Permit (58) CITY OF TIGARD ELECTRICAL PERMIT
Ili
COMMUNITY DEVELOPMENT ( Permit#: ELC2017-00171
[GARD
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 /oMINI Date Issued: 03/15/2017
Parcel: 1S135CA02600
Jurisdiction: Tigard
Site address: 11130 SW GREENBURG RD
Project: Good Neighbor Center Subdivision: None Lot: None
Project Description: Electrical for TI:(2)branch circuits for lighting and receptacles; (2)low voltage systems for Data
telecommunications and Intercom.4/10/17,REPRINTED to add low voltage for fire alarm
Contractor: ON ELECTRIC GROUP INC Owner: EAST WASHINGTON COUNTY SHELTER
1709 SE 3RD AVE PARTNERSHIP COUNCIL
PORTLAND, OR 97124 DBA GOOD NEIGHBOR CENTER
11130 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503-234-9900 PHONE:
FAX: 503-234-1001
FEES
Quantity Description Date Amount
2 ea Limited Energy 03/15/2017 $150.00
Specifics:
2 crt Branch Circuits wo/Purchase 03/15/2017 $63.60
Service or Feeder
Type of Use: COM 1 ea 12%State Surcharge- 03/15/2017 $25.63
Class of Work: ALT Electrical
1 ea Plan Review Electricial 03/15/2017 $53.40
Type of Const:
Occupancy Grp: 75 Restricted Energy Permit 04/07/2017 $75.00
9 12%State Surcharge- 04/07/2017 $9.00
Electrical
45 Misc Administration Fee 04/07/2017 $45.00
Total $421.63
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 rough OA- = 2-001-00•0. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B A. • 1 $ /-41_,41.4-4.i.—/ Permittee Signature: C.. / '1 M7Arr!dialr'e-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: ��/7
� 111
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 Fol(oFFicv I SE ON1.1
Received 9 , /
7 Op Permit 4: g_l_e_ v7_00 /7/
A
City of Tigard t,A f,,R 3 0 ?HI/ Date/By:
111Ir 13125 SW Hall Blvd„Tigard,OR 97Y2T. Plan Review
. Phone: 503,718.2439 Fax: 503.51,1„ 9.,, ,,,. -. , Date/By: Related Permit 0:
Inspection Line: 503,639,4175 Ready Date/By: ' tans: [fa See Page 2 for
I I"A RI) Internet: wwwtigard-or.gov ' . . . , .,, Notified/Method: I Supplemental Information
%4:4- , 7111k7„: 114 :-ttiltY 'T,"4, 4114SPe"Atk- -7-01f t : IllkW- 7 /3414EM,Ot '---- .411GPi%„.
0 New construction 0 Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked):
0 Service or feeder 400 snips or more Q Building over three stories,
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards, i
1,413KG9141:9, 20,,,IISTROMOrti,,,,„,,I,V; "'"',11E, "14; exceeds 10,000 amps at 150 volts or 0 Floating buildings,
0 1-and 2-family dwelling IE Commercial/industrial 0 Accessory building less to ground,or e>cceeds 14,000 0 Commercial-use agncultura]
amps for all other installations. buildings,
0 Multi-family 0 Master builder D Other: 0 Fire Pumn, 0 Installation of 150 KVA or
-14WPSfttiThilrf1*AThil•Arinigke4Tpvii„,,, 7--,;k:iis, ,g El EAndlerr=frn, larger separately derived
Job#: 705824 I Job site address: 11130 SW Greenburg Rd
niotorloadof system ,
City/State/ZIP: Tigard, OR 0 Six or more residential units, occupancy-
0 Health-care facilities, 0 Recreational vehicle parks
Suite/bldg./apt.#: I Project name:Good Neighbor Center O Hazardous locations. 0 Supply voltage for more than
o Service or feeder 600 atispe or more, 600 volts nominal,
Cross street/directions to job site: '-- -'1''''1:? :: 7-72, :WteittffutegitiL:,
ittestription I Osy. I rads I Tolld i *
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
. .
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea,add'l 500 sq,ft,or portion 33.92 1
PrAir, ,:41F, 401, DWA*40,1410k.:.WOW --:1,,a. ,-Aor-,: '40, - Limited energy,residential 75,00 2
Please add (1) Low Voltage for fire alarm (with above sr(B.)
Limited energy,multi-family
75,00 2
to permit ELC2017-00171 residential(with above sq,ft) .
_rRenewable Energy 0 See PaAge 2
l'LL-4,'Ca'-'01,(01wW-9,0*1* 'V latra,', -",lhaitgo'rr' '''f47 - ",:'''4 Services or feeders Installation'alteration,and/or relocation_
Name: East Washington County Shelter Partnership 200 amPs Or less j 100,70 2
-
Address: 201 amps to 400 amps 133,56 2
401 amps to 600 amps 200,34 2
City/State/ZIP: 601 amps to 1,000 amps 301,04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552,26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125,08 2
Owner signature: ., Date: 401amps to 599 amps 168,54 2
_ —
l.v. 1W -- -- -- ,,,„.,'I,l.,.r,,,F,- ' -Branch circuits—new,alteration,or*Sinaloa,p
panel
A,Fee for branch circuits with
Business name: On Electric Group above service or feeder fee,
7,42 2
each branch circuit
Contact name: Mark We inbender 3 Pee for branch circuits without
- service or feeder fee,first
Address: 1709 SE 3rd Ave branoh circuit 56.18 2
City/State/ZIP: Portland, OR 97214 Each addl branch circuit 7,42 2
Miscellaneous(service or feeder not included)
Phone:(503 ) 234-9900 I Fax: :(503) 234-1001 Each numufactured or modular
, 67,84 2
dwelling,service and/or feeder
Email: Mark.Weinbender@oeg.us.com
Reconnect only 67.84 2
AlirZg:.:"i"' --?..MEC44'i,f-cONTAtcl61.; --41k ir--4.111:- :1111g- Al Pump or irrigation circle 6784 2
Business name: On Electric Group Sign or outline lighting 67,84 ,., _ 2
.
Address: 1709 SE 3rd Ave Sigma cIrcuit(s)or limited-energy.
ID See Page 2 2
panel,alteration,or extension
Each additional inspection over allowable in any of the above
City/State/ZIP: Portland, OR 97214 Additional impaction(1 hr min) [ 66,25/hr
Phone:(503) 234-9900
Fax:
( 503) 234-1001 — ..
Investigation(1 lir min) 90.00/hr
Email: laurel.semprevivogonzalez@oeg.us.corn Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 203 Electrical Lie.: 26-95c S pry,Lie.: 48 8S $ a lfleull listed l/S hr,111111 90,00/hi,
— 'r areffillr '-,- 10611W11 (0.4 : S t'k' ,alEES'.--,w,v1,,,,;,,,,,,'.
Suprv.Electrician signature,required: - r or - Subtotal: 75.00
Print name: Mark Weinbender Date: 03/30/17 0PlanReviewRequired(25%of permit fee):
,
State surcharge(12%of permit fee): 9.00
4. Ck.14.4:64 *01 --
TOTAL PERMIT FEE: 8 4.0 0
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name:Mark Weinbender Date: 03/30/17 days after it has been accepted as complete.
.., — * Number of inspections allowed per permit. _ - - t t.e_'dd
I:Mudding\?Grinds\ELC_PemritApp_ELR_ERE doe Rev 06/17/2015 440-4615T(11/05/COM/WEB $129 . 00
Total
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
IZ1w Nyry.y 1 T ,{y�� „�4 p:. - �i� �. FEE'S`CHEnu ��'
Sth*NT11AL W 1(k O IJl• _ " ^ih . ,.,.._. l Q7. 1 Each 1 Total l
3r
sc
Fee for all residential systems combined: $75.00 Rcen Renewable electrical energy systems: _
Check Type of Work Involved: 5 kva or less 100.70 2
5,01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200,34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alasm 25.01 to 50 kva 301,04 2
Garage Door Opener* 50.01 to loo kva 552.26 2
g p >100 kva(fee in accordance 552,26 2
with OAR 918.309-0040)
Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0,0 3
Each additional inspection over allowable in any of the above:
• Other: Each additional inspection is 66,25/hr 1
Qharged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/3 hr min)
b 7 r�^ 1�)NTS i��i�"�rE.' RIVAL Flt `VEE
COMM RCIAL W*O L) ONLY .....}1 Vii , 1"t`. .. ...
Fee for each commercial system: $75.00
Subtotal allowedeper toPage l):
y ' Number of inspections per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_Perrni lApp_ELR_ERE.doc Rev 06/17/2015
CITY OF TIGARD ELECTRICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit#: ELC2017-00171
7 i f:;A It D13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2017
Parcel: 1S 135CA02600
Jurisdiction: Tigard
Site address: 11130 SW GREENBURG RD
Project: Good Neighbor Center Subdivision: None Lot: None
Project Description: Electrical for TI:(2)branch circuits for lighting and receptacles;(2)low voltage systems for Data
telecommunications and Intercom.
Contractor: ON ELECTRIC GROUP INC Owner: EAST WASHINGTON COUNTY SHELTER
1709 SE 3RD AVE PARTNERSHIP COUNCIL
PORTLAND, OR 97124 DBA GOOD NEIGHBOR CENTER
11130 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503-234-9900 PHONE:
FAX: 503-234-1001
FEES
Quantity Description Date Amount
Specifics: 2 ea Limited Energy 03/15/2017 $150.00
2 crt Branch Circuits wo/Purchase 03/15/2017 $63.60
Service or Feeder
Type of Use: COM 1 ea 12%State Surcharge- 03/15/2017 $25.63
Class of Work: ALT Electrical
Type of Const: 1 ea Plan Review Electricial 03/15/2017 $53.40
Occupancy Grp:
Total $292.63
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 ru s are set forth in OAR
952-001-0010 through 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.223)1987 or 1. .332. 44.
Issued By: Permittee Signature: L., t_—
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 � t I (1It 01 I I('1' 1 s1:()`1:v
i City of Tigardtv,,,. \,,,, Rel ea -7
- Plan Rovi
, /.p.+b 13125 SW Ball Blvd.,Tigard,OR )�} t DatdDy. i/ ( it's* �
Phone: 503.718.2439. Fax: 503.598,1960`t R .� DB y ew J 3 r� Related Permit 4: 0 c
1. t 1i i Inspection Line: 503.639.4175 ,�`� l,"k;I\"* ynateB • .. Durk ` 7 r �'�.•�
� ,::„;4�,°:�„#=2�^ternet: www.tigard-or.gov � 1 QMH
otiii ental formation
qui "% �j Seo Page 2 for
�� -� ed/M' J f���� �. Supplemental In
< ,:.i:::.rpT1AlY:41ti:.YlE'Vy:;....;,.,•.,-,:,....., :
0 New construction CI. Addition//alteratl a a . l ..,,, nt Please check all that apply(submit a seta of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other:
I.
:;,::;;. where the available fault mutant ❑Marinas and boatyards.
.1 53' . tl' - «::.,:, ss,
- .,.. ,. .-:a: _ , � .s:�A::n.'.�Q��:_�O�-;CS)I![�'1;1ZiJCTI'JO.:<" :- exceeds`` ;' �`: `` :'� H `:;:::;''`.`•--:'`:;.i.':-. ]0,000 amps at volts or ❑Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 Multi-family 0 Master builder ❑Other: amps for all other installations, buildings.
, ..:','.,-i- �* p �a,�. ,.. P 15DKVAor
. .: ,::-... . ._._ �. :_.�.. '�bl� �'�; .4,0Q*.?:'". ':.i--.*:,:,': ;'-.:::...,;:,..:,•-s',.` ❑Emergency larger separately derived
Job II:705824 I Job site address:11130 SW Greenburg Road D Addition of new motor load of system.
10011P or more.
City,o.., JZIP:Tigard,OR 97223 0 Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle padre.
Suite/bldg./apt.#: I Project name:Good Neighbor Center D Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: ri.
_:; ,•..;.- yrs'.
:�; '"°�;'':•:,,`gam �11luhE;<`.- ` - ;; ;,
assrrlauoo I Qtr. I Each': I. Total 1 *-
New residential single-or malti-family dwelling unit.
Subdivision: I Lot d: Includes attached garage.
Tax map/parcel#: 1.000 sq.h.or loss 168.54 4
-- - :;aw,. ..nj,>_ ':a,:.:. :;.:�:� - - - .� -. _ _ sq. or portion 33.92 1
.......:'yCIdir..: , "shy{”' j 1411 �i010 -'.Y:".',::� -
'>R�w,.• el'M_'t:r dQ�d +;sT�.Y'+11�:'?v+�:+�``.;,;.,.., ' Y"."`'` ^``'.:: Limited energy,madonna'
Addition of Classroom and office to existing building (with above sq.ft.) 75.00 2
Limited energy,multi-family
Branch circuits for lighting and receptacles residential(with above sq.ft.) 75,00 2
, .;'fir` ; :[ P P ?` - :s;-= swti..i tt, ,. r"• .7?..t•. ; Ef �Y 2
_ - ServicesRenewable or feeders tastallatlon,altcra❑ tlSeeon,Page and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 12508 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
i. ``': ;4 rt , ,,--...F - Branch circuits—new,alteratio� or extension,. .. ..�:,..=::,�: �' :: �''��"e:�:.;.;--�`=`i3:•.n,�1:u:+:1�s:`n:,i�� -�� ��=>i';'1�$li�'�:;a:� '; ,;.;�': on,per panel
. .-. � A.Fee for luanch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: __ _ i_ _ _ B.Fee for branch circuits without
__ - -- 56.18 2
branch circuit
City/State/ZIP: Each add't branch circuit 1 7.42 7.42 2
I Miseellaneons(service or feeder not included)
Phone:( ) Fax::( ) Each manuthetured or modular
Email:
dwelling,service and/or feeder 67.84 2
n ;'` ;r:= a:s,;' r,, r 1 :. , . r Reconnect only 67.84 2
. ._ .. -. - . .. -. . ... Pump or irrigation circle 67.84 2
Business name:On Electric Group Sign or outline lighting 67.84 2
Address:1709 SE 3"e-Ave. Signal circuit(s)or Iitnited-energy See Page 2 1S0 2
panel,alteration,or extension g
City/State/ZIP:Portland,OR 97214 Each additional inspection over allowable in any of e above
Additional inspection(1 hr min) 6625/hr
Phone:(503)234-9900 I Fax:(503)234-1001 Investigation(1 lir min) 90.0W hr
Email: /� Industrial plant(1 hr min) 78.18/hr
/ Inspections for which no fee is
CCB Lie.: 203 I Electrical Lie.: 26-95 Suprv.Lie.: 4818S 4�/// in -,.lis %hrmin 90.00/hr
Suply,Electrician signature,required:
;7:: ` 1gIa>''. KOe12.I)°Eil WIITEX-g
Subtotal:/
213.6
Print name: Mark Weinbenderio /`'` ` Date: 3/10/16 El Plan Review Required(25%of permit fee): -5*90. 1.3. y
State surcharge(12%of permit fee): 25.63
Authorized signature: Thi permit application expires if a permit Is not Dm, . , , 180.
Print name: Mark Weinbender Date: 3/10/16a days after it has bean accepted ss tom ( L --
1.•.BuitdiaglPormitalBLC Po milApp BIR BREAD Rev 06/17/7015 440.46151(11A15/COM,WltB Number of inspections allowed pia permit
Electrical Permit Application—City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
•
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100,70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
0 Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
0 Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fbe in accordance 552,26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Bach additional kva over 25 7.42 3
0 Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Eachadditional url y(1 hr�1 66.25/hr 1
Inspections for which no fee is
90.00/hr
et ;!�571'__-,� QIsJ ,'`ayt :i...ti ... ,`.Y� .Si 7:oq�*4.""Ir�' .ra4�!7sci,eifically listed(II hr min)
u ;:1"L'lA
� a;?:M� Subtotal(Enter on Page 1): .
Fee for each commercial system: $75.00
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
0 Clock Systems
® Data Telecommunication Installation
❑ Fire Alarm Installation
o HVAC
0 Instrumentation
® Intercom and Paging Systems
0 Landscape Irrigation Control*
❑ Medical
0 Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
0 Other:
Total number of commercial systems: 2
*No licenses are required. Licenses are required for all
other installations
lAnaildinglPonnitslSLC Pat milApp_ELtt_llt deo Roy 06/17/2015
ON ELECTRIC GROUP
1709 SE 3rd Ave
Portland, Oregon 97214(503)234-9900
TRANSMITTAL
Date: 3/10/2017
To: City of Tigard
Attn: Dianna Howse RE: Good Neighbor Center Classroom
13125 SW Hall Blvd
Tigard, OR 97223
Herewithin (X)
Under Separate Cover ( )
Direct ( )
Dear Dianna,
Here is the plan review and application that we discussed. Whenever payment is required, I will pay it ASAP.
Thank you!
These Items are being sent:
( ) For your immediate action, keep us advised of action taken
(X) For you to process
( ) For your inspection and approval
( ) For your General Information and File
( ) For your Approval or Corrections
( ) For you to correct if required, &return conforming copies to us
( ) Please advise If additianal copies are required atter Approval is rec'd
( ) Please return copies to us with approval or correction notations
( ) For you to submit a proposal upon work indicated as being changed
( ) (Approved)(Disapproved) By As noted
Please contact us promptly if there is a problem or question Very Truly Yours,
Laurel Semprevivo Gonzalez
ON ELECTRIC GROUP, INC.