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Permit (7) CITY OF TIGARD ELECTRICAL PERMIT IN i : COMMUNITY DEVELOPMENT Permit#: ELC2019-00792 Date Issued: 12/05/2019 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134BC00200 Jurisdiction: Tigard Site address: 12180 SW SCHOLLS FERRY RD Project: One Medical Group Subdivision: None Lot: None Project Description: Electrical for TI: Contractor: RIVIERA ELECTRIC LLC Owner: ATLAS GREENWAY LLC 7312 NE PAR LN 333 NW NINTH AVE, STE 1009 VANCOUVER,WA 98662 PORTLAND, OR 97209 PHONE: 503-740-2291 PHONE: FAX: 360-230-2330 FEES Quantity Description Date Amount 57 crt Branch Circuits wo/Purchase 12/05/2019 $471.70 Specifics: Service or Feeder 1 ea Sign or Outline Lighting 12/05/2019 $67.84 Type of Use: COM 1 ea 12%State Surcharge- 12/05/2019 $64.74 Class of Work: ALT Electrical Type of Const: 1 ea Plan Review Electricial 12/05/2019 $134.89 Occupancy Grp: Total $739.17 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 c,pyo les or direct questions to OUNC by calling 503.23219877 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. Electrical Permit Application FOR OFFICE USE ONLY Received City of Tigard - / +i w- Permit#: C 13125 SW Hall Blvd.,Tigard,OR 97223 M l l PlanDateReview: 1/ /I f_(1 (jt —C7( d ,� Plan l I i'e� f /3/j Related Permit 4:,� 19_ to C Phone: 503.718.2439 Fax: 503.598:1960� Date/By: r / Inspection Line: 503.639.4175 ,. g 1 ZWB Ready Da / r s ® See Page 2 for TIGARD Internet: www.tigard-or.gov J 1 �1 dtified ', .: 3//�? �.. ,�;*� ,•, Supplemental Information y ./ !1 6 TYPE OF WORD` Ft4 `d ;1.4 ;r`s PT. I Y " l 1I led r ear , ❑New construction ©Addition/alteration/replaCem�nt ' tS , lease 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 ❑Other: where the available fault current 0 Marinas and boatyards. lit a i 0, , 4,P1M345 CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. 0 1-and 2-family dwelling X❑Commercial/industrial p Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: 12180 SW Scholls Ferry Rd 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP: Tigard/OR/97223 0 Six or more residential units. occupancy. ®Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name: One Medical 0 Hazardous locations. 0 Supply voltage for more than D Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE ��A� / Description J Qty. I Each total �w f. Cfiti /LL I/�'L c' cm t►r � ��IY t� 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 WORK Limited energy,residential New tenant construction in existing pharmacy store. Existing utilities. New lights,rooms, (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 controls,receptacles,etc. residential(with above sq.ft.) Renewable Energy 0 See Page 2 ❑ PROPERTY }' ER I V TENANT Services or feeders installation,alteration,and/or relocation Name: On frtC I C -` C--1 j/V U` 200 amps or less 100.70 2 Address: ' - - .r-- 10 C V I'L KA201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: Y 4r-0,\7-\Gc-SCeJ '(A 44 k 1 ` 601 amps to 1,000 amps 301.04 2 Phone:(A Is) "2J'2, c2 _...172..., Fax:( ) /` FOver 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 RIAPPLICAh� ', p� T'k k ion. I-4, C(]N ' ®� Branch circuits—new,alteration,or extension,per panel ., A.Fee for branch circuits with 2 Business name: -sc yKAA-- U t f s above service or feeder fee, 7.42 2 each branch circuit Contact name: �i ;c,\/\, /.\..v-„A �;- B.Fee for branch circuits without 1 servAddress: q�7� rovvv ',v ci f3 branche or feederstfee,first 56.18 2 / ��� branch circuit City/State/ZIP: ve h' `11 51 s (` cO2` 1 Each add'l branch circuit 56 7.42 2 /� Miscellaneous(service or feeder not included) Phone:( cd) (3(002— 3(0)z,c Fax::( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: c2>l C!,,-V. Vd,,, A I.401414. . 01 J(�/1Cf<, 6..c.,VI- Reconnect only 67.84 2 ,, Pump or irrigation circle 67.84 2 or outline lighting 1 67.84 2 Business name: � Pli Sign Sh� g �v3 Signal circuit(s)or limited-energy g Address: ��� J� 1 panel,alteration,or extension. 0 See Pa e 2 2 V Each additional inspection over allowable in any of the above City/State/ZIP: �� ,�(�/ Additional inspection(1 hr min) 66.25/hr Phone:( ) 6 Fax. (1k;Cil 1 a . / j Investigation(1 hr min) 90.00/hr 5p � Industrial plant(1 hr min) 78.18/hr Email: / ! f''' i7 Inspections for which no fee is 90.00/hr CCB Lie.: ectrical Li rv.Lic.: s.ecrfically listed CA hr min) {L . ..1 h " F r f€.1 II 1"p11, Suprv.Electrician signature,required: tit\ Subtotal: Print name: Date: o Plan Review Required(25%of permit fee): A. State surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signature: 11411114id, -'11".00 This permit application expires if a permit is not obtained within 180 Print name: ch ekv-d 7 �. Date: 1k. , b' , k/"/t days after it has been accepted as complete. /� t — ` * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitAppELR_ERE.doc Rev 06/17/2015 440-4615T(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 SCnEDULE Description Qty. I Each 'total * Fee for all residential systems combined: $75.00 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 Alarm 25.01 to 50 kva 301.04 2 ElGara e Door O ener* 50.01 to 100 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 P1 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 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('A hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): 3 Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: E Audio and Stereo Systems ❑ Boiler Controls f] Clock Systems 0 Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* x❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Electrical Permit Application Ftl►Z t)► ► I( I I S►.t)v► l City of Tigard # l E C E I V E Received t �► 13125 SW Hall Blvd.,Ti ard,OR 97223 R Date/B : .o t' —( 11111 I Phone: 503.718.2439 g DEC 0 5 2019 Plan Review Date/B Permit#:Related Permit#: Email: TigardBuildingPermits@Tigard-or.tv Ready Date/By: Juris: See e Page 2 for Line: 503.639.4175 InternewYr rrDNotifed/Method: Supplemental Information* LDI`G 0 glnN TYPE OF WO PLAN REVIEW ❑New construction ❑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 CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural ngs. ❑Multi-family ❑Master builder 0 Other: 0 ampsirfor all other installations. Inbustallation pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: 27,e �) Addition of new motor load of system. / d J i AV .5 �4,c,/y J` "fei' i10oHP or more. ❑"A„ "E„ '1.2„ City/State/ZIP: )'( "1.3„ 9 0 Six or more residential units. occupancy. +,j/ d 7 2G ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: �'"' Project name: 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total 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 WORK Limited energy,residential 75.00 2 1 7:: . (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) 0 PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 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:( ) 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 0 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7.42 2 Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 124 V) 6 F-'t" ( LE_17_-(c. e,L-L- Sign or outline lighting 67.84 2 Address: 70 7 7 N 1l 6 Signalnlter tiont(s)or limited-energyxes0 See Page 2 2 � /`7 t,�� y'� panel,alteration,or extension. City/State/ZIP: P i �`�'(l'�i W l 0 6 Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:(510 7''o Z e9 ( Investigation(1 hr min) 90.00/hr r Industrial plant(1 hr min) 78.18/hr Email: I'1 viera.,"7e c ,c,.. tf� t/u 4 v c.,, e,U A Inspections for which no fee is I90.00/hr CCB Lic.:/37 7---? Electrical Lic.: /II lAuprv.Lic.: 52 92/ specifically listed(%z hr min) �ulr e,required: ' ELECTRICAL PERMIT FEES Suprv.ElectriciMI , Subtotal: Print name: 71 gc- J13Date: /2/51/7 0 Plan Review Required(25%of permit fee): !!! State surcharge(12%of permit fee): TOTAL PERMIT FEE: 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. I:\Building\Permits\ELC_PermitAppELRERE.doc Rev 10/26/2017 440-4615T(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 Description I Qty. I Each I Total * Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: n 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 552.26 2 with OAR 918-309-0040) n H• eating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(A hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): y * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ B• oiler Controls n C• lock Systems n Data Telecommunication Installation Ti F• ire Alarm Installation ❑ HVAC n Instrumentation Ti Intercom and Paging Systems Ti Landscape Irrigation Control* Ti Medical n Nurse Calls ❑ Outdoor Landscape Lighting* n P• rotective Signaling El Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017