Permit CITY OF TIGARD ELECTRICAL PERMIT
N COMMUNITY DEVELOPMENT Permit #: ELC2012 -00477
T I G AR o 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/11 /2012
Parcel: 2S110DC00500
Jurisdiction: Tigard
Site address: 11455 SW SUMMERFIELD DR
Project: Schwindt Medical /Dental Office Subdivision: WILLOW- BROOK -FARM Lot: 17
Project Description: Electrical for new 3,815 square foot medical /dental officebuilding.
Contractor: ALL ELECTRIC Owner: CDBK PROPERTIES LLC
4676 COMMERCIAL ST, #183 11565 SW DURHAM RD BLDG F 100
SALEM, OR 97302 TIGARD, OR 97224
PHONE: 503 - 851 -1704 PHONE:
FAX: 800 - 851 -2549
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 09/11/2012 $201.40
Specifics: amps or less
1 ea Services or Feeders - 201 to 09/11/2012 $133.56
Type of Use: COM 400 amps
Class of Work: NEW 31 crt Branch Circuits w /Purchase 09/11/2012 $230.02
Service or Feeder
Type of Const: 1 ea 12% State Surcharge - 09/11/2012 $67.80
Occupancy Grp: Electrical
1 ea Plan Review Electricial 09/11/2012 $141.25
Total $774.03
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A ENTION: Or on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 0010 through OAR 52- -0090 ou may may o�y of the rules or direct questions to OUNC by calling 503.232.1987 or 1 00.332.2344.
Issue By: '` Permittee Signature: 1l J/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
COTRACTOR NSTALLATION ONLY
frA/13-. SIGNATURE OF SUPR. ELEC' A Date: 7/ /1 a ')
^
LICENSE NO.
Call 503.839.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
Electrical Permit Application i.,I--- FOR OFFICE USE ONLY
City of Tigard AUG 1 4 2012
g Received !/ '/
`J _ Date/By: "{ / 12- , ', Permit No.: E' /A ,6124/7
q 13125 SW Hall Blvd., Tigard, OR 97 ,i •.� " Plan Review P/
C ' Phone: 503.718.2439 Fax: 503.5 r +�� ,,$ , 1 r' _ „ ,, Datc/By: IZ7f / i'? - f ref Permit:
T I G.t K D Inspection Line: 503.639.4175 , s , ' '.' , " ', j`�‘' Date Ready/By: ' Imis: el See Page 2 for 4 . 41 A
Internet: www.tigard - or.gov N.. ed/Method: X ;941 1 Supplemental Information
TYPE OF WORK # / t ' /l PLAN REVIEW
® New construction 0 Addition/alterationheplacement Please Check all th ffi Pp (aabmir 2 sets of plan wfit nrs checked below):
�t Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
U ❑ Other where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Q 1- and 2 -fame dwelling e Commercialfmd l Q A b
ustfiaccessory uildin less s o for o oor ther exceeds 14,000 11 Commercialise agricultural
g g 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.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: I Job site address: 11455SW Summerfield DR 1 °0� °! more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/Statef /P: Tigard, OR 97224 OH:airb -tee fad. ❑ Supply voltage-for more than
['Hazardous locations. 600 volts nominal.
y
Suitelbidglapt no.: I Project na SchwindIDentat Office 11 Sen/ice or feeder 600 amps or mom
FEE SCHEDULE
Cross street/directions to job site: Durham & Sttmmerfield ntplon I Qty. I Fee. I Total I •
New residential single- or maltl- family dwelling unit.
Includes attached garage.
Subdivision: Willow -Brook -Farm I Lot no.: 17 1,000 sq. R or less 168.54 4
Ea. add'1500 sq. fi. or portion 33.92 1
Tax map/parcel no.: 2s110dc005OO Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft)
Limited energy, multi- family
New Dental Office Building residential (with above sq. 8) 75.00 2
Services or feeders installation, alteration, and/or relocation _
200 amps or less 2 100.70 201.40 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 1 133.56 133.56 2
Name: CDBK Properties 401 w 600 amps 20034 2
601 amps to 1,000 amps 301.04 2
Address: 11565 SW Durham Rd Bldg F100 Over 1,000 amps or volts 552.26 2
Ci /State/ZIP: Tigard, OR 97224 Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, Iease, tent, or exchange, according to ORS 447, 449, 670, and 701. 401 soaps to 599 ads 16854 2
Branch circuits – new, alteration, or extension, Per panel
Owner signature: Date: A Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 31 7 42 230.02 2
each branch circuit
Business name: All Electric B- Fee for branch circuits without
service or feeder fee, fret
56.18 2
Contact name: Monte Baker branch circuit
Each add'l branch circuit 7.42 2
Address 4676 Commercial St #183 Artscelbmenas (service or feeder not Included)
City/State/ZIP: Salem, OR 97302 Each mg, service manufactured or modular 67.84 2
dwelling, service and/orfeeder
Phone: (503) 851 -1704 I Fax : (503) 851 -2549 Reconnect only 67.84 2
Pump or irrigation cinelc 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: All Electric panel, alteration, or extension. Page 2 2
— Each additional inspection over allowable in any of the above
Address: 4676 Commercial St #183 Additional inspection (t hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Salem, OR 97302
Industrial plant (1 hr min) 78 -18/ hr
Phone: (503) 851 -1704 I Fax: ( ) Inspections for which no fee is 9000/ he
specifically listed ('Si hr min)
CCB Lic.: 153954 Electrical Lic.: 24 -479C Su . Lic.: 4926S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required Subtotal: 564.98
Plan review (25% of permit fee): 141.25
Print name: Monte Baker ��JJ Date: 8/13/12 State surcharge (12% of permit fee): 67.80
Authorized signature: ����v O ® TOTAL PERMIT FEE: 774.03
/ This permit application empires if a permit is not obtained within 180
name: I Date: Date: days after it bas been aded m complete.
• Number of inspections allowed per permit •
l: \Su ld ng\PenititMELC- PamitApp.doe 07 /01/10 440- 4615r(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
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems* •
❑ 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
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ H VAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
p Nurse Calls
p O utdoor Landscape Lighting*
❑ P rotective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\euimingWee \ELC -Pe mitApp.doe 07/01/10