Permit CITY OF TIGARD ELECTRICAL PERMIT
hn,ar ,� DEVELOPMENT SERVICES PERMIT #: ELC98 -0253
, ' 1 � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
DATE ISSUED: 05 / 1 / 98
PARCEL: 19136DA -00100
SITE ADDRESS...:11308 SW 68TH PKWY
SUBDIVISION • ZONING:MUE
BLOCK • LOT JURISDICTION: TIG
Project Description : Installation of 20 branch circuits.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION : 0
EACH ADD'L 500SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp • 0 1st W/O SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 19 IN PLANT • 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS • ) 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
PROVIDENCE HEALTH SYSTEMS type amount by date recpt
11308 SW 68TH PKWY PRMT $ 130.00 DEB 05/12/98 98- 305696
TIGARD OR 97224 5PCT $ 6.50 DEB 05/12/98 98- 305696
Phone #:
Contract or:
OREGON ELECTRIC CONST /GROUP $ 136.50 TOTAL
1010 SE 11TH AVE
REQUIRED INSPECTIONS
PORTLAND OR 97214 Ceiling Cover Elect'1 Service
Phone #: 234 -9900 Wall Cover Elect'1 Final
Reg #..: 203
This persit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification C . lose rules are set , rth in OAR 952-061-N10 thr R 952-601 -1987. You say obtain a copy
of these rules or direct ques • to Ili by call•ng ( � - 1987.
Ci
Permittee Signat :re•. i' 4 L�i ■ A. Issued By AL} •
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: X/,Q�� L�� DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD ELECTRICAL PERMIT %, . ,,, ti . :, DEVELOPMENT SERVICES PERMIT #: ELC98 -0253
0' DATE ISSUED: 05/12/98
!�- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171
PARCEL: 1S136DA- 210100
SITE DDRESS...: 1 1308 SW 68TH PKWY
SUBDIVISION • ZONING:MUE
BLOCK LOT • JURISDICTION: TIG
Pro.j ect Description : Installation of 28 branch circuits.
- -- RESIDENTIAL UNIT --- -- ----TEMP SRVC/FEEDERS--- MISCELLANEOUS-• - - -•-
1000 SF OR LESS • 0 0 - 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD' L 500SF...: 0 201 - 4')0 amp . 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 - 600 amp • 0 S1_GNAL /PANEL- • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS - --- -- -- -ADD'L INSPECTIONS-- -
0 -• 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 --- 400 amp • 0 1st W/O SRVC OR FDR.: 1 PER HOUR • 0
401 - 600 amp • 0 EA ADD'L BRNCH CTRC: 19 IN PLANT....,,......: 0
601 - 1000 amp - 0 PLAN REVIEW SECTION• -
1000+ amp /volt.....: 0 > =4 RES UNITS • ) 600 VOLT NOMINAL..:
Reconnect o n l y • • ; 0 SVC /FDR )= 225 AMPS..: CLASS AREA /SPEC OCC. :
Owner: -- -- FEES -• - - - - --
PROVIDENCE HEALTH SYSTEMS type amount by date recpt
11308 SW 68TH PKWY PRMT $ 130.00 DEB 05/12/98 98- 305696
TIGARD OR 97224 SPCT $ 6.50 DEB 05/12/98 98-305696
Phone t: • -
Contractor: -----
OREGON ELECTRIC CONST /CROUP $ 136.50 TOTAL !
1010 SE 11TH AVE
-- REQUIRED INSPECTIONS -----
PORTLAND OR 97214 Ceiling Cover Elect'1 Sgrvic
Phone #: 234 -9900 • Wall Cover • Elert'l Final
Reg #...: 203 i
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 sore than 188 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Crat . ose rules are set .rth in OAR 952 -'� 1 -0010 thr R 952- 001-1987. You say obtain a copy
of these rules or direct questyi6 s to by call•ng t %, . -1987.
Permittee Signature. �Q U/c A0/0' , R �
Issued By J -
IL 7
. - - - -._ ____--- _--- - - -__- -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. t LEC' hJ : MATE : .S� /�
LICENSE NO: •_ __ — —_ ____ _ M_ _ __.. -____.
+++++++++++++++++++++++++++++++++++++++÷++++++ 4 - +• + + +•v + + + + + + + + + + + + + + + + + + ++ + ++
Call 639 -41 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + +-r +• + + + + + + + + + + + + + + + + + ++ ++
Community Development 1 \, ELECTRICAL PERMIT APPLICATION
•• 13125 SW Hall Blvd.
Tigard, OR 97223 r\ Planck/Rec. #
Al I',ii ' � Permit # E [,C9'e at5
i' i Phone (503) 639 -4171 � Date Issu c- I ' b
'` FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 q,�,\ Issued b D�
Inspection (503) 639 -4175 `'�
1. Job Address: JOB No 24421 4. Complete Fee Schedule Below:
Name of Development Pnovidence Heat.th &listen) Number of Inspections per permit allowed
Address 11308 SW 68th Plavq. Service included: Items Cost(ea) Sum
City/State/Zip T- C..galtd, OR 4a. Residential - per unit 4
1000 sq. ft. or less 5110.00
-
Name (or name of business) Req.Lona.e C owr i.e t. Each additional 500 sq. ft. or 1
portion thereof 525.00 -
Commercial ® Residential ❑ Limited Energy 825.00
- Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 41). Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor Oh.egon Hectic-Lc Ghoup 200 amps or less $60.00 2
Address 1010 SE 11 tih Ave. 201 amps to 400 amps $80.00 2
City Po t.�and State OR Zip 9 7214 1
401 amps to 600 amps 8120.00 2
ty p 601 amps to 1000 amps $180.00 2
Phone No. 503/234 -9900 Over 1000 ampsorvofts 8340.00 2
Contractor's License No. 6-95C Reconnect only $50.00
- Contractor's Board Reg. No. 203 4c. Temporary Services or Feeders
/ Installation, alteration, or relocation 2
, Signature of Supr. Elec'n 200 amps or less $50.00 2
-
License No. 2841S Phone No. 23V-9900 201 ampsto400amps 875.00 2 - 401 amps to 600 amps $100.00
• Over 600 amps to 1000 volts
2b. For owner installations: see •b' above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5.00
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder tee. 2
not intended for sale, lease or rent. First branch circuit 1 $ 35.00 2
Each additional branch circuit 1 $5.00 55.00 95. Oii
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle 540.00 2 - Each sign or outline lighting 840.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension 540.00 -
4 or more residential units in one structure Minor Labels (10) 5100.00
-
Service and feeder 225 amps or more
System over 600 volts nominal 41. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
-
In Plant 855.00
Submit 2 sets of plans with application where any of the above
p apply. Not required for temporary construction services. 5. Fees:
NOTICE 5a. Enter total of above fees $ 130.00
5% Surcharge (.05 X total fees) $ A SO
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDON ' FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK I Subtotal $
COMMENCED. POSIED ❑ Trust Account # $
Balance Due $ 136.50
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