/23/2018
F[ a \d D13125 SW Hall Blvd., OR 97223 503.718.2439 j �
Parcel: 1S135DA02400
\t-, Jurisdiction: Tigard
Site address: 11045 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Electrical for a new 16,327 square feet,32-bed residential care facility. 10/25/18: REPRINTED to correct address
from 11035 to 11045.
Contractor: ERIC OLSON ELECTRIC COMPANY Owner: BROOKSIDE RCF LLC
10013 NE HAZEL DELL AVE PMB 432 5987 SE ROBHIL DR
VANCOUVER,WA 98685 MILWAUKIE, OR 97222
PHONE: 360-609-4901 PHONE:
FAX: 360-693-2980
FEES
Quantity Description Date Amount
8 ea Services or Feeders-200 07/23/2018 $805.60
Specifics:, amps or less
1 ea Services or Feeders-601 to 07/23/2018 $301.04
Type of Use: COM 1000 amps
Class of Work: ALT 214 crt Branch Circuits w/Purchase 07/23/2018 $1,587.88
Service or Feeder
Type of Const: 1 ea Plan Review Electricial 07/23/2018 $673.63
Occupancy Grp: 1 ea 12%State Surcharge- 07/23/2018 $323.34
Electrical
Total $3,691.49
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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987( or 11.8800.3332.2344.. �(�
Issued By: �./ v�� Permittee Signature: 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.
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2018 00416
T n G A .o 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/23/2018
Parcel: 1 S 135DA02400
Jurisdiction: Tigard
Site address: 11035 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Electrical for a new 16,327 square feet,32-bed residential care facility.
Contractor: ERIC OLSON ELECTRIC COMPANY Owner: BROOKSIDE RCF LLC
10013 NE HAZEL DELL AVE PMB 432 5987 SE ROBHIL DR
VANCOUVER,WA 98685 MILWAUKIE, OR 97222
PHONE: 360-609-4901 PHONE:
FAX: 360-693-2980
FEES
Quantity Description Date Amount
8 ea Services or Feeders-200 07/23/2018 $805.60
Specifics: amps or less
1 ea Services or Feeders-601 to 07/23/2018 $301.04
Type of Use: COM 1000 amps
Class of Work: ALT 214 crt Branch Circuits w/Purchase 07/23/2018 $1,587.88
Service or Feeder
Type of Const: 1 ea Plan Review Electricial 07/23/2018 $673.63
Occupancy Grp: 1 ea 12%State Surcharge- 07/23/2018 $323.34
Electrical
Total $3,691.49
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through I•R 952-001-0090. You m •• copy of the •les or direct questions to OUNC by calling 503.232,1987 0 344. ,
s`;
��� Permittee Signature: air
Issued By: �� `6 g
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application EGA �`,
Tigard h'E)i"f l3hl'lE h:153,t?hl,N
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'r 13125SL Hall Blvd_lvd_Tigard.OR 97223 t� l d U D t-llv , tants if.
7f$
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n fim,$ew _ a.tem
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CITY OF III3A tolaw 7 s---
.j.1- 4�Re'e#teiPmm r: ��' i(ll, .
T 1 C t1k2 i3 Email: T ardBuildtngPca ita cr Tigard-0441v,, t z tsar fig,; t ti ` 1
inspection Line: 503.639.4175 lnterae fw 1 t3thrrg � -y,l E S plc Page:few
ofiYtcd Mec*K3et: �u le
/� i j - pp'ruraiel information
l TT '"E OF 't O d p , " :lit REVIEW ..
tl
New construction 0 Additionialteration`rcp1ac`ercnt 1 lease el," all that app!,{submit vets of Plan,w Yeti:,checkedi.
0Demolition 0 Othe Cl Servicecit fe der ttta aanla5 or anc se 0 l3asils ink(rocs t sty st>rms.
i where the'available fault current ClMinims and b< #%tarda
CATEOEtRV:OF CONSTRUCTION ire t4 i0.00 aap of i sivolts or
0 Homing baltdays.
tt,s teground,ur evc edv 14,000 0 nasa^Wlai use as ea#urr. IQ 1-ura ?-hnnil3 duelling Ccnta ssalindustrial - Accessory building amps So alt other installations. iund ag:.vinti-Family0 Master builder
0 Other: °Firepump
Installation;$1150 KVA na. j
JOB SITE INFORMATION AND I°CATION l0l:ia%erseaarx sl:steze$ larger separateldevised i
ia: _ Job site address: - 3 <i1 J 1 1 i °addition of new rumor load of system
Job tCity; p ..� 1 V l f t�7tl or a3 QTc. 1 1. '#' #
�state/ZI' \\% Pte --2-2I 0Six or ns xecsd actor]units. #y#n p.
"'..". • -- _.,._ _ 1 0 ldtatib are facilities 0 Recreational%chicle p:16
Suite bld ';apt 6: _
1 Project ct unit e: p e 57 jF t�sd�u>lssa?�or�. 0Supply voltage i�rz Haut.,.t-;:,a
flei_ smicc or tester&t0 amps or more, 6°0 volt,near#ictal. l
r
Cross s ect,directions to job site: —
Orserlpiiacr ..._
{ Qty„,a tsacN ( 7otat# _
New residential single-or multi-fandly dwelling unit.
t Subdivision: of : includes attached garage,
_._--_.
Tax map/parcel#: .. 1 ytJtt£i sq.ft.car lees {" i t ,s {' .
'k"8 - *3 t
n_ . , " _ Ea,add` 500 sit ft.or onionI2I21 -4fLimited energy,residential »si
,trQ
�- l d. �l.�Gt� t17 {deduct ,v sq.ft.)
°
}_3 7 ..;... _o. 1 anrrrcct evil#� ,mufti-family
tl#
rl. :,'"?..--(/
. �t 'c. .16residential(with shone sr IL) -ill C�'Fflr IYIt lTT iT Renewable Ener l IS See Paae2) „, - 1 ..,.."4 ti `f
Services or feeders installation,alteratioi and/or relocation
2''c`Idlre.
9c vwN C)G,V'v <c., 200 amps or less *MItor 70 ,:i.c l•
Address: SeCb �E 2tll amps to 400 amps 133.>6
1"cam+ �a `(�Y :_ 1 401 amps to 600 amps 200,34
.q.>`,.1_lW f?...,_ . .�'f .7,2„:-L . 60i,!..,„,,,1,0'`d analis ( Ua 30\”04r Phone:(�3} el # ` L\5(---1--Z r over 1,000 ampsorvolts 552.26
rEmail: pe v1y1 c 'n Yn�A i,~� . -Lo
Temporary services r r 1 eclers installation,alteratiota nd/orT
Etttui
relocation
Owner installation: lis installation is being adc on property that I own which is not 200 amps or less . i
intended for sale,lease.rent,ore:cha ge,according to ORS 447.449,670,and 701, 5.3b t
iris _ , 201 amps to d tb amps l"5.dg �t
Owner signature; _„...111111.!:,,„_, ].hate: t / 20/l' dill amps try 5
0,Ai" ICMBranch eireztits-nese,alteration or extension aer-_anti
C3 CONTACT PERSON ...-
i
CLE f A.Fee'Or branch circuits with t
Business name:i f f ;pix, t,St.rs-ice or IL er fee, I ^' 1' i
'` each branch circuit
Contact name: ! I #
ts II ' B.l-c for branch circuits witlirlat
.ddi'css, ijuil ` f+, �} 116- RI Savo or pec ler ftp.first I
4..."....i.„4..., * NA? >i bre '' circuit 'tri 1X }l
„� ..° r 0 / -- Each auid ll branch circuit 1 7.4$ j
I
,ilw
Phone: p '-" Miscellaneous ser nice or feeder not included) _
�to) 2 J '_ l g q Each manufacturedor modular '�
Email >f _" duellini sets tie and'cr inciter fi'."`t
Lf) jy w-
. I,',"tit' 11 ' s
/SW / Rs canned only 07.P4
CONTRACTOR
-•--_....s-..�...._-..w........_ /d Pump oz irri>rafian-cucie _ . b'7 84 r
Business name: ! a 0 o I° C S! i Sign outline lighting 2...
wr.�rl j _ or €h rii.Sk
Address: air
irlSignal oircait+s)or limited atery AI,
met altmtson,ora tension. see Mage 2
}} �1 ! aw j 1 Each additional inspection over ntla vable in any of the above
Additional inspections(1 hr mill) 66
'`lar
1 Phare:. i _.._
CE.'//1
t _ --Investigation i:in min) °ri.t3i1 hr
Email: i/V Y q- j ,rt j%�� � Industrial pant(1 hr unit/ 8i '
i 4r� L'' gg�^,,pp s.l� 1n 1 a
CCB pV J. 'citiiieensfrz vshithisoI'ecis
4 Electrical Lie,: Sopa a'. f ic., � f y a cilicaliv listed ll'''hrtnin)
90.00i-1;1—
i
d (l'hx }
j 5unii.El'ectsrieaiatl i e �f ELECTRICAL RMI " F" :
l nature required; ;� _.,,Print risme. .
Subtotal:
_.
l�utG; 1k # Plan Review Regatrcd(25° afpctmitfee?
-
State surcharge(12%of permit Mc):
Authorized signature: ..ailt• TOTAL PERMIT FE
(� Y
t 17Tzt]t name: �r n sr _ i This permit application expires 1!n permit is not obtained pain t8
t _ 1
4 l tiays atter it has been accepted as complete.
I fiurtdm;'Pct Pi -mw.., * Yumberofinspkctionsallowedperpermit.
f E?P•-LR ERE is to 4.1.0.45'..ai'{§:, COM WEB
a
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
ilOM'.,4/42.11Y.0$40./t A-SOO
Desrrtplton tv. Each "total
Fee for all residential systems combined: $75.00
Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133,56
E Audio and Stereo Systems*
15.01 to 25 kva 11111 200.34
Wind :eneratlon s,stems in excess of 25ftva:
0 Burglar Alarm
25.01 to 50 kva 301042
50.01 to 100 kva 552.26 11. 2
0 Garage Door Opener*
>100 kva(fee in accordance
with OAR 918-309-0040)
0 Heating,Ventilation and Air Conditioning
Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
0 Vacuum Systems* >100 kva—no additional charge 0,0 3
Each additional inspection over allowable in any of the above:
E Other: Each additional inspection is
66,25/in 1
charged at an hourly(1 lir min)
Inspections for which no fee is
90.00/hr
specifically listed 1/4 hr min)
*01140:00441/0400$14,Wif "
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
O Audio and Stereo Systems
1-1 Boiler Controls
El Clock Systems
O Data Telecommunication Installation
E Fire Alarm Installation
O HVAC
O Instrumentation
E Intercom and Paging Systems
O Landscape Irrigation Control*
O Medical
O Nurse Calls
E Outdoor Landscape Lighting*
I— Protective Signaling
O Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
12Building•Permits•UryertnitApp OLE ERE doe Rev 10,26'2017
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11045 SW HALL BLVD, TIGARD, OR, 97223 June 11 , 2019 at 8:46:00 AM
Record Type: Record ID:
Commercial - Electrical ELC2018-00416
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor