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Permit II ,, CITY OF TIGARD ELECTRICAL PERMIT 'tt, ;, COMMUNITY DEVELOPMENT Permit #: ELC2010 -00707 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/22/2010 Parcel: 2S 101 AD03500 Jurisdiction: Tigard Site address: 6600 SW HAMPTON ST Project: Quest Diagnostics Subdivision: Lot: 0 Project Description: Electrical for TI. Contractor: GARYS ELECTRIC CO Owner: PACIFIC REALTY ASSOCIATES 1401 SW WALLULA DR 15350 SW SEQUOIA PKWY #300 GRESHAM, OR 97080 PORTLAND, OR 97224 PHONE: 503 - 465 -8145 PHONE: 503 - 624 -6300 FAX: 503 - 465 -8517 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 12/22/2010 $100.70 Specifics: amps or less 14 crt Branch Circuits w /Purchase 12/22/2010 $103.88 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 12/22/2010 $24.55 Electrical Type of Const: Occupancy Grp: Total $229.13 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 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 OA' • - 001 -0090. You - • • • - - : > •f th- - - • direct questions to OUNC by calling 50 41 ' 2.1987 or 1.800. .2344. Issued By: 4��%! P ermittee Signature: " • . • R , a 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 � �� . FOR OFFICE USE ONLY City of Tigard ��� Date /B : la , / hi Permit No.: '_ _ A I 6 0 q 13125 SW Hall Blvd., Tigard, OR 973 Plan Review Phone: 503.639.4171 Fax: 503.598. 60 `� �� DateB : Other Permit i I, .. -- I 0 1' I Ci A It 17 Inspection Line: 503.639.417 G C u Date Ready/By: ® See Page 2 for Internet: www.tigard or.gov 0 � © � G ot4 Notified/Method: !/ Supplemental Information TYPE OF WORT ` 1 .� CIvr• PLAN REVIEW ❑ New construction Addition / alteratia �ement Please check all that apply (submit 2 sets of plans w /items checked below): 1J ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. p� ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: COO 5 (mJ tt f7 Six or more more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: - Ti 34r ❑ Health -care facilities. ❑Hazardous locations. ❑Supply voltage for more than 600 volts nominal. Suite/bldg. /apt. no.: Project name: /W - C S ❑ Service or feeder 600 amps or more. (/' R_�I �( o �J 01 SII FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I * New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'l 500 sq. ft or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 i Q� / r t Limited energy, multi- family Zi1Sii i /06 e re e( go ! LI di residential (with above sq. ft.) 75.00 2 gg�� Services or feeders installation, alteration, and /or relocation 0 r • A ri.' le, r O c iqq Q4() 6 E' t e- SI'4 C 200 amps or less I 100.70 MO, 7b 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City/State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee j ` C� 7 42 I t,'3 c 2 each branch circuit / Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'l branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 tY dwelling, service and/or feeder Phone: ( ) Fax:: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy Business name � e'�I LO panel, alteration, or extension. Page 2 2 C-c,�s Each additional inspection over allowable in any of the above Address: t 9.01 S i,J W4 j f i l Or Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: L�r.e5t4hM a 17©'0 Investigation Industrii(1hrmin) 66.25/ hr 1 / Industrial plant (1 hr min) 78.18/ hr Phone: (503) 1 4 GT.- 50 L(5' Fax: (9'3 ) 4‘5 < / -7 Inspections for which no fee is � �)q specifically listed (%a hr min) 90.00 / hr CCB Lic.: 1 4 30 Electrical Lic.:C i 2. Suprv. Lic.: L1 S ELECTRICAL PERMIT FEES / 4 / ( ■ I 7 # 1�� Subtotal: �l j ,. Suprv. Electrici sig u required: 41 I ! 0 r Plan review (25% of permit fee): Print name: . Date: I-�eC Z. 2 gO / St su r charge (12% of permit fee): )-?-el . 1 Y TOTAL PERMIT FEE: ; '3 , Authorized signature: This permit application expires it.a permit is not obta ned within 180 days after it has been accepted as complete. Print name: Date: + Number of inspections allowed per permit. C\Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T( 11/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined .. $75.00 Check Type of Work Involved: n Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical n Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\ Building \Permits\ELC- PermitApp.doc 07/01/10