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Permit
CITY OF TIGARD ELECTRICAL PERMIT 111"' : COMMUNITY DEVELOPMENT Permit#: ELC2019 00796 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/07/2019 Parcel: 1S134BC00401 Jurisdiction: Tigard Site address: 12442 SW SCHOLLS FERRY RD 100 Project: Providence Medical Group Subdivision: None Lot: None Project Description: Replacing (1)branch circuit and(1)low voltage system for fire alarm. Contractor: COCHRAN INC Owner: PROVIDENCE HEALTH & SERVICES-ORE 7550 SW TECH CENTER DR#220 ATTN: REAL ESTATE& CONSTRUCTION TIGARD, OR 97223 4400 NE HALSEY BLDG 2 STE 190 PORTLAND, OR 97213 PHONE: 503-234-6564 PHONE: FAX: 503-238-2098 FEES Quantity Description Date Amount 1 ea Limited Energy 11/07/2019 $75.00 Specifics: 1 crt Branch Circuits wo/Purchase 11/07/2019 $56.18 Service or Feeder Type of Use: COM 1 ea 12%State Surcharge- 11/07/2019 $15.74 Class of Work: ALT Electrical Type of Const: Occupancy Grp: Total $146.92 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. Yo m tai a copy of the rule or direct questions to OUNC by calling 503.23 .7800.33 . 44. 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 h it tn.I I( I; II SI ONLY ' 4 Cityo f Tigard 1 C IV w ceived �� t; Date/BY: L� 7 dG. ✓:'�y: ,/ Permit#: �L/C- 7_, T —W 7 (.' 111 .- s 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 2`' Phone: 503.718.2439 Fax: 503.598.1960 NOV 7 2019 Related Permit#: DateBy: �� /47 (elf- Inspection Line: 503.639.4175 Ready Date/By: Janis: H See Page 2 for TICYARD. Internet: www.tigard-or.gov CITY OF TIGAR1)Notified/Method: G' Supplemental Information PE F. 4t ❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available faultcurrent Marinas and boatyards.ar a ;; , „ $ , -or C:C)>"STRIJC 'I ,. :it„,...,,,, ; exceeds 10,000 amps at 150 volts or ❑Floating buildings. ElI-and 2-family dwelling ©Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or 1 ' ^ Emergency separately system. larger se aratel derived 9�=.:'. ,r„ a, � ❑Addition of new motor load of system. Job#: Job site address: 12442 SW Scholls Ferry Rd 100HP or more. ❑"A","E', `1-2","1 3 , / City/State/ZIP: Tigard, OR 97223 ❑Six or more residential units. occupancy. i ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name: Elevator Upgrad ❑Hazardous locations. ❑Supply voltage for more than" ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: Scholls Ferry Rd Description Otv. Each 1 Total I * New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. 1,000 sq.ft.or less Tax map/parcel#: Ea add l 500 sq. or portion ortio n 33.92 1 L t; a<..,{(1 WW + s R ,0 R Limited energy,residential 75.00 Add (1) low voltage circuit, Replace (1) shunt trip breaker (with above sq.ft.) 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) a 4 Renewable Energy 0 See Page 2 :, _it. ,, - % • •; (• .,. - CI,°T l Alm... 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:( ) I 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 o t0 Branch circuits-new,alteration,or extension,per panel i . A.Fee for branch circuits with Business name: Cochran Inc above service or feeder fee, 7.42 2 each branch circuit 'Contact name: Gary Eades B.Fcc for branch circuits without Address: 7550 SW Tech Center Dr service or feeder fee,first 1 56.18 56.18 2 branch circuit City/State/ZIP: Tigard, OR 97223 Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( 971 ) 250-1273 Fax: :( ) Each manufactured or modular dwelling,service and or feeder 67.84 2 Email: GEades@cochraninc corn R 1 67.84 2 ,,, Ct7NT e econnect o y n ' • , ; _,,...'''',, 7,.4 i,......�.m, Pump or irrigation circle 67.84 2 Business name: Cochran Inc Sign or outline lighting 67.84 2 Address: 7550 SW Tech Center Dr Signal circuit(s)or limited-energy ion extension. El See Page 2 75.00 2 panel,alterat ,or City/State/ZIP: Tigard, OR 97223 Each additional inspection over allowable in any of the above. Additional inspection(1 hr min) 66.25/hr Phone:( 971) 250-1273 Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr - to/I`,r)--. Inspections for which no fee is 90.00/hr CCB Lie.: 72942 Electrical Lie.: 37-546C Suprv.Lie.: 6277S specifically listed(V2hrmin) Suprv.Electrician signature,required: � , ELECTRICAL PERMIT EEE5 p g q / Subtotal: $131.18 -" Print name: Mike Grogan l Date: 11-05-19 ❑Plan Review Required(25%ofpermit fee): State surcharge(12%of permit fee): $15.7 4 Authorized signature: / TOTAL PERMIT FEE: $146.92 C This permit application expires if a permit is not obtained within 180 Print name: GaryEade �y Date: 11—0 5-19 days after it has been accepted as complete. 1 Number of inspections allowed per pemtit. L\Building\Permits\ELC_PermitApp EL ERE.doc Rev 06/17/2015 440.4615T(II/05/COM/WEB Electrical Permit Application—City of Tigard -Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDE T1[AL WORK ONLY: C��_ � � : FEE SCHEDULE Description I Qt2c I Each Total 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 Wind generation systems in excess of 25 kva: n B• urglar 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 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 ri V• acuum 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('/z hr min) CO I RCIAI,_WOW O LY a: ,i<: ELECTRICAL, PERMIT FEES ,..., .. allowed Subtotal(Enter on Page I): Fee for each commercial system: $75.00 * Number of inspections allowe 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 ❑ L• andscape Irrigation Control* n M• edical Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling Other: Total number of commercial systems: 1 *No licenses are required. Licenses are required for all other installations is\Building\Permits\ELC PermitApp_ELR_ERE.doc Rev 06/17/2015