Permit (174) CITY OF TIGARD ELECTRICAL PERMIT
1111111
'I COMMUNITY DEVELOPMENT Permit#: ELC2018-00501
Date Issued: 08/22/2018
T f f;A R r 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103DD01100
Jurisdiction: Tigard
Site address: 13939 SW PACIFIC HWY
Project: Walgreens Subdivision: None Lot: None
Project Description: Adding(15)branch circuits for lighting and power in remodel for Providence Express Care Clinic inside Walgreens.
Contractor: TICE ELECTRIC Owner: WALGREEN CO#5780
5405 N LAGOON AVE. PO BOX 901
PORTLAND, OR 97217 DEERFIELD, IL 60015
PHONE: 503-872-8230 PHONE:
FAX: 971-230-3330
FEES
Quantity Description Date Amount
15 crt Branch Circuits wo/Purchase 08/21/2018 $160.06
Specifics: Service or Feeder
1 ea Plan Review Electricial 08/21/2018 $40.02
Type of Use: COM 1 ea 12%State Surcharge- 08/21/2018 $19.21
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $219.29
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 95 Yo may obtain a c•py of the rules or direct questions to OUNC by calling 503.232 7 or 1.800 .2344. Q
Axi
Issued By: / 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.
Electrical Permit Application , , 1:012.OFFICE l''F ONI.I
City of Tigard _ Received
: P; t : 1. ' ,
13125 SW Hall Blvd.,Tigard,OR 97223 I U L 2 6 2 018 Plan Review JS''elated Permit#
I Phone: 503.718.2439 Fax: 503.598.1960' Date/B : �i� . A"? i /.
Inspection Line: 503.639.4175 r , , 'eady n ate:y: �' 111111111111 r' See Page 2 or
T I G A R D L-1¢ f k; r r'�r , ..tified/Method: ' �� Supplemental
www.tigard-or.gov � Su lemental Information
I 11,'4 :.+ r ////»1�/�, i-s
.. zs.- ,ms, *w -OF* i ,.' - i - s. ,. PLAIN R VIZW; ;:
New construction iI Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CO TRECT ON ," exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family El Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB S1'1`E�1N1I ''*1 AND LOCATION ' 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#:5.4676 Job site address:13939 SW Pacific Highway IooHP or more. ❑"A","E","1-z","t-3",
0 Six or more residential units. occupancy.
City/State/ZIP:Tigard/Oregon/97223 ®Health-care facilities. 0 Recreational vehicle parks.
0 Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name:Walgreens Providence EC ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE"
Descri.tion ILTSIIIIIIMMIIMMII
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION'OF', ','"1 ` `. Limited energy,residential
. 75.00 2
with above s..ft.)
(15)Branch Circuits for lighting and power in remodel for Providence Express Limited energy,multi-family
residential(with above s..ft.) 75.00 2
Care Clinic inside Walgreens
0 PROPERTY Q' R t n 1v44NT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:
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: 401 amps to 599 amps 168.54 2
►,, APPLICANT 1 , 0 CONTACT PERSON Branch circuits—new,alteration,or extension, a er s anel
A.Fee for branch circuits with
Business name:Tice Electric Company above service or feeder fee, 7 42 2
each branch circuit
Contact name:Kevin Shannon B.Fee for branch circuits without
service or feeder fee,first 1 56.18 56.18 2
Address:5405 N Lagoon Ave branch circuit
City/State/ZIP:Portland/Oregon/97217 Each add'l branch circuit 14 7.42 103.88 2
Miscellaneous service or feeder not included
Phone:(503)872-8238 Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:kevins@ticeelectric.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Tice Electric Company Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:5405 N Lagoon Ave
sane],alteration,or extension.
Each additional ins•ection over allowable in an of the above
City/State/ZIP:Portland/Oregon/97217 Additional inspection(1 hr min) 66.25/hr
Phone:(503)233-8801 Fax:(503)231-3372 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:sarac@ticeelectric.com Inspections for which no fee is
90.00/hr
CCB Lic.: 166 Electrical Lic.: 26-126C Suprv.Lic.: 3940S so-cificall listed Y hr min
ELECTRICAL PERMIT"FEES '
Suprv.Electrician signature,required: /e04,44.64-e: 4_,444,4,4,6,0.,....._ Subtotal: 160.06
Print name: Robert Richardson Date: 07/26/2018 El Plan Review Required(25%of permit fee): 40.02
State surcharge(12%of permit fee): 19.21
TOTAL PERMIT FEE: 219.29
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
L\Building\Permits\ELC_PermitApp ELR_ERE.doc Rev 06/17/2015 4404615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY:: FEE;SCHEDULE'
Fee for all residential systems combined: $75.00
RenewableQtyEaeh Total
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 Alarm 25.01 to 50 kva 301.04 2
El Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ 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
charged at an hourly(1 hr min)
Inspections for which no fee is
specifically listed(1/2 hr min) 90.00/hr
COMMCROAL:WORK ONLY:, ELECTRICAL ?EMT FEES
Fee for each commercial system: $75.00 subtotal(Enter on page I):
*
(SEE OAR 918-309-0000) Number of inspections allowed per permit.
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_PennitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13939 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2018-00501
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13939 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2018-00501
Inspection Type: Inspector:
125 Wall cover Jeff Grove
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor