Permit CITY OF TIGARD ELECTRICAL PERMIT
'`�1 COMMUNITY DEVELOPMENT Permit #: ELC2013 -00172
T fop RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/03/2013
Parcel: 1S134AA02100
Jurisdiction: Tigard
Site address: 10300 SW NIMBUS AVE P -A
Project: FMC Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 3
Project Description: TI demo existing office suite for new outpatient dialysis treatment center (12 treatment bays and 1 separation)
Contractor: WHISKEY HILL ELECTRIC INC Owner: FRESENIUS MEDICAL CARE, NA
PO BOX 206 5251 DTC PARKWAY
HUBBARD, OR 97032 GREENWOD VILLAGE, CO 80111
PHONE: 503 - 981 -4640 PHONE. 303 -712 -1814
FAX: 503 - 981 -4643
FEES
Quantity Description Date Amount
3 ea Services or Feeders - 200 03/18/2013 $302 10
Specifics: amps or less
82 crt Branch Circuits w /Purchase 03/18/2013 $608.44
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Plan Review Electricial 03/18/2013 $227.64
1 ea 12% State Surcharge - 03/18/2013 $109.26
Type of Const: Electrical
Occupancy Grp:
Total $1,247 44
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. ATTE 6r - ; •n la, requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -001- 10 through OAR 9 • 001 -0)1. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332 2344.
/ / / Y-') /
Issu By: t I i� Permittee Signature: f it
OWNER INSTALLATION ONLY
The installation is being made on property I own which is no '•tended for sale, lease or re . -
OWNER'S SIGNATURE ne!s�wr '��� d
Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'
/ �:. / _ , -- Date: i ff
I
LICENSE NO. q4a/
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.
RECEIVED
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard MAR 18 2013 Date /By: �{ A � � IS
Ai, Permit No.: e� C L 3 ��L7�
III
- • 13125 SW Hall Blvd., Tigard, OR 97 P lan Review Q
� Jl OF TIGARD 1 i5 Other Permit "lac �✓ 0�� Ph 5037182439 55
T I G A R n Inspection Line: 503.639.4175 LDiNG DIVISION Date Ready /By: Juris ]] /�► el See Page 2 for
Internet: www.tigard - or.gov Note echo : Si,
7 yap Supplemental Information
TYPE OF WORK t PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below).
❑ New construction ® Addition/altergtion /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ 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
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3",
Job no.: TI - 184 Job site address: 10300 SW Nimbus Ave. 1001IPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Portland, OR 97223 El Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: FMC - Scholls Ferry ❑ Service or feeder 600 amps or more.
. ., `, I Iy" /, 5 a ,xr
Cross street/directions to job site: Description 1 Qty. I Fee. - Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fl or less 168.54 4
Ea. add' 1 500 sq. ft. or portion 33.92 1
f map 'parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Wiring Building residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 3 100.70 302.10 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
City/State/ZIP: /State /ZIP: Temporary services or feeders installation, alteration, and /or
tY 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
above service or feeder fee, 82 608.44
❑ APPLICANT ❑ CONTACT PERSON 7.42 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
Y 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: Whiskey Hill Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: PO Box 206 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Hubbard, OR 97032 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 981 - 4640 Fax: (503) 981 - 4643 Inspections for which no fee is 90.00 / hr
se - cificall listed ('/2 hr min
CCB Lic.: 162985 Electrical is . C36 Suprv. Lic.: 4621S i , a l s : m
51k. Suprv. Electrician signature, required o Subtotal: 910.54
Plan review (25% of permit fee): 227.64
Print name: Curt Cribbins Date: 3/12/13 State surcharge (12% of permit fee): 109.24
TOTAL PERMIT FEE: 1247.4q
Authorized signature:
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.
I
I:\ Building \Permits\ELC- PermitApp.doe 07/01 /10 440- 4615T(11 /05 /COM/WEB
1
CITY OF TIGARD FEE AND PAYMENT HISTORY
III I . 1312 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
ELC2013 -00172 - 10300 SW NIMBUS AVE P -A, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Services or Feeders - 200 amps or less 220 -0000 -43103 $302.10 $302.10 $302.10 3/18/13 Check 190641 $0.00
Branch Circuits w /Purchase Service or 220 -0000 -43103 $608.44 $608.44 $608.44 3/18/13 Check 190641 $0.00
Feeder
Plan Review Electricial 220 -0000 -43110 $227.64 $227.64 $227.64 3/18/13 Check 190641 $0.00
12% State Surcharge - Electrical 100 -0000 -24001 $109.26 $109.26 $109.26 3/18/13 Check 190641 $0.00
Totals for Fees $1,247.44 $1,247.44 $1,247.44 $0.00
Receipt # Payment Method Check # Pavor: Receipt Date Receipt Amount
190641 Check 10748 Whiskey Hill Electric Inc 03/18/2013 $1,247.44
Total Payments: $1,247.44
Balance Due: $0.00
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10300 SW NIMBUS AVE P-A, TIGARD, OR,
97223
Commercial - Electrical
120 Electrical rough-in
04/15/2013 00:00
ELC2013-00172
PASS
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10300 SW NIMBUS AVE P-A, TIGARD, OR,
97223
Commercial - Electrical
130 Ceiling cover
05/16/2013 00:00
ELC2013-00172
PASS
Violation Summary:
Inspector Contractor