Permit q CITY OF TIGARD ELECTRICAL PERMIT
1111 1 COMMUNITY DEVELOPMENT Permit#: ELC2014-00552
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2014
Parcel: 1 S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 206
Project: Providence Medical Group Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: (6)branch circuits for a health-care facility remodel.
Contractor: COCHRAN INC Owner: PROVIDENCE HEALTH SYSTEM-OREGO
7550 SW TECH CENTER DR#220 ATTN: REAL ESTATE&CONSTRUCTION
TIGARD, OR 97223 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-234-6564 PHONE:
FAX: 503-238-2098
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo/Purchase 10/16/2014 $93.28
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/16/2014 $11.19
Type of Use: COM Electrical
Class of Work: ALT 1 ea Plan Review Electricial 10/16/2014 $23.32
Type of Const:
Occupancy Grp:
Total $127.79
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 folio. ules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma obtain a -• of the -es or direct questions to OUNC by calling 503.232.1 87 or 1.800.332.2344.
Issued By: ` i_ = •ermittee Signature:
AMP
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 1()u ol,FicE:USE ONE)
City of Tigard "°d
• g r,DatdBy: 2.5111 _ Permlt No '`��n! —4)435.5-14
:� 13125 SW Hall Blvd.,Tigard,OR 97223 fJ
° p /
Date/13 vie /► Oth«Permit
Phone: 503.X8.2439 Fax 503.598.1960 SE` `'� `
T I G A R 1) Inspection Line: 503.639.4175 r Pate Ready/By. Suns Eft See Page 2 for
Internet: www.tigard-or.gov oft, !Jdotif ,ethod: Q i , , -07-4 Supplemental Information
TYPE OF WORK �1 % ,�� ' ,, •v ' t •''` PLAN REVIEW
❑New construction ®Addition/alteration/repl ent Please check all that apply(submit 2 sets of plans wfitems checked below)
❑Service or feeder 400 amps or more ❑Building over three stories
❑Demolition ❑Other: where the available fault current ❑Mannas 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 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system
❑Addition of new motor load of ❑"A "E","I-2","I-3",
Job no.: Job site address: 12442 SW SCHOLLS FERRY RD IOOHP or more occupancy
❑Six or more residential units. ❑Recreational vehicle parks
City/State/ZIP:TIGARD,OR 97223 ®Healthcare facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:206 Project name:SCHOLLS MED HOME ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description
I Qty. I Fm 1_ 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'I 500 sq.ft.or portion 33 92 I
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 7500 2
Limited energy,multi-family 7500 2
MEDICAL REMODEL residential(with above sq.It)
' Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
® PROPERTY OWNER 1 ❑ TENANT 200 amps or less 100 70 2
201 amps to 400 amps 133 56 2
Name:PROVIDENCE 401 amps to 600 amps 200.34 2
Address:4400 NE HALSEY ST 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552 26 2
City/State/ZIP:PORTLAND,OR 97213 Temporary services or feeders installation,alteration,and/or
i
locaton
Phone:( ) Fax:( ) relocation -
200 amps or less 59.36 1
Owner installation:This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
❑ APPLICANT ❑ CONTACT I ERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
•
------- -- B.Fee for branch circuits without
Contact name: service or feeder fee,first I
56.18 56 18 2
branch circuit
Address: Each add'I branch circuit 5 7.42 37 10 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
Phone:( ) I Fax: :( )
dwelling,service and/or feeder 67 84 2
Reconnect only 67 84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:COCHRAN INC Signal circuit(s)or limited-energy See
panel,alteration,or extension Page 2 2
Address:7550 SW TECH CENTER DR,SUITE 220 Each additional inspection over allowable in any of the above
City/State/ZIP:TIGARD,OR 97223 Additional inspection(I hr min) 66 25/hr
-
Investigation(1 hr mm) 66 25/hr
Phone:(503)234-6564 Fax:(971)205-4268 Industrial plant(I hr min) 78 I8/hr
3 Inspections for which no fee is 90.00/hr
CCB Lie.: 72942 Electrical Li 37-54(C Suprv.Lic.: 7 U\7 S specifically listed(%x hr min)
It ELECTRICALPERMIT FEES
Suprv.Electrician signature,required: Subtotal: 93.28 r
Print name: RICHARD SMITH Date: 9/22/14 Plan review(25%of permit fix): 23.32 ).-3-31-
State surcharge(12%of permit fee): 144e— I f,fq
Authorized signature: TOTAL PERMIT FEE: I j ], 7
Print name: CLAYTON KOLER Date: 9/22/14 This permit application expires if a permit is not obtained within 1
days after it has been accepted as complete.
• Number of inspections allowed per permit
1.1Building\PermilstELC_Perino App ELR_ERE doe Res OS/21/2013 440-461ST(11PoS/COMAVEB
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12442 SW SCHOLLS FERRY RD 206, TIGARD,
OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00552
Jeff Grove
Violation Summary:
Inspector Contractor