Permit C OF T'GARD
ELECTRICAL PERMIT
PERMIT #: ELC2000 -00641
DEVELOPMENT SERVICES DATE ISSUED: 11/21/00
" - 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S136DA-00100
SITE ADDRESS: 11308 SW 68TH PKWY
SUBDIVISION: ZONING: MUE
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of 19 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: 18 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:
BENENSON 68TH PARKWAY OREGON ELECTRIC CONST /GROUP
KEY LLC, THE 1010 SE 11TH AVE
BY FIRST AMERICAN TAX VALUATIO • PORTLAND, OR 97214
WORCESTER, MA 01615
Phone: Phone: 234 -9900
Reg #: LIC 203
SUP 1302S
ELE 26 -95C
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT CTR 11/21/00 $166.55 2720000000( Elect'I Final
5PCT CTR 11/21/00 $13.32 2720000000(
Total $179.87
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE / ISSUED BY:
WNER INS LLATION 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 639 -4175 by 7:OOpm for an inspection the next business day
10/18/2000 13:30 FAX 5036847297 City of Tigard 1005
"Dc- +c f .2-503 o
• A Electrical Permit Application
Date received: // 2 , Permit no.: Ee?o00 //49
4 - City of Ti gard Project/appl.no.: Expire date:
City of Tigard address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: CM Receipt no.:
Phone: (503) 639 -4171 _
Fax: (503) 598 -1960 e G(/�c'0�1j - Case file no.: Paytnenttype:
Land use approval:
TYPE OF I'LRiMII I
0 1 do 2 family dwelling or accessory Commercial/industrial 0 Muld- family 0 Tenant improvement .
O New construction IZI Addition/alterationfreplacement 0 Other. 0 Partial
.10B SITE INPORMAl Io`
Job address: 1 1 0 a qw 64th Pk way Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 'Block Subdivision:
Project name: T n n, m r a t a o „ c } Description and location of work on premises:
Estimated date of completion/inspection:
s CONTRACTOR APPLICXI ION FEE SCHEDULE
Job no: 2-3_ Fee Max
ttoa Qty. (ea.) Total . no. imp
Business name: Qr gon Electric Grob New r al- do&ormuld- famiyper
Address: 1 n 1 n $R 1 1 t h dwtallagttaltlaeludesatmehedgsrege. '
City: port 1 a ri I S 1Z: 4 Serviceinduded:
Phone: . • i ax: E - mail: 10003 . ft. or less 4
CCB no. • s A Elec. bus. lie. no: a . LTA... Each additional ee 500 • . ft. or portion thereof
limi ted ceKdv, residential 2
CIIty/znet:o tic. no.: I ,_'1101Warl� Limited energy, non- residential 2
,mp �--7.1Ve ,v _ 11 /13./00 Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): a • e a • - License no: Setvtces or feeders - btstaOatton,
1 alteration or relocation:
PROPERTY OWNER. 200 amps or leas 2
Name(print): Providence Health System 201 mops to 400 amps 2
401 amps to 600 turps 2
Mailing address: 601 amps to 1000 amps 2
City: 1 State: I ZAP: Over 1000 amps or volts 2
Phone: 1 Fax: 1E-mail: Reconnect only I
Owner installation: The installation is being made on property I own Temporary services orfeedere
which is not intended for sale, lease, rent, or exchange according to installation, alteraeon,orrdoeatioo
ORS 447, 455, 479, 670, 701. 200 or Las 2
201 amps to 400 amps 2
OWner's signature: Date: 401 to 600 amps 2
EN G I N E E R Branch circuits - new, alteration,
Name: or extension per panel:
A. Pee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch ainauta without purchase
Phone: Fax: E-mail: of service or feeder fee, rust branch circuit 1 4 6 _ 8S 2
Each additional brands circuit: 18 119 _ 7 0
I'I,1N ' RIiV1T\%' (Please check all that apply) Mee. (Service or feeder sotinetoded):
O Service over 225 amps- commercial 0 Health- carefaciliiy Each pump or irrigation circle 2
O Service over 320 amps- rating of 18x2 0 Hazardous location Euch sign or outline lighting 2
family dwellings 0 Building over 10.000 square feet tar or Signal circait(s) or a limited energy panel.
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over dust slodes 0 Feeders, 400 amps or more tDescriptions
0 0ccup;unt load over 99 persons 0 blanuf ctmr.d structures or Rv park
O Eghssllightingplan 0 Other Each additional Inspection over the allowable in any artful above:
Perinspection 1 1 I 1
Submit — sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Nor all Jurisdictions accept credit cards, Meese call jurisdcriat for more informoaon. Notice: This permit application Permit fe e $ 166.55
O Visa 0 MasterCard expires if a permit is not obtained' Plan review (at — %) $
Credit cart n "' ab ' / / within 180 days after it has been State surcharge (8%) .... $ 13 _ 32
Di"" accepted as complete. TOTAL ' $ 179 _ 8
Name Of Glummer as mow° on credit card •
$
CaMtWldc! annum A.nowl 440.4611 (64.101COMJ
10/18/2000 IL 0 FAX 5038847297 City of Tigard Z008
.Elec$rical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee 575.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4' Chedc Type of Work Involved:
Residential - per unit
1000 sq. R or less 3145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft or
portion thereof 533.40. 1 ❑ Burglar Alarm
Limited Energy $15.00
Each Manurd Home or Modular
Dwelling Service or Feeder 590.90 2 ❑ Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less 580,30 T _ 2 ❑ Vacuum Systems'
201 amps to 400 amps 3106.85 2
401 amps to 600 amps 5180.60 2
601 amps to 1000 amps 5240.60 2 ❑ •Other
Over 1000 amps or volts 5454.65 2
Reconnect only $86.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less 366.85 2 (SEE OAR 918-260 -260)
201 amps to 400 amps 5100.30 2
401 amps to 600 amps 3133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see e "b" above.
El and Stereo Systems
Branch Circuits • ❑
New alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee
Each branch circuit 56.65 2 ❑ Data Telecommunication Installation '
b) The fee for brarxd, circuits
without purchase of service ❑ Fire Alarm Installation
or feeder lee.
First branch circuit 1 546.85 a 6 ft S
Each additional branch circuit --_ 56.65 119.70 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not induded)
Each pump or irrigation circle $53.40
Each sign or outline doting 353.40 ❑ intercom and Paging Systems
Signal circuits) or a limited energy
panel, alteration or extension 575.00 ❑ Landscape Irrigation Control`
Minor Labels (10) 3125.00
Each additional inspection over ❑ Medical
the allowable in any of the above ❑ Nurse Calls
Per Inspection $62.50
Per hour 362.50
In Plant 573.75 ❑ Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Enter total of above tees • $ 1 6 6 S C ❑ Other
8% State Surcharge $ 13.32
Number of Systems
•
25% Plan Review Fes
Sae - Plan Revievr section on f No licenses are required. Licenses are required for an other installations
1
front of application 0 5 8 7
Fees:
Total Balance Due f $ •
Enter total of above fees S
Trust Account # 203
8% State Surcharge $
• / `� Total Balance Due $
i:\dsts\forms\elafecs.doc 10/09 /00 •
CITY OE TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour II Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 1- Z AM PM BLD
Location / / it 5" Y f "l w`7- Suite
MEC
Contact Person Jo/NA Ph $3) - Z4 7� PLM
Contractor S -e - /tn1 .3v 3 NY Z 7/ 7 SWR
BUILDING Tenant/Owner
ELC ( c/r
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab I 2_70 - / SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
FAIL
Service
Rough In
UG /Slab
Low Voltage
Fire
► = -
v-- PART FAIL
Backfill/Gradin
9 •
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: _ [ ] - - ble to inspect - no access
Fire Supply Line
ADA
Approach %Sidewalk
Date /- 22 0 / Inspector
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OFTIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
4 BUP4
Date Requested / Z AM PM BLD •
Location / /, a ¥ 5 w G f /& "/( Lv4 Suite MEC
Contact Person Ph . 63c Z 7 f PLM
/`
Contractor(gre 7_ re __ h Ph SZj- t' y Z 717 SWR
BUILDING Tenant/Owner ELC 22frr av C s/ (
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler WeL./..e
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
P SS PART FAIL
CLECIBIC
Service
Rough In 6044,
UG /Slab
Low Voltage C
Alarm
F.
AS PART FAIL
Backfill /Grading •
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date 1 2., - 6 Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.