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Permit n CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2009 -00440 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/28/2009 Parcel: 25101 AC01300 Jurisdiction: Tigard Site address: 7105 SW HAMPTON ST Subdivision: Lot: 0 Project: Kaiser Dental Project Description: Install duplex outlets in exam rooms 1 & 2. Job No. 98763 Owner: FEES KAISER FOUNDATION HEALTH Quantity Description Date Amount PLAN OF THE NORTHWEST #838, ATTN: GENERAL ACCCOUNTING 11TH F, 500 NE 2 crt Branch Circuits 08/28/2009 $53.50 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 08/28/2009 $6.42 Electrical Contractor: CHRISTENSON ELECTRIC INC 111 SW COLUMBIA ST, STE 480 PORTLAND, OR 97201 PHONE: 503 - 419 -3300 FAX: 503 - 419 -3695 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $59.92 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 i 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. A ENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notif -tion Center. Those rules are set forth in OAR 952 -001 010 through OAR' • -0. ' -0148. You may obtain a copy of the rules or direct questions to OUNC by cal " • 50 .246.6699 or 1.800.332.2344. Issued / Y l Permittee Signatu f [kffar 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' ., • ., i��� _ Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. O - .-AUG -27 -2009 THU 08:50 AM CHRISTENSON ELECTRIC,INC FAX NO, 95034193695 P. 01 Electrical Permit Application r'Oir.OFIIi E1 :SE ONLY "� City of Tigard R eceives WO 9 G � ,ego 4 2 w �i O Perm No,: 13125 SW Hall Blvd., Tigard, OIt�97ia23, }' I Plan Review " ~ k. Phone: 503,639.4171 Fax: 503 n - L 1 Da, . OtherPcnrtit Inspection Line: 503.639.4175 11 D 1 „ - �:e' Date Re nd B tu 1IC ARI) U Y Y See Page2for IntemeC www,tigard- or,gov t r. f nn • t NotiftedRvlcthoch / C. Supplemental Information ''C ,J.. . 7f' 'h.ra .c r: 1 .. �. . rh.;a, . r rvr r Ir. �:r..� �.l' 'i ;' • I, 6'^ 1 , . t�;...,, ; , y r �! :l�” , 'I;� �'1 r .' o d� ,.,. ..c „ q ,,., .. ^:k >' iS °2T Ir *ri, ., < " �9�` i l �i1' :i11 .i9 air, , ,,,�, 1, .:'✓Jv:, '.{.,• . :' ;.l :t. , I ' -5 - .. r , ;. f , ,..61 i10t. -J..L +rr tirAG 7 6 ,'r rtdjl t: ,'' r 1 . ,, : ..,.It' 1$a , d`Mra'', „ ...: 6:-.,. Fr...:,..,. �,. �. � : 1.. 1a.. ��,. 19. k1,,. 73�:, ��� : ",:'.::Ca,f'C�fi:}�1!.���t., '�.,� "�; r `;.`! .,,IIiFl.•..1/�' �. . {I{`1�;� " "'at� ,,.,, ..V"'�rl 't'r,�ll- �IY..t�, 1�..1 }� r �:,:' }. .,- „o- ,.,..r�.,r..{I;r. Ar. , .. 9'' 1 !,rdr >a,.:a�l'�'�+',�ni,�kt��. � ,.16,rrl...f.!'. �,..R.n:,,• „.:�1111,1r�.;; Tew construction Addition /altergtion/- rcplacemcn •�' ^ ”' tiLY Please check all that apply (submit 2 sets of plans w /items checked below): L1 1 t `-'• © Service or feeder 400 amps or more D lluilding over three stories. [] Demolition El Other ini ill ni ' l(� DIVISION where the available fault current El Marinas and boatyards. :• �!:;` is �,:,. ;;i': :y,.�,i.. :.,1`; -1"i . .. �.rr.,, ' viii � '!i 4.`r',�' ,, " "r "> i, 4�')th !, ". exceeds 10000 S0v or .' li', I < �, a.:, " �i{ . 'lr l , , . :.nCA'. ,..tl at,,.: �' �Ca�AI$ 7` I O'..,, ON" a I,; ir,; ll:. � ! �Ri g' i� ..iJl�.l,f.,e� Iti;,iii'y:;i'' tls amps Ohs f �]bttildings. -. ui 7: i::. i •..a�,tv:i;�:{4:�n... -.. �I, ,.Y, F,,.f. . . ... ... .. .: . ..,. .r ..� I�..d fh4 '. {I`,,.., ' r.'„' less to ground, or exceeds 14,000 0 Commercial -use agricultural 0 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: 1:IFire pump. ❑ installation or 75 xvA or ;51. �,� '' ".,i t'' ^'.;:.: y ' ,a,' i.. •• , r: ^. { • ... - •.• i „ �,, ❑ Emergency Y larger separately derived system. rt r'r , ; . v' ,,, : , '.,b L•mer ens system, pq 1 : 'f: +J� .'` ITE'. 1 ' 'Q b ° (�?'' Im,) { ,d, Y 'i . .r. y .. . ' � Job no.. "6-1L93 (� ' Job b site address: SN (� 100p1P or more. occupancy. —�� 1 ��� --" rnl ❑ rx or more residential units, ❑ Recreational vehicle parks. City/State/ZIP: ` a ( y f cf -7 3 `Health -cart facilities. 0 Supply voltage for more than ❑ Hazardous locations, n t Q,\( & 1�' 1 boo volts nominal. Suite /bldg. /apt.no.: Project name: � 0 Service or feeder 600 amps or more. . . / :'; i :g , .lii. l ; ,,,I q r „ uc:�A , i0:4 ;Yldt.iiV Y Crass street/directions to job site: l l ' DacrlpUon � Qfy. I, tre i` . +:I�:I,;Ilia''1'.R' ". 1'��' .� '7 J i I - J'Cb 1 '+ E: T o l t a :dP l I ;r.pX;il : Q :i.. 1 1 ��,, t ee . (.5,1)2)-) -- alq I New residential single - or multi - family dwelling unit. —CND 'Includes attached garage - Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map /parcel no.: Ea. add'I 500 sq. ft, or portion 33.40 1 . r,. :,....,y':i,.:;�:,:,,:: ; I:,�' ..�.. " r'r• .. „ d,, energy, residential Limited ener 00 2 'iLkiir:n " . a'” I I,• E' �'�. Its ',r: .'::ltd ci : I:' ; ft,'ru . :.{ v 75. y i1RMr -�„ Q ��M„ i; '!i ` r 'u' ., , �� r. ,, r „ I•' _1 , . �:1 ; ..: (with abU C a({� ft.) I —” Limited energy, multi - family 75.00 2 di �4V l&(S kJ-1r\ t itt I, I f b (m roDMS residential (with above sq. IL) ` C j �� 1 � Servfee8 or feeders Installation. alteration, and/or relocation 1,. ` , ' ,.., L/ . ! "S" r o 80 -30 2 .. MI 200 am ps r less { hi�i V ' : ii' r'i:'r'•M r. ul Sf(., I- t �ll,�1.iC'11SI% ';c rl,• - ,"•:: �y B Q r -, O L ,-- .'''',�i lir r , y, tl r ' '.7. , �i 'I ' ,.. ; , ; ! , 1 81��F t , 1 { a,,. o- y , I� It l air 20l ampsto400amps 106 85 2 Name: 401 snips to 600 amps 160.60 2 601 snips to 1,000 amps ' 240,60 2 Address: Over 1,000 amps or volts 454.65 2 ‘-. ' /State /ZIP: Temporary services or feeders installation, alteration, and/or relocation r.,unc: ( ) I Fax: ( ) 200 amps or less 66.85 Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps . 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signature: Date: Branch circuits- new, alteration, or extension, per panel ,, a Ln "; 1'. '.,lA. r: =,;' : ,. t .: A. Fcc for branch circuits with , 1 :ji;, �dp:,i . I : I.t p .0 �I't:'. 1,! Li', 1,,, '! ,.. h 71irl�+.�!'! tip('��1 • ' ;i.i! "''' ,. ,ii , ,j 11 , �h�,�TY�.}tI ` i i x :t�� r4' .�; ��Str�Itr L „�' 11`TQi''�k�'1,'.�r ��WTit� 1 r ��y above service or feeder fee, 6,65 2 Business name: each branch circuit B. Fee for branch circuits Contact name: witho service or feeder fee, 46.85 I-14 i 2 first branch circuit Address: Each add'I branch circuit L I 6.65 I 6 lw 2 Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 90.90 2 Phone: ( ) Fax: : ( ) dwelling, service and /or feeder Reconnect only 66,85 .. 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTQh i t t 1I I,I d Sign or outline lighting 53.40 2 Signal circuit(s) or limited - Business name: Christenson Electric, Inc. energy panel, alteration, or Address: 111 SW Columbia, Suite 480 extension. Describe: Page 2 2 City /State /ZIP: Portland, OR 97201 Each additional Inspection over allowable In any of the above r Per inspection 62.50 • Phone: (503) 419-3300 �`; 3 � . (A Fax: (503) b 0 S, investigation per hour (I hr min) 62.50 CCB Lic.: 458 Electrical Lic.: 26 -34C Suprv. Lic.: 1994S industrial plant per hour 73.75 r li .:d.., . i''':El uZTMIdt1C'U 'tPTtl Rl�l ' i.T.1 iF'�F : S'': ,:I Suprv. Electrician signature, required: �'1� : ..,; Subtotal: C jPj t ; Print name: Robert Axt —'--� /sate: r Plan review (25 %of permit fee): ?J �' r e ! S tate surcharge (12% of permit fee): ' . r,.{ „tori2rd signature: fri TOTAL PERMIT FEE: ...rm001A Print name: This e n , .. .. ! n expires If a permit Is nut obtained Within I80— Daft: cc it . , n accepted as complete. Number of inspectidn allowed per - ermit, 1 Ni uildingu 'crrnasE.C- PerAILApp,doe 0503/00 460- 4615T(11105' 4MIW' ' ■ - AUG -27 -2009 THU 08:51 AM CHRISTENSON ELECTRIC, INC FAX NO. 95034193695 P. 02 - - . .. . ►r war ivtN> LC(1t 2003 • re:4 7\ N S • • • c i • f' f " 0 7-4 4*; •