Permit • CITY OF TI G A R D ELECTRICAL PERMIT
AllIkt.
„a rho DEVELOPMENT SERVICES PERMIT #: ELC98 -0197
' ° 'I�I ' I DATE ISSUED: 04/17/98
:� ' _- 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 De scr i pt ion : Providence /RN tenant area. Job *18115
- -- 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/0 SRVC DR FDR.: 1 PER HOUR : 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 54 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
BENENSON 68TH PKWY type amount by date recpt
PO BOX 15144 PRMT $ 305.00 JSD 04/17/98 98- 305022
DEPT KEY SPCT $ 15.25 JSD 04/17/98 98- 305022
WORCESTER MA 01615
Phone #:
Contractor:
OREGON ELECTRIC CONST /GROUP $ 320.25 TOTAL
1010 SE 11TH AVE
REQUIRED INSPECTIONS
PORTLAND OR 97214 Ceiling Cover Elect'l Service
Phone #: 234 -9900 Wall Cover Elect' 1 Final
Reg #..: 203
This peruit 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 188 days. ATTENTION: Oregon law requires you to fo ow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - X1-0010 through OAR /":7. You pay obtain a copy
of these rules or direct questions to OUNC by calling 583)246 - 1987.
Permittee Signature 21 1 / / �/ I ssued By:_
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 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
4: -
Community Development ELECTRICAL PERMIT APPLICATION
/adr 13125 SW Hall Blvd. �"Z Tigard, OR 97223 Permit # ( 9e.t
Date Issued
tiJ'n Phone (503) 639 -4171 L /�� j.
"' FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Providence /RN Number of Inspections per permit allowed
Address 11308 SW 68th Parkway Service included: Items Cost(ea) Sum
City /State /Zip Tigard ,OR 97223 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) Providence Health Each additional 500 sq. ft. or
portion thereof $25.00
Commercial Residential ❑ Limited Energy $25.00 1
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Installation,
sorle alteration, orrelocation
Electrical Contractor Oregon Electric Group 200 amps or less $60.00 2
Address 1010 Se 11th Ave. 201 amps to 400 amps $80.00 2
City Port 1 and State OR Zip 977'14 401 amps to 600 amps $120.00 2 601 amps to 1000 amps $180.00 2
Phone No. 234-9900 Over 1000 amps or volts $340.00 2
Job NO. 18115 Reconnect only $50.00 2
contractor's license NO. -95C 4c. Temporary Services or Feeders
Contractor's Board Reg. No 0 Installation, alteration, or relocation
Signature of Supr. Elec'n 200 amps or less 2
License No. 2841S Phone No. 134 -9900 201 amps to 400 amps $50.00 2
401 amps to 600 amps $75.00
Over 600 amps to 1000 volts $100.00
2b. For owner installations: See "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip 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 ofservfeeor feeder fee. 2
not intended for sale, lease or rent. First branch circuit 1 $35.00 35.00
Each additional branch circuit 5/1 $5.00 9 _ On
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or Irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. 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 $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ 305 .00
NOTICE 5% Surcharge (.05 X total fees) $ 15 . 25
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 320.25
5b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. / \E- $ wwdv mdeNdea 111 Trust Account #
Pr m app ,, O // 1�( +
( 414(1 9 �/ Balance Due $ 320.25
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