Permit 11 CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit#: ELC2014-00643
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/10/2014
Parcel: 1S135CA01200
Jurisdiction: TIGARD
Site address: 11380 SW GREENBURG RD 5
Project: COLUMBIACARE SERVICES Subdivision: GREENBURG Lot: 11
Project Description: Reconnect only.
Contractor: Owner: COLUMBIACARE SERVICES INC
3587 HEATHROW WAY
MEDFORD, OR 97504
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 11/10/2014 $67.84
Specifics: 1 ea 12%State Surcharge- 11/10/2014 $8.14
Electrical
Type of Use: COM
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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 OAR 952-001-0090. You may obtain a cop or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344,
Issued By: �_
y: � __�� Permittee Signature:
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.
From:Columbia Care Services 15418588167 11/10/2014 09:35 #942 P.001/002
Electrical Permit A lien ' EI M FD FOR OFFICE USE ONLY ,
City of Tigard ;.,� is .
13125 SW Hall 3ivd.,Tigard.OR 97 V 1 0 2014 Plat;Review
•• Phone: 503.718.2439 Fax: 503.598.1-,■ Dare Bv: / !1, '
inspection Line: 503.639.4175
CITY s I V* av) Dote Read:3;: kris - 'age 2for TIGALD Internet: www.tigard-orgov
Notified/Method: �....t Supplemental Information
TrPE at INGUIVISIOt _ •
elati,R�r•i�� :.
fE New construction ❑Addition alteration replacement Phase a,eck al that apply(submit 1 sets of plans mi./items errs 3 below):
0 Service or seder 400 amps or mom ❑Building over three see r.es.
El Dcmoliton ®Other:Reconnect only where Me available fait ec,rent ❑Marinas and boatyards.
_ ' :1.:;: CA1-EGORY,OF CONSTRUCTION ; "' exceeds 10,C0C amps at 150 vests or ❑11oaenq buildings• less to rroend,or exceeds 14,000 ❑Commercial-use agriculteial
•VI-and 2-family dwelling ❑Commercial/industrial ❑Accessory building altos for all Miter ins:snarlers. built:tags
S Multi-fartily ❑lviaster builder ❑Other: ❑Fire puma. ❑Installstion cf 15C K VA cc
_ ❑Emergencesys:ein, larger arsa:arely derived system.
JOB SITE INFORMATION,.?4N LOCATION ❑:•,;�,•E•• .•1-3•.,
� ❑AddAion of new leveler Iced o:
Job no.: Job site address:11380 SW Greenburg Rd 100 HP or more occupancy.
❑Six or more residential units. ❑Recreational ve:Cele parks
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities, 0 Supply voltage fcr more than
❑Huai do,:s(:cations. 600 volts no:natal
Suite/bldg"/apt,no.:5 Project name:Greenburg ❑Service or feeder 6C0 ash or mere
.- FEE SC:IIEDUT.E
Cross street/directions to job site:SW 981h Ave Description Qiy. Fee Total
1 New residential single-or multi-family dwelling unit.
i Includes attached garage.
Subdivision: Lot no.: 1,0.50 sq f:.or less 168.54 4
Ea.add')500 sq ft or portion 33.92 I
Tax map/parcel.no.:2S1 24CB-00400 Limbed energy,residential 75.00
DESCRIPTION.OF W ORit S?" ,' f ; J (with above<-q.ft.i _ `
Lrmtedenergy.multi-family 75.00 2
Reconnect only residential(with above sq.ft.)
Rene»able Energy 0 See Page 2: .
Services or feeders installation,alteration,andior relocation
® PROPERTY OWNER ❑'.TE;NANT 200 amps a:mss iCC.70 2
' 20:amps to 400 snips 133.56 2
Name:ColumbiaCare Services -
amps;0 600 amps 200.34
Address:3587 Heathrow Way _601 amps:0 1,000 ar ips 301.04 2
Over 1,000 amps or volts 552.26 2
City::Srate/ZIP:Medford,OR 97504 Temporary services or feeders installation,alteration,andior
• Phone:(541)858-8170 Fax:(541)858-8167 relocation 200 amps or less 59,36 l
Owner installation:This installation is being made on property that i own which is not 201 amps to 400 amp= 125 08 2
intended for sate,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 593 amps 168 54 2
Om net signature: Date: Branch circuits-new,alteration,or extension,per panel
Q.APPLICANT r . I a; :Ei.CONTACT:PERSON '-':' A.Fee for brand circuits itit
above service or feeder fee,
i.42 2
�
Business name:ColumbiaCare Services each branch circuit B.Fee for branch circuits virhosa
Contact name:Joel Burchfiel service or feeder fee.first 5618 2
: Winch circuit
Address:3587 Heathrow Way Each ade'I branch circuit I 7.42 • ! 2
City/State/ZIP:Medford,OR 97504
Miscellaneous(service or feeder not included)
Eaci manufactured or modular 5714 •
Phone:(541)858-8170 Fax::(541)858-8167 dwelling,service andior feeder `
Reconnect only 1 67.84 67 84 2
E-mail:jburchfiel,columbiacare.org Pump or trgatton ciTC a 67.84 2
. _ CONTRACTOR _. i., ! • Sign o-outline Lighting 67.84 : 2
Business name: Si3nal cucu:tisi or limited-energy See
Panel.alteration,or extension. Page 2 ( 2
Address: Each additional inspection over allowable in any of the above
Additional inspection(: h:mini 66.25%hr
City/State/ZIP:
Investigation;l hr mot) 66.251
hr
Phone:( ) Fax:( ) Industrial plant;1 hr min) 78.18;hr
ttupectiors for which no fee is I 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lie.: . speci5cel:y listed(4 hr rain;
Suprv.Electrician signature,required: ELECTRIC Eft ll PEES
Subtotal; ; 67.84
Print nine: Date:
Plan review(250%of permit fee):
State surcharge(12%of permit fee): B'•111
Authorized signature: TOTAL PERMiT FEE: 5,q,... -Print name: Date: days permit application expires if a permit is not obtained within t 0
days after it has been accepted as complete.
• Number o?inspections showed per perm 1.
t"Ai.'.11necTniulELC_PenrilApp_E,R_ RS.eoc Rev 65.'2::J:3 440.46.ST(':UOS/COM.V E3
From:Columbia Care Services 15418588167 11/10/2014 09:36 #942 P.002/002
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL%YORK ONLY: FEE actiEotLE
Fee for all residential systems combined .. 375.00 Des:nprion I Qry. I For l istai 1
Renewable electrical energy systems;
Check Type of Work Involved: 5 kva or less. If 100.70 2
5.01 to IS kva 3 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generatioo systems in excess of 25 kva: _
❑ Burglar Alarm 25.01 to 50 kva 301.04 ! 2
50.01 to 100 kva 552.26 2
Garage Door Opener* >100 kva fee in accordance with
OAR 9'.8-309-004c) 552.26 2
Heating,Ventilation and Air Conditioning
Solar generation systems in excess of 25 kva:
System*
Each acdi:ioral kva over 25 7.42 I 3 •
❑ Vacuum Systems* >7 00 kva—no addaioaal charge 0 0 • 3
Each additional inspection over allowable is any of the above:
❑
Other: Each additional espection as �,:
charged at an hourly(1 hr min) 6 he
:nspwhors for wh:cit no fee is
spec`ezllt:I>ted l! hr mint cc.00 hr
COMMEI04 14ORK ON>r . ELECTRICAL P l%tlt FEES
Fee for each commercial system 875.00 Subtotal: i
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL I'ERIVITFEE:
This permit application expire_if a permit is not obtained within ISO
❑
Audio and Stereo Systems days after it has been accepted its complete.
Namber of inspections allowed pep-nit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alann Installation
❑ HVAC
❑ Instrumentation
• Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ M• edical
❑ N• urse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ O• ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
`..Burc V.Perml•f.Et.0 Pa,micA.pp_FL.R_ERE dac Rey Oi21,23 3