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Permit w. ti 'CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2009 -00082 ° COMMUNITY DEVELOPMENT DATE ISSUED: 2/26/2009 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S112AB-02300 SITE ADDRESS: 14150 SW MILTON CT ZONING: I -L SUBDIVISION: BONITA INDUSTRIAL PARK LOT: 005 JURISDICTION: TIG PROJECT: NORTHWEST MEDICAL TEAMS Project Description: Install (2) branch circuits. 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: 1 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: NORTHWEST MEDICAL TEAMS INTERNATION JOHANSEN ELECTRIC INC 14150 MILTON CT 10948 SE VALLEY VIEW TERR TIGARD, OR 97224 HAPPY VALLEY, OR 97086 Phone: Contact #: PRI 503 - 698 -3417 FAX 503 - 698 -2486 FEES Description Date Amount Reg #: ELE 3 -243C [ELPRMT] ELC Permit 2/26/2009 $53.50 LIC 51539 [TAX] 12% State Surchar 2/26/2009 $6.42 SUP 2053S Total $59.92 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 rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699.or 1.800.332.2344. r (� l Issued By: /�O« iZ ),k (1,J Permittee Signature: �� �Q Jcvl \ io[ -ko Y ) 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'N: 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. • , • Electrical Permit Application RECEI1 i l l ►,; <►t , lc r t 51: t;\t., City of Ti and Receive g FEB 2 6 200' DateB- • . , • `R '. PennitN..: 1 z ` 0 , Y r a ii I 1 , -- 13125 SW Hall Blvd., Tigard, OR 97223 Plat, Review Phone: 503.639.4171 Fax: 503.598.1960 Other Permit: ; ; , ; ,: r , inspection Line: 503.639.4175 CITY OF TIGARPed. Ready/ay: tans: See for Internet: 2 Information • I 11 Internet: www.tigard or.gov - 1 , , \ alu ;lied/Method: 1r Supplemental lnformatloa f �r tir� , o- 6 • 1 7 R 4: r Ul; i l� AI • 6 1 , > FI r t . .p P az ++c - ' 1 i -<_ .� !' r�. r ?' + , w �. i � - i t ilter r i�'. ,r, , tar i�. ~i ,J - 4; '° Y � u'rtl , t�k: -,�'[� 6..� -� ` +_ ; t" I'��9#i�`i 0 � � '��" yt 't� � ' �� � � ' di.a:.i'a,Y�i�,. } ❑ New construction ® Addition /alteration/replacement Please check all that apply (submit j sets of plans wlitemt checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition , ❑ �! 1I where the available fault current ❑ Marinas and boatyards. t .I ' {` a i 17i1iLul �dhld>�i ` i1 s. l ! 0�i' � ;l 1;. r ' •51 :,, L(: exceeds 10,000 amps at 150 volts or ❑ Floating buildings. ❑ 1- and 2- family dwelling ®Commereial/industrial ❑ Accessory building leas to grouod, or exceeds 14,000 ❑ Commercial -use agricultural maps for all other iaa ❑ Multi-family mll�ona buildings. � ❑ Master builder ❑ Other ° Fire pump. ❑ installation of 75 KVA or NI I ` ' ' : !I t 5 arm r6�ia+iiiufE,Ea '�J 'iirtG �i a r� 1 i; ❑ Enterge ocysystem, larger separately. droved system. t s�• hnhv�� lr;�'11. ❑ Addition of new rooter load of ❑'A 'E , «l -2 1 -3 Job no.: Job site address: 14150 SW Milton C t 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parka City /State/ZIP: ❑ Health - care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt.no.: l Projectname: Medical Teams Int ❑ Service or feeder 600. t 4 m!t' a. , F .. I t I Ej�1 1IS11T :�l.i'c�3Cti .1_:! :ii,i.�..l:a l ill,, ! Cross stneetldirections to job site: nmrrtpme Qtr. Fla Total • New residential single- or multi - fatally dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. ft or less 145.15 4 Tax map /parcel no.: Ea. add'I 500 sq. ft or portion 33.40 1 { ''- Malt I' ;. ; z i:•'iIf rit r rf Limited energy, residential 75.00 • "1 Male' ' . t*i. � rtxC,aariw r:11 F alb +.6.. 7: !' if&it� b_ f :tilt T. (with above sq. fl) 2 1 Limited energy, multi- family I I 75.00 2 Replace 2 it fixtures residential (with above sq. ft.) Services or feeders installatiokalteration, and/or relocation �n t�}� aooratse_ , r t 200 amps or less 80.30 2 l.s � . ` ► .. E !! �'9':Gr IF :::, ' :1 1 ' ,' . ,i1,.4 201 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 1,000 amps or volts 454.65 2 City/State/ZIP: Temporary services or feeders Installation, alteration, and/or relocation Phone: ( ) I Fax: ( ) 200 amps or less 66.85 I 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps r 133.75 12 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel �� „, A. Fee for branch circuits with 31I s tit'' �e biijM i�'i`' s r?�" u "x`' above service feeder f ce or eeer ee, ldi'iil�t .;ll[;. , mmit ilammo r...mar aim zu .i' b 6.65 2 each branch circuit Business name: Johansen Electric Inc. B. Fee for branch circuits Contact name: Charlynn Lenten without service or feeder fee, 46.85 b 2 first branch circuit , Address: 10948 SE Valley View Terrace Each add'i branch circuit 6.65 to . ( 1 S 2 I Miscellaneous (service or feeder not included) City /State/ZIP: Happy Valley, OR 97086 Each manufactured or modular 90.90 2 Phone: (503) 698 -3417 Fax: : (503) 698 -2486 dwelling, service and/or feeder Reconnect only 66.85 2 E -mail: johansenelect@msn.com Pump or irrigation circle 53.40 2 'r1 o 'nom`: i' in 'll iii M . O . a +.IIEE «f +' St or outline Ii htin 53.40 31i c]I��t�:�I �P° g g 2 Business name: Johansen Electric Inc. Signal circuit(s) or l united- anew panel, alteration, or Address: 10948 SE Valley View Terrace extension. Describe: Page 2 2 City/State/ZIP: Happy Valley, OR 97086 Each additional inspection over allowable In any the above — 13.9417 Per inspection 62.50 Phone: (503) 69 I Fax: (503) 69&2486 _ Investigation per hour (t hr min) 62.50 CCB Lie.: 51539 I Electrical Lie.: 3 - 243C I Suprv. Lic.: 2053S Industrial .lam per hour 73.75 Suprv. Electrician signature required ' i���1 «- q � r :�i2 : i SW : � .', 44 1 ' -"Pod../ Subtotal: Print name: Carl K. Johansen Date: 2/26/09 Plan review (25% of permit fee): State surcharge (12% of permit flee): CO - y2 - Authorized signature: C --.,.._ TOTAL PERMIT FEE: 5 9.92. Print name: Charlynn J. Leifsen �� Date: 2/26/09 This permit application expires if permit b not obtained stiletto 180 days after it has been accepted as complete. • Number of inspections allowed per permit. 1: \BuildiagTemsssELCPemu1App.dec 05/73106 440 T • d XEId 13C213Sd1 dH Wd90 : T I 600E 9E clad • INSPECTOR'S SIGNATURES ARE NOT Inspections Required for: � 2ezq 06082 REQUIRED ON GREEN INSPECTION CARD:" 1 . ..Code Inspection Description I PASS •aie ° I : By ✓ .' " Code . Irispection'Descnpnon; PASS Dafe ` ..I . By BUP - Building Permit • ELC - Electrical Permit 405 Excavation 105 Underground /slab cover 410 Fill 110 Temporary electrical service 415 Grading 115 Electrical service 205 Footing 120 Electrical rough -in 805 MFG - Structure grading /footing 125 Wall cover 210 Foundation walls 130 Ceiling cover 215 Footing drain 135 Low voltage 220 Slab 140 Sign installation 310 Crawl drain 145 A/C or heating unit circuit 225 Post /beam structural 150 Hot rub /spa /pool 230 Underfloor insulation 195 Misc. inspection: 235 Shear walls /anchors 199 Electrical final 240 • Exterior sheathing 245 Firewall 250 Roof nailing ELR - Restricted Energy Permit 255 Wtr proofing basement walls 135 Low voltage 260 Tilt -up panel 195 Misc. inspection: 265 Masonry 199 Electrical final 270 Reinforcing steel (rebar) 275 Framing 810 MFG - Structure set -up MEC - Mechanical Permit 280 Insulation • 605 Post /beam mechanical 285 , Drywall nailing 610 Gas line 287 Suspended ceiling g 615 Mechanical rough -in • 295 Misc. inspection: 620 Hydronic piping 899 MFG - Structure final 625 Duct work 498 Grading final 630' Fire damper 299 Final inspection 635 Smoke detector shutdown 640 Exhaust hood 695 Misc. inspection: 699 Mechanical final BUP - Fire Protection System Permit 905 Sprinkler underfloor /slab PLM - Plumbing Permit 910 Sprinkler rough -in 915 Fire alarm rough -in 305 Plumbing underslab 920 Suppression trip test 310 Crawl drain 995 Misc. inspection: 315 Post /beam plumbing 998 Alarm final 320 Plumbing rough -in 999 Sprinkler final 322 Shower pan • 330 Water service 335 Rain drain 340 Storm drain SIT - Site Work Permit 505 Sanitary sewer 405 Excavation 345 Culvert /catch basin 410 Fill 350 'Septic tank 415 Grading 395 Misc. inspection: 205 Footing _ 399 Plumbing final 210 Foundation walls 215 Footing drain 420 Sprinkler supply lines • SWR - Sewer Permit 495 Misc. inspection: 505 Sanitary sewer 498 Grading final 595 Misc. inspection: . 499 Final inspection 599 Final inspection 1 \ Building \ Forms \InspCard- AOP- Blank.doc 02/02/07 CITY OF TIGARD BUILDING DIVISION PERMIT #:ELCZOoq,• 2. 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:— Z tsa Phone: (503) 639 -4171 ICI 1 Inspection Requests (24 Hrs.): (503) 639 -4175 . ':� INSPECTION WORKSHEET FOR DATE: 2, "1:1 •QCj TIME: PAGE: SITE ADDRESS: 110 610 S t4 "%1 LION) CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: 1 � t i OWNER: PHONE #: CONTRACTOR:V 6Nie5, sum- PHONE #: Inspection Request Scheduled For: yat-. 'Z1 -tiOi Pour Time: Code # Inspection Description Confirm # Contact # Message Kit C ELECI • Corrections /Comments /Instructions: • l►/ PASS ❑ PARTIAL APPROVAL 111 CANCEL ❑ NO ACCESS ❑ ' ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Cr'% VOe L. Date: .2 -1 • 01 Phone #: (503) 718 - 2-496 FROM COCHRAN-BROADWAY (THU>FEB 18 2010 7:581ST. 7:58lNo.75000OOS23 P 1 Electrical Permit Application s G r~ City of Tigard Re c Receeived d $ Permit No.. fl-C'9014 - GL'?3 O o~ Dm- 13125 SW Hall Blvd., Tigard, OR 97223 3 S Plan Review Phone: 503.639.4171 Fax: 503.591,* 9 Date/13 _ _ OtherPennit: o~O Inspection Line: 503.639.4175 Date Ready/8y lw s. 0 See Pate 2 for Internet: www.tigai-d-or.gov Notified/Method: Supplemental Information 41 :t1N :REVIEW . TYPE U~t!Ultit ~A _k ❑ New construction ❑ Addition/alteration/replac-eiyient Please check all that apply (submit 2 sets of plans w:iiems checked below): ❑ Service or feeder 400 amps or more ❑ Huilding over three stories. ❑ Demolition ❑ Othec where the available fault current ❑ Marinas and boatyards. AT- exceeds 10.000 amps at 150 volts or ❑ Floating buildings. less to ground. or exceeds 14.000 ❑ Commercial-use agricultural ❑ I- and 2 -family dwelling Q-C-ommercial/industrial ❑ Accessory building amps forall other installations. buildings. ❑ Multi-family ❑ Master builder ❑ Other ❑Fire pump. ❑ Installationof75 KVA or JOW SITE INF"ORMAMO AND:. I.OCAT[ON ❑ Emergency system. larger separately derived system. _ . _ _ [I Addition of new motor load of ❑,.A•. ,E•....l_2,. ,•I 1. 1 mo Job no.: Job site address: -J55[) s Cer)fcr - `pr ix more occupancy. ❑S ix or ore residential units. ❑ Recreational vehicle parks. ❑ Health-care facilities. ❑ Supply voltage for more than City/State/ZIP; z i GL Pd ❑Hazardouslocations. 600 volts nominal Suite/bldg./apt.no.: 2 Project name: QU VD-4,. ❑Serviceorfeeder600ampsorwore Cross street/directions tojob site: nescri lion Fee Total New residential single- or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168-54 4 Tax map/parcel no.: Ea. add'I 500 sq. R. or portion 33.92 1 ,tom Limited energy, residential 67.84 2 p A, (with above sq. ft.) U y Limited energy, multi-family 67.84 2 residential (with above sq. fl.) Services or feeders installation alteration, and/or relocation 2W amps or less 100.70 2 . ROPTR'rY ON NEA . T VANT 201 amps to 400 amps 133.56 - 2 Nanic: 401 amps to 600 amps 200.34 2 - 601 amps to 1,000 amps 301.04 2 Address: Over 1.000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( } Fax: ( ) 200 amps or less 59.36 3 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps (68.54 2 Owner signature: Date: Branch circuits - new, alteration, or extension per panel A. Fee for branch citcuits with gp yr (`~~q( p.;gaa~ g above s(avice or feeder lee, 7.42 2 each branch circuit Business name: ,r- Q 5 ContmOb B. Fee for branch circuits Contact name: without service or feeder fee, 1 56.18 2 I I V I VYl,eS first branch circuit Address: Each add'] branch circuit 7.42 2 Miscellaneous (service or feeder not included City/State/ZIP: Each manufactured or modular - - dwelling, service and/or feeder 67.84 2 Phone: ( } Fax:: ( } Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 - m*r s r e,as~,xcx or limited- Business name: L energy hran I n e acpanel, alteration, tcllior Address: ~Z (_S E S+ extension. Descnbe: Page2 2 City/State/ZIP: U I/,~ 10,Y) at C) r<- X721 Each additional inspection over allowable in any of the above Per inspection 66.25 Phone: z3 4 5b4 Fax' (563> 2 3 Sind Investigation per hour (I hr min) 66.25 CCB Lic.: 129 42- Electrical Lic.: -31544.o C Suprv. Lie,: 344-1,5 Industrial plant per hour 78.18 • ~ - = ELECF~I~A1.: PEI~M11' , SEES Suprv. Electrician signature, required: _ Subtotal Print name: -v Date: r v Plan review ( of permit fee): Kiev, h ems, K~'r Stale surcharge (12% of pemtit fee): , 3 7 Authorized signature: TOTAL PERMIT FEE: y 0, / 3 This permft application expires ifs permit is not obtained within 190 Print name: Date: days after it has been accepted as complete. Number of inspections allowed per permit. I BuIlJinl; Pninns FL('-Pemilnptl.dM HP01,09 440-4615TI 1105 COtv1 WEB