Permit (157) CITY OF TIGARD ELECTRICAL PERMIT
II ' COMMUNITY DEVELOPMENT Permit#: ELC2019-00211
TI G A It.(:) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2019
Parcel: 1 S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Medical Group Subdivision: None Lot: None
Project Description: Adding(8)circuits and limited energy for fire alarm and nurse calls for remodel of existing X-Ray suite for TI.
Contractor: OEG INC Owner: PROVIDENCE HEALTH&SERVICES-ORE
1709 SE 3RD AVE ATTN: REAL ESTATE&CONSTRUCTION
PORTLAND, OR 97124 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-234-9900 PHONE:
FAX: 503-234-1001
FEES
Quantity Description Date Amount
2 ea Limited Energy 04/18/2019 $150.00
Specifics:
8 crt Branch Circuits wo/Purchase 04/18/2019 $108.12
Service or Feeder
Type of Use: COM 1 ea Plan Review Electricial 04/18/2019 $64.53
Class of Work: ALT 1 ea 12%State Surcharge- 04/18/2019 $30.97
Type of Const: Electrical
Occupancy Grp:
Total $353.62
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 yo- to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA- = -001-00''),„You 4=y obtain a cop of the rules or direct questions to OUNC by calling 503.2, 1987 or 1.800.332.2344.
Issued By: I /Ak/.A./Z -•0 Permittee Signature: 4 7it .-v==s\ �( \...,
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.
1101057-571 I RECEIVE I
Electrical Permit Application 1.0R 01.I'1( 1. 1 SI.Oy1.1
City of Tigard APR 1 2019 Receivedty: y oZ /� iii rolei.
CORJ/
Date `,Iii
i- ' 13125 SW Hall Blvd.,Tigard,OR 97223 PlanReview,. �lM _Phone: 503.718.2439 Fax: 503.598.1960CITY OF TIGARDDate/By: /(o /qI � �� ����73
Inspection Line: 503.639.4175 BUILDING DIVISION Ready Date/ , ns. ® See a e 2 for
1 1 I �t I I Internet: www.tigard-or.gov Notified h. ��, ' Supplemental Information
//i6/�i�: ,Aur...7
TYPE.OF WORK /,'// PLAN REVIEW
❑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.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 snips at 150 volts or 0 Floating buildings.
❑ I-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#:2016201A [ Job site address: 12442 SW Scholls Ferry Fond 10011P or more. ❑ 'A", E",'1 2", 1-3',
City/State/ZIP:Tigard,Oregon,97223 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 100 I Project name: Diagnostic Imaging-X-ray 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:217 take exit 4B to SW Cascade FEE SCHEDULE
Turn right on SW Scholls Ferry Rd.,turn right on SW North Dakota Description 1 Qty. I Each 1 Total I
New residential single-or multi-family dwelling unit.
Subdivision: i Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: 1S134BC00401
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Remodel of existing X-ray suite,new walls,sound board upgrades Limited energy,multi-family 75.00 2
paint,mechanical,plumbing and electrical support systems residential(with above sq.ft.)
.t PROPERTY OWNER I 0 TENANT' Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name:PROVIDENCE HEALTH&SERVICES-OREGON 200 amps or less 100.70 2
Address:4400 NE HALSEY STREET-BUILDING 2,Suite 190 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:PORTLAND,OR 97213 601 amps to 1,000 amps 301.04 2
Phone:(503)215-6282 I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 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
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
0A.Fee for branch circuits with
Business name: OEG,Inc above service or feeder fee,
7.42 2
each branch circuit
Contact name: Jeff Hill B.Fee for branch circuits wit/row
service or feeder fee,first 1 56.18
Address: 1709 SE 3rd Ave. branch circuit 56.18
City/State/ZIP:Portland,Oregon 97214 Each add'l branch circuit 7 7.42 51.94 2
Miscellaneous(service or feeder not included)
Phone: (503)475-0510 I Fax:(503)234-9900 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:jeff.hill@oeg.us.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:OEG,Inc Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ® See Page 2 150.00 2
Address: 1709 SE 3rd Ave. panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Portland,Oregon 97214 Additional inspection(I hr min) 66.25/hr
Phone:(503)475-0510 I Fax:(503)234-9900 Investigation(1 hr min) 90.00/hr
Email:jeff.hill@oeg.us.com Industrial plant(1 hr min) 78.18/hr
inspections for which no fee is 90.00/hr
CCB Lie.: 203 I Electrical Lie.: 26-95C < Suprv.Lie.: 4818s specifically listed(:/i hr mm)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:,�' - 'A.__. Subtotal:
Print name: Mark Weinbender Date: 03/20/19 0 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.
Brvnh17f"015 440-615T111r051COM,WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Renewable for all residential systems combined: $75.00 _I I Each I Total I
Y electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
0 Audio and Stereo Systems* 15.01 to25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to loo kva 552.26 2
❑ GarageDoor Opener*
p >100 kva(fee in accordance
55226 2
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
❑ Vacuum Systems* >100 kva--no additional charge 0.0 3
Each additional inspection over allowable in an of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specitically.listed Q4 hr min)
COMMERCIAL WORK ONLY: • ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00Subtotal(Enteron Page 1): I
* Number of inspections allowed per permit,
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
® Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
® Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: 2
*No licenses are required. Licenses are required for all
other installations
1:\Building\PermitslHLC_PcrmNAPP_F.LR_BRadoc Rev 06/I7/20I5