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Permit UPI CITY OF TIGARD ELECTRICAL PERMIT q PERMIT #: ELC2009 -00046 COMMUNITY DEVELOPMENT DATE ISSUED: 1/30/2009 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S101AC 01300 SITE ADDRESS: 07105 SW HAMPTON ST ZONING: MUE SUBDIVISION: BEVELAND NO. 2 LOT: 018 JURISDICTION: TIG PROJECT: KAISER DENTAL Project Description: (1) branch circuit for new rooftop unit. Job No. D1705 RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: KAISER PERMANENTE MCCOY ELECTRIC CO INC 500 NE MULTNOMAH SUITE 100 2014 SE 9TH AVE PORTLAND, OR 97232 PORTLAND, OR 97214 Phone: Contact #: PRI 503- 234 -7521 FAX 503- 234 -9473 FEES Description Date Amount Reg #: ELE 26 -82C [ELPRMT] ELC Permit 1/30/2009 $46.85 LIC 8277 [TAX] 12% State 1/30/2009 $5.62 SUP 2175S Total $52.47 REQUIRED ITEMS AND REPORTS This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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_than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those r s are set forth in 0 R 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies se rules or direct questions to OUNC at 503.24 .6699 or 1.800.3 .2 4 Issue By: r (Li/IA Permittee Sign ure; v /, , r te, 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: C L1RACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: _ i / DATE: LICENSE NO: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. ■ Jan. 30. 2009 8:40AM McCoy El ect r 1 c Co. No. 0611 P. 1 Electrical) rerknu pp__ n FOR OFFICE .: I • - l3ityofTigard ����vEr„,te/Ele s g n : � �t� � Permit No.: �7 � !1 � 13125 SW )Hall Blvd.. - 1 igard, OR 9722 ao ltw r ' Phone: 503.639.4171 Fax; 503.598.1 60 Datel8y; Other-Permit: 171;f1R15 Inspection Line: 503. 639.4175 JAN 3 0 2009 lyalefteadyrny: Juric H Set P ge2for Intemet: wwve.tigard or.gov Notified/ Method: "/"16. Supplemental Information rF,.- .- r�,r�,F� - 1ncv.. ., -, . -s k�.k d� - �'�" �T� a: i - '• � F -- - _ ..,,� . lY rr p „�K -z ty r g� -`• rr .... � {- a.^ .y w`�= lrtF - - = _. e#. FL_ -: �na ,:.naiwm�_ r � � . „ t � �'�-:� �s,r:.� 0 New COnStroCtion ► i Addition/al tcr'atBki lit. 11 fr _ 6 T • j Please check all that apply (submit 2 sets of plans wine ms checked below). ❑ Service or fccdu 900 amps or more ❑ Building over three stories. ❑ Demolition • Other: where the available fault current . -- _ ... 9 , . , -. � - F�- .nas.,a l boatyards. '7'7:- Marinas sntl boatyar . � o sr 1w rza. - `-`� exceeds p&p at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 1- and 2- family dwelling Ce ommercial/industrial ❑ Accessory building snips for all other installations. buildings. [] Multi- family ❑ Master builder ❑ Other: 9 Fire pump. ❑,installatio of 7S KVA or 'M � i . ,,•• -- — - -• Emergency system. larger separately derived system, . — - ..-- p+„,t , l s , -J - w.IN,. ! _ - . n Addition ofocw motor load of 0 " ", E " " 2 .... 1.3 ... Job no.: 7 0 Job site address: ' 1 4 11, 10011P or more. occupancy. I 1. ❑ Six or more residential units. ❑ Recreational vehicle parks, City /State/ZIP: .--- a ti 0 N facilities. ❑ Supply voltage for more than �•� ❑ Hazardous locations. 600 'Oils nominal. Suite/bldg. /apt. no.: Project name: _- rld 0 Service or feeder 600 amps or more, -t, I L . _t Cross street/directions to job site: .. le 0 + - 11:11 New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 5q,11. Or less I 145,15 4 Tax map/parcel no.: Ea. add'1500 sq. ft. or portion 33.40 I v ' =. Limited energy, residential :, ! 'Qf _ :...- - -- ° 74 (with above sq. fl.) 75.00 2 F. s i' .-4 �_ ....' i s � ? Limited energy, multi - family 11 e • —Air ! residential with above :..11. 75.00 2 IP w - Services or feeders installation, alteration, and/or relocation � 200 amps or less _ 80.30 2 - 7,1-, . ,i .r . " ,d. Pl .,.. •?= :•-.._ ;_ , �•_..: v te..: 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps • 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over I,000 amps or volts 454.65 2 City / Slate/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 66,85 1 Owner installation: This installation is being made on property that I own which is not 201 amps lo 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits- new, alteration, or extension, . er panel Owner signature: _ Date: r ;._• Fee for branch r with A. circuits wi r i ,1 ` E2 , S k �. _ �= — '� - e,, a. . P - �I above service or feeder fee, i5' by ..'. --. '.., .,R _._N wa ^ � ' �*�.' - • r' 6.65 2 Business name: McCoy E lectric • Fe4 branch br h circuit y B. Pcc for branch circuits 24/, - C r reCt . ^.B t_: Kent first service or feeder fee, I 46.85 P 2 first branch circuit Address: same Each add'i branch circuit . ` 6.65 2 Miscellaneous (service or feeder not Included) City /State/ZIP: same Each manufactured or modular 90,90 2 dwelling, service and/or feeder Phone: (503) 234 -7521 Fax: : (503) 234 -9473 Reconnect only 66.55 E-mail: Il ksloper @mccoyeleetrle,corn Pump or irrigation circle I 53.40 = ; x y r A,. a r',�! ,{ ' ?� Sign o outline lighting 53.40 13E r Business name: McCoy Electric Signal circuit(s) or imited- energy panel, alteration, or Address: 2014 SE 9 Ave extension. Describe: Page 2 2 K City/State/ZIP: Portland, Or 97214 Eacb additional inspection over allowable in any of the above Per inspection 62.50 Phone: (503) 234 -7521 Fax: (503) 234 -9473 Investigation per hour (t hr min) I 62.50 CCB Lie.: 8277 Electrical Lie.: 26 - 82C Suprv. Lie.: 21755 industrial plant perhour 73.75 ..,.., ...- ,, pgall -4' -5 . rid - ;.il ' Suprv. Electrician signature, required: `i. ,... y 1-44-,42------/ Subtotal: • ,IS Print name: James R. Hall ( Date: / ___-__ _ Plan review (25% of permit fee): 5 , L ©/ State surcharge (12 %ofpenmit fee): Authorized signature: 111 T TOTAL PERMIT FEE: 7. Lr7 Print name: Date: permit appliesttou expires If o permit is not obtained within 180 Date: days after it has been accepted as complete. • Number of inspections allowed per permit. 1:1 Bvtldins \Permit6 \BLC- PennitApp.doc 0512 ?!06 • 440 5T(: 1105/COMA4En CITY OF TIGARD BUILDING DIVISION PERMIT #: ! l_(>2UO 00016 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/30/2009 Phone: (503) 639 -4171 � Inspection Requests (24 Hrs.): (503) 639 -4175 "__ INSPECTION WORKSHEET FOR DATE: 202009 TIME: '7 :00AM PAGE: 32 SITE ADDRESS: 07106 SW HAMPTON ST CLASS OF WORK: SUBDIVISION: BEVELAND NO. 2 LOT #: 010 TYPE OF USE: PROJECT NAME: KAISER DENTAL DESCRIPTION: (1) brand, circuit tor now rooftop unit. Job No. D1705 OWNER: KAISER PERMANENTE, PHONE #: CONTRACTOR: MCCOY ELECTRIC CO INC PHONE #: 503 Inspection Request Scheduled For: Date: 2/C 2009 Pour Time: Code # Inspection Description Confirm # Contact # .Message 109 Electrical final 08034GU1 503 - 2347521 Y Corrections /Comments /Instructions: PAS n PARTIAL APPROVAL ❑ CANCEL NO ACCESS AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: C," th Date: / /4 Phone #: (503) 718- I Iv I