Permit (37) CITY OF TIGARD . ELECTRICAL PERMIT
I1
t
COMMUNITY DEVELOPMENT Permit#: ELC2016-00328
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ® Date Issued: 04/20/2016
Parcel: 2S102CB03500
Jurisdiction: Tigard
Site address: 10050 SW GARRETT ST
Project: Bethesda Subdivision: None Lot: None
Project Description: Replace(1)house panel,(4)feeders and(4)branch circuits for Units A, B, C&D.4/21/16, REPRINTED to add(2)
branch circuits for laundry washer&dryer.
Contractor: SQUARE 1 ELECTRIC INC Owner: BETHESDA LUTHERAN COMMUNITIES IN
10117 SE SUNNYSIDE RD., STE. F-216 600 HOFFMANN DR
CLACKAMAS, OR 97015 WATERTOWN, WI 53094
PHONE: 503-867-2423 PHONE:
FAX: 503-914-0432
FEES
Quantity Description Date Amount
5 ea Services or Feeders-200 04/20/2016 $503.50
Specifics: amps or less
4 crt Branch Circuits w/Purchase 04/20/2016 $29.68
Type of Use: MF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 04/20/2016 $63.98
Electrical
Type of Const: 2 crt Branch Circuits w/Purchase 04/25/2016 $14.84
Occupancy Grp: Service or Feeder
0 ea 12%State Surcharge- 04/25/2016 $1.78
Electrical
Total $613.78
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 acc• - .pproved 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. ATT.(TION: Oregon 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 952-01 -0.'O. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 2.1987 or 1.800.332.2344.
Issued = : ( !' �JA J Permittee Signature Qt-fe
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.
Feb.07.2012 02:05 AM Square 16 Electric, Inc 5039140432 PAGE. 1/ 1
Electrical Permit Applin d, i lED t.< t•l l i I INi ,,,
City of Tigard /�p N1 03 : /ZEZI Permit No.: E�4�«o—00 3,9--
13125 SW Hall Blvd.,Tigard,OR 94BR 2 1 2 016 Plan Review other ;r
Phone: 503.7182439 Fax: 503,5�98.196�01_ r^�y f�r� Date/t1 ;
Inspection Line: 503.639.4175CI 1 Y OF TIGARD Rimy Mir
Internet: www.tiprd-or,go I•II nIN r ��++ Notified/Method;
TYPE OF WORK PLAN REVIEW
❑New construction )0 Addition/alteration/rcplacement Please check all that apply(submit a sets of plans w/kerns checked below):
///��� 0 Service or Ponder 400 amps or more ❑Building over three stories.
O Demolition 0 Other where the available fault current 0 Marinas end boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 vola or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-me agricultural
❑ 1-and 2-family dwelling Commercial/industrial 0 Accessory building amps for all other imtdlatioee, buildings.
CI Multi-family ❑Master builder 0 Other: ❑Fire pump. 0Imallaion of 75 KVA or
❑Emergency system. larger uparetoly derived system.
JOB SITE INFORMATION AND LOCATION 0 Addition or new motor load of 0"A^»E""1-2""1.3",
Joli no.: Job site address: at„) (�p�� f Six r more. oecapancy
lC�o�a 0 Six or more residential units. ❑Reaeslirntd vehicle penin.
City/State/ZIP:--r-l a D q.--).-2,L ❑Health-care catlities. a Supply wimp for more'ban
"Q t ❑Barardous locations. 6100 volts nominal.
SuiteibldgJapt.no.: Project name: 62bE Ad 'L � O Service a feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: nr,r.tan4. 1 o,. I rr. t r ret
New residential single-or mull-family dwelling snit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.it.or lees 168.54 4
Ea.add'I 500 sq.ft,or portion 33.92 l
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sft.) 75.00 2
q
Limited energy,multi-family 75.00 2
r- residential(with above aq.R)
1�"`'� Y'� 2 �'('� S POW- Services or feeders imtellation,alteredon.and/or relocation
1.)0&4, /b , e --O 0-40 Xy:t ' * E(r C..20110-00.2 13 200 amps or Ices 100.70 2
`❑ PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2
Name: 601
amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 .1 2
• • Temporary services or feeders lastalhttlau,alteration,and/or
City/State/ZIP: relocation
Phone:( ) Fax:( ) 200 amps or kart 59.36 1
Owner installation:This installation is being made on property that 1 own which is not 201 amps to 400 amps '?5.08 2
' intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for brach circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B.Fee for branch circuits without
.W._.....,._...... service or feeder tee,first SG.I 8 2
Contact name: branch circuit
. ._ . Each add'l branch circuit 2. 7.42 14.2,f 2
Address: Miscellaneous(service or feeder not'sanded)
City/State/Z1P: dwelling,service and/or modular Each rnanulischired or
feeder 67.84 2
Phone:( ) Fax::( ) _Reconnect only , 67'84 2
_ Pump or irrigation circle 67.84 2
rE-mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or Iimitedeene gy
A panel,alteration,or extension. Page 2 2
Business name: 50k( 4 e,„ .-I„ E ec, ce;G 1 ",..1-7-1 C- Each additions'inspection over allowable in any of the above
Address: 10 I f SE St,ur1 n &cL. IRs'.Alit f-"7,,,j Additional inspection(1 hr min) W 6625/hr
n ' n�' Investigation(1 hr min) _ 66,25/hr
City/State/ZIP: i eti2�-�<ayy)as i V e `''1 i 0I S industrial plant(1 hr min) 78.18/hr
Phone:(503) (6V- —'- 23 Fax:(5p3)CI I 32. hispe tions for which no fee is 90.00/hr
_ seeciicany listed 04 lir min)
CCB Lie.:'950410 Electrical Lie.:C,2 2(p Suprv.Lie.: 5 f-1"'7 S ELECTRICAL PERMIT FEES
Subtotal: 1 LA . '4
Suprv.Electrician signature,required: .
/ .„....-'-- Plan review(25%of permit fee):
Print name: + ?R )�,4 Date: L_ j 21 Ii 1p State surcharge(12%of permit fee): I .1 )
"''`t\ TOTAL PERMIT FEE: I (p . (p'_
Authorized signature: Thier permit application expires ifs permit is net obtained within 180
Print name: : . days slier f4 bas been accepted as complete
Number of inspections allowed per permit
i:1BuildinePermlWaLe:PamltAppioe 07/01/10 440-45151(1 ubsiMMAv¢9
�� CITY OF TIGARD ELECTRICAL PERMIT
1114 COMMUNITY DEVELOPMENT Permit#: ELC2016-00328
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/20/2016
Parcel: 2S102CB03500
Jurisdiction: Tigard
Site address: 10050 SW GARRETT ST
Project: Bethesda Subdivision: None Lot: None
Project Description: Replace(1)house panel,(4)feeders and(4)branch circuits for Units A,B,C&D.
Contractor: SQUARE 1 ELECTRIC INC Owner: BETHESDA LUTHERAN COMMUNITIES IN
10117 SE SUNNYSIDE RD., STE. F-216 600 HOFFMANN DR
CLACKAMAS, OR 97015 WATERTOWN,WI 53094
PHONE: 503-867-2423 PHONE:
FAX: 503-914-0432
FEES
Quantity Description Date Amount
5 ea Services or Feeders-200 04/20/2016 $503.50
Specifics: amps or less
4 crt Branch Circuits w/Purchase 04/20/2016 $29.68
Type of Use: MF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 04/20/2016 $63.98
Electrical
Type of Const:
Occupancy Grp:
Total $597.16
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. ATT ION: Orego law r•• •s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 through OAR 952-64 -0090. •ay obtain a copy of the rules or direct questions to OUNC by calling 50 2311987 or 1.800.332.2344.
Issue By: k .^ ///e _I 1 - Permittee Signatu eP`
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' "b� f 4 41�. Date: _ 4
LICENSE NO. 37 7 S
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.
Feb.06.2012 01:09 AM Square 1 Electric, Inc 5039140432 PAGE. 1/ 2
Electrical Permit Applica CElVED l frit t>I 1 1( 1 i ,1 nl,,, , y
11311125 SOV Hall Tigard
d.,Tigard,OR 972 P R 2 0 2 016anReviewDate/13 :
Received ' i!O P"°i1t No,: 5/( GO :'
Ili II Phone: 503.718.2439 Fax: 503,598.1960 DatdEry: Other Permit:
i , Inspection Line: 503.639.4175 CITY OF T I G AR D Notife Myhty, >m,: Supplemental Pagai2t foror..so.
Internet for
www.dgard-or.gov BUILDING DIVISION
TYPE F WORK PLAN REVIEW
[a New construction Ni Addition/alteration/replacement Please check all than apply(submit 2 sets of pians Vilma checked below):
❑Service or feeder 400 amps or more Cl Building over three stories.
❑Demolition 0 Other: where the available fault current ❑Manama and boatyards.
-
CATEGORY OF CONSTRUCTION exceeds 10.000 amps an 150 volts or 0 Floating buildings.
Ices to ground,or exceeds 14.000 0 Commeraiat-use agrieiMwal
o 1-and 2-family dwelling Commercial/industrial ❑Accessory building amps for all other installations_ buildings,
❑Multi-family Master builder 0 Other. C3 Fire mono. D installation of 75 KVA or
0 Emergency system, loge`separately derived system.
JOB SITE INFORMATION AND LOCATION p ❑Addition of new motor load of ❑"A""E""1-2","1-3"
.lob'no.: Job site address: 10050 S(.�) ((``2�t2 1 r.-44 , -I . ix or ear more. y.
lel ❑Six or more residential gaits. ❑Recreational vehicle pules.
City/State/ZIP:-T
Cir� (�Health care facilities. ❑supply voltage for more than
l G41�-. -a l,rte 1 t� V�y t`1 L ❑Haardous locations. 600 volts nominal.
Suite/bldg./apt no.: Project name: e_4 0 Service or feeder 600 amps or mom.
FEE SCHEDULE
Cross street/directions to job site: Merl.** 1-oar- 1 Fee I 'cera I •
New re ldeadal single-or multi-famlly dwelling snit.
Incladee attached garage.
Subdivision: 1At no.: _ 1,000 sq.ft.or Ism. 168.54 1 tj 4
Tax map/parcel no.: Limited 1 n00 energy, esft de pinion 33.92 t
� 75,00 2
DESCRIPTION
WORK (with above sq.It) ,
Limited energy,multi-family 75.00 2
RepVca .4 putts+ 1 Vibusc e.k Ua2c'ix:sk s'C�c►a bts4A-ti '`i, dential(with above sq.it).
f Services or feeders installation,alteration,and/e7.r rdocatioa
orA4i k%'r'WGt b k¢ "f_d iQ`,61 200 amps 6t less 3 100.70 i
❑ PROPERTY OWNER ❑ TENANT i 201 amps m 400 amps 133.56 2
0 401 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
Tservices or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:( ) Fax:( )
200 amps or less 59.36 1
201 amps to 400 amps 125,0E 2
Owner installation:This installation is bcing made on property that I own which is not 401 amps to 599 amps 168.54 2
' intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. Bnach circuits-new,alteration,or extension,per panel
Owner signature: _ Date: A.Foe for branch circuits with ,
0 APPLICANT 0 CONTACT PERSON
above service or feeder Re, y _ 7,42 pZ 2D D 2
each branch circuit
Business name: B.Fee for brunch circuits without
service or feeder fee,first 56.18 2 .
Contact name: breech circuit
-. Each w!d'1 branch circuit 7,42 2
Address: Miscellaneous(service or feeder not included)
/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:
-- Signor outline lighting 67.84 2
CONTRACTOR Signal Otranto)or Iimited-energy
panel,alteration, extension. Page 2
Business name: ,%tA. � . 6( .C4- r G t s�G b adds ir►sai lsupeedoo over allowable any of the above 2
Address: 1 O i l sc st t.,ri n side Rd . S i E F-2.I Cr, Additional Inspection(1 hr min) 6625/hr
City/Statc/ZiP: akQt,,p ,,t, e q-I 01 S Investigation(l hr min) 66 25/hr _ _
�1cIn M,,,Q�] t �1 Industrial plant(I hr min) 78,18/hr
Phone:(�) Owl - 2.-j 2 3 Fax:('o3)q 14-��32 Inspections for which no fee is 90,00/hr
specifically listed('h hr mita
CCB Lie.:`Ct 5 0C?h Electrical Lie.:(,0 p 2,(D Suprv.Lic.'5.43:17....5_ ELECTRICAL PERMIT FEES
ES 533•
14
Subtotal:
Suprv.Electrician signature,required: ,-- ,fL
Plan review(25%of permit Ice): 9
Print name: 1/a , ,�+, ?R Date: Ijf a U�/(0 state surcharge(12%of pennn tee): �- - 4 3'
`�-+Mti TOTAL PERMIT FEE: 7(O q ,`14 l
Authorized signator,: IP
^This parrots application aspires if a permit is ant obtalued wilds 180 9 7
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit,
l
t:+ oC 'JK ba %r l: l A- MQ-464 p e4v r ,^' .
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
10050 SW GARRETT ST, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00328
Herb Stabenow
Violation Summary:
Inspector Contractor