Permit CITY OF TIGARD ELECTRICAL PERMIT
C
Permit#: ELC2015-00999
COMMUNITY DEVELOPMENT
Date Issued: 12/21/2015
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135BC00202
Jurisdiction: TIGARD
Site address: 10763 SW GREENBURG RD 100
Project: Acadia Healthcare Subdivision: OAKBURG Lot: 27
Project Description: (1)200 amp service and(20)branch circuits for TI for new tenant.
Contractor: SANTIAM ELECTRIC INC Owner: BELANICH, ROGER M
820 REES HILL RD 22020 17TH AVE SE#200
SALEM, OR 97306 BOTHELL,WA 98021
PHONE: 503-365-0673 PHONE:
FAX: 503-581-4886
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 12/21/2015 $100.70
Specifics: amps or less
20 crt Branch Circuits w/Purchase 12/21/2015 $148.40
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 12/21/2015 $29.89
Electrical
Type of Const:
Occupancy Grp:
Total $278.99
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 0 0 - 090. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198-77 or 1.800.332.2344.
Issued By: e l�—e Permittee Signature: eAl !/7r1PL16',I- C)-S
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
City of Tigard
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q:E(�
13125 SW Hall Blvd.,Tigard,(M. U® ED PRleacnBRcvicw
C Phone: 503.718.2439 F'm: 503.598.1960 Date/By: Rel sted Pcnnit# �Vl QQ��
Inspection Line: 503.639.4175 DEC 21 2015 Ready Datc/Ily, luris: la See Puge 2 for
Internet: www.tigud-or.gov Notified/Method: Supplemental Information
' ' e ,JI apply(submt l selr urlJ w/ e checked):
New construction ®AddltaIjtl � �ON 0Ncrvice or lender dUU amps uYm»r C3 Budding ovcr11oCC
3LOrICS.
❑Demolition ❑Other: whery tha mailable fauh uuo.ul ❑Mwina¢and buatymds.
ex000ds 1()'000 am s;d 150 volts or ❑Flualing huddin
.:'.: , : � �>~. t.. ul:/.()ttY;et1��C:��1'_ti�ltl�=l�fi`�. ; '�t• �..; .`�z, p L4%•
lecv rn grr»md,or o crrds 14,00 .
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building, I ❑tallaI-LL%tl at1'IGLLIILLIaI
I amps for all of her insl:dhtliurt.+. buildidionggs'.
❑ Multi-family ❑Muster builder ❑Other: ❑
1 Fire pump, ❑Inslall;oion ul•150 KVA in'
( " ,� ?'ti QBa.S1TE��_ UR y,IQIV1yAIVn 1:()C 1 I(1NZle4k
Fg�y" Ipy C1 Emergency system. larger separately denvcd
ki ❑Addition of new motr load of system,
Job#:215193 Joh site address: 10763 greenburg rd IOnrn"nt In,ne. ❑"A" "F•' "1-7•' "1-3•'
occu
Cary/Stale/zIl';tigard or 97223 0 Six or more rrsidenti. units occupancy.
P
I Itlahlrcurfucililitls ❑RCcreatipn,ll vehicle p:vks.
Suite/bldg,/apt.#: 100 Projeel name:CRC ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross sheet/dircetions to-job Site:217 l
IlrenYl 11011 _I Pty. I Each Total New residential single-or multi-family dwelling unit.
Subdivision: Lot 9: Includes attached garage.
1,000 sq.fl.or less 168.54 4
Tax map/parcel#: I5
Lu.odd i UO oy.n.or portion 1)92 I
DCP ' Wt ( Limited energy,res
idential
(will)above sq.A.)
electrical demo.service,receptacles and lighting for TI
75.00 2
Limited energy,multi-family 75 00 2
residential(with ahnve sq,R,)
aw 1}•.. e , I Renewable Ener - Ca See Page 2_
;V a.In wa ah IPROPE'RTY�_QW'1yER.?��(W.."IN 1 j� ,❑ -}'1r:1VAr-J ,,.i �d. ) Services or feeders in.stnllntion,alteration,and/or relocation
Name; 200 amps or less 1 100.7U 10U.70 2
Address; 201 amps to 400 amps 133.56 2
401 wraps to 600 imps 2U0.34 2
City/State/LII': 601 amps to 1:000 amps 301,NI 2
Phone:( ) Fax:( ) Over l,000 amps or volts 552.26 2
Temporary services or feeders Installation,alteration,and/or
Email: relocation
Owner installation:'I'his installation is heing made on property that I own which is not 200 amps mr Icss 59.36 I
itltendcd for sale,lease,rent,or exchange,according to ORS 447,449,670.Intl 701. 201 amps to 400 amps 125.08 2
Owncr signalarc:_.,_._..-,__.._-... ....-..,..,.._,.__....,_.—_ Date: 401 amps to 599 amps 168.54 2
Branch circuits-new,alteration,or extension,per panel
�' 'ter_' x®. .PLIC ;; , ' rawd�?COM1TAG7E'E►i50N,.�'�y
- — A.Pec for branch cirwits with
Business name:Santiam Electric ubove service or feeder tee, 20 7.42 1118.40 2
each blanch circuit
Contact name:Scott 13.Fcc ter branch circuits withour
service or feeder fee,first 56.18 2
Address:820 RCCc Hill Rd. branch circuit
City/State/ZIP:Salem.Or 97306 Each add'I branch circuit 1 1 7.42 2
Miscellaneous service or feeder not included
Phone:(503)365-0673 Fax: :(503)581-4886 Fact)manutuctumcl or modular 67.84 2
dwelling,service und/or feeder
Rmail:Stlnti8melectriCny.tom Reconnectunly 67.84 ?
Pump or irrigation code 67.84 2
business name:Santiam Electric Sign or uuttine lighting 67.84 2
Signal circuits)or limited-cncrj•y
Q Seepage 2
Address:820 Rees Hill Rd. panel,alteration,or extension.
City/State/ZIP:salem,or,9730G Each additional inspection over allowable in any of the above
Additional inspection(ihrmin) 1 66,25/1,r
1'lione:(503)36.5-0673 Fax;(503)581-4886 ltrvcstipaliun(1 hr ruin) 90.00/hr
F..mail:Santiamcicctrir.�)ry.com Industrial plant(1 hr nein) 78.18/hr
lnsIvction5 for which no fcc Is 90.(*/hr
(:0131-,ic.: 127117 L-lectricalLic•; 24-386c Suprv.Lic.: 4417s s cificall listed(If.•hrmin)
- -•-., - ----.._-- ----Isar - ��
i , ��r' 1°3?,ir'r�T'Y13EC,TRIC'Y►'L PERMIT;;p•FEES^:�� .i•,
Suprv.Electrician signature,required: .Subtotal: 249.10
Print name: Scott Martin Date: 17dec15 I O Plan Review Required(2.5%of permit fee):
Statc surcharge(12%of permit kc): 29,89
Authorized signature: TOTAL PERMIT FEE: 278.99
_ This permit application cxpirm if a permit 6 nal obtained within 180
Prins no— v 4 Date; ,2•�I- l days after it has been ncceptexi use cnmplete_
' Number of inspections allowed per permit.
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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
10763 SW GREENBURG RD 100, TIGARD, OR,
97223
Commercial - Electrical
115 Electrical service
PASS
ELC2015-00999
Herb Stabenow
Violation Summary:
Inspector Contractor
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
10763 SW GREENBURG RD 100, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00999
Jeff Grove
Violation Summary:
Inspector Contractor