Permit CITY O TIGARD I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2007 -00026
COMMUNITY DEVELOPMENT
DATE ISSUED: 2/6/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DA-00100
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL ZONING: MUE
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Alternate feeder and switchboard. Located in 1st floor main electrical room.
Job No. 188159
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: 2 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: 2 > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: X CLASS AREA/SPEC OCC:
Owner: Contractor:
BENENSON 68TH PARKWAY
KEY LLC, THE
BY FIRST AMERICAN TAX VALUATIO
WORCESTER, MA 01615
Phone: Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 2/6/2007 $922.60
[ELPLCK] ELC Pln Rev 2/6/2007 $230.65
[TAX] 8% State Surcharge 2/6/2007 $73.80
REQUIRED ITEMS AND REPORTS
Total $1,227.05
J
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 1.800.332.2
Issued By: it : / i t / Permittee Signature:
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.
ss.--; C- i\ .
Electrical Permit Applic toprrp 45', / ---, ' i FOR OFFICE USE ONLY
FL '
City of Tigard Received / / I, . 7 13
Permit NoE7 f....0a=6.
Date/By:
13125 SW Hall Blvd., Tigard, OR 97223 JAN 1 0 2007, , Plan Revie QA 1
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: 0 b Other Permit:
Nif:',40
Inspection Line: 503.639.4175 .........1* ',-• 4 : IL, Date Ready/B/ , 4 Juris: 55 See Page 2 for
Internet: www.ci.tigard.or.us ' l' ..+V LI, 1 . .- ---- -
\,-9 A \ 1 ACo Notified/Method: , if? i...._..).7) ...-- Supplemental Information
'101, 4 - ,: ,' .•-• i...,:::-.:;',': :
0 New construction 0 Addition/alte;ation/repla cement 4 0 p ' '1 0 * 1 ''' . 1 :1 . ..e..'e che: a' • " t pply:
V,...: il l'' , 0 ` ' amps, comm'l ['Hazardous location
0 Demolition 0 Other:
17,,,!; ice ove 320 amps -rating OBuildng over 10,000 sq. ft.,
; ' . • , , .„ . - • .. . - CATEGORY OF CONSTRUCTION. '- :. :', .:- 7:, _.. ' 7 1- and 2-family dwellings 4 or more new residential
0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building stem over 600 volts nominal units in one structure
• : ilding over three stories SFeeders, 400 amps or more
0 Multi-family 0 Master builder 0 Other:
• Occupant load over 99 persons 0Manufactured structures or
,., . . . .. .. . - . .
• . . s ' : .. . ' ' - ' JOB's:ITE INFORMATION AND LOCATION -
. .
- °Egress/lighting plan RV park
. ,-.
OHealth facility 00ther:
Job no.:/%f/ 1 Job site address: "r 8 i f m..0...;. , i)
. i IP re4.7, Submit 2 sets of plans with any of the above.
City/State/ZIP: .- 74,00,...J darer-se., The above are not applicable to temporary construction service.
—
. ' . TEE; SCHEDULE.: '', •'. '
Suite/bldg./apt. no.: Project nameigl4 axj- F _ es
1 '
••
ID cription 1 Qty. I Fee. 1 Total i
Cross street/directions to job site: /7" /17190A lge..-4. /e6PrI . New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.: •
Limited energy, non-residential 75.00 2
- , • • .
DESCRIPTION OF WORK • - ' -- Each manufactured or modular
. , . . ..
• x .
y l i or,v,46) _,,, dorif /eft, c/e„.. /Jew c5 ;: i dd 4 4 / s d welling, e rvi ces er e
c d/i installation, feeder
t al lati o n ,
alteration,9a0n9c1/0 2
or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
' 0' PROPERTY OWNER • 1 . lEf TENANT. ' ' :: . :
401 amps to 600 amps 160.60 2
Name: A )6( s', A,_. 601 amps to 1,000 amps 240.60 2
Address: 97 He- Z /1r,0 .--, Over 1,000 amps or volts 4 454.65 f 2
Reconnect only 66.85 2
City/State/ZIP: p 01 92/3 Temporary services or feeders installation, alteration, andJor
relocation
Phone: (603 ) 46,313, I Fax: (- 03) 2 - 1 ,r•- 44,78 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
•-,'
..:, .Y . . 0 ;APPLICANT , - 0 CONTACT PERSON • A. Fee for branch circuits with
.. ,
service or feeder fee, each
Business name: branch circuit 2:- 6.65 040 2
' B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 2
each branch circuit
Address:
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: : ( )
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
., .
CONTRACTOR • , .- -• . . , - . . ,. - . ' energy panel, alteration, or
extension. Descnbe: Page 2 2
, i
Business name: ' d A ,..... 0... %.1 ,.- e c. N.,- ,....
I • ,
Each additional inspection over allowable in any of the above
Address: (_:. 2_ c, 5 kr,
I - N :ay.,. Per inspection 62.50
City/State/ZIP: ? \-- (1.4 .._ (.19-... cr? 244 Investigation per hour (1 hr min) 62.50
Phone: (Sca3 ) 2:3Ck 5 Lk I Fax: ($3) 232, ..-2_cutg Industrial plant per hour 73.75
, ' '• ,. .- ' ., , ELECTRICAL PERMIT FEES';'.. , ' • , : ' - ' , .
CCB Lic.: 7 2„.42 1 Electrical Lic.: 31-5 ( 1 Suprv. Lic.: 3.44-1-5 Subtotal
Suprv. Electrician signature, required: Q Plan review (25% of permit fee) 2 r'
State surcharge (8% of permit fee) 73,s v
•
Print name: V_ Sr \c\ .c*X-C■ Date:
TOTAL PERMIT FEE /2.. 2 pi
Authorized signature;, •-•
---
This permit application expires if a permit is not obtained within 180
Print name: Date:
days after it has been accepted as complete
• Fee methodology set by Tri Building industry Service Board
** Number of inspections per permit allowed.
L -N , i: \ Building \PermitsELC-PermitApp.doc 12103 440-4615T(10/02/COWWEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00026
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/6/2007
Phone: (503) 639 -4171 41 i�l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/9/2007 TIME: 7:00AM PAGE: 26
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE HEALTH SYSTEMS
DESCRIPTION: Alternate feeder and switchboard. Located in 1st floor main electrical room.
Job No. 188159 3/19/07 ADD 6) 201 to 400 amp & 2) 601 to 1,000 amp.
OWNER: BENENSON 68TH PARKWAY, PHONE #:
CONTRACTOR: BROADWAY ELECTRIC - COCHRAN INC PHONE #: 503. 234 -6564
Inspection Request Scheduled For: Date: 5/9/2007 Pour Time:
Code # Inspection Description / m ri # Contact # Message
195 er ection 047947 -01 503-522 -7360 N
C; t ns /Comme n t s /Is ctions:
p1 P P R aV Pk, eta— � I It -IN "re(Lt1tJA1
C
S'- 04.0 % — G-m, Nit L ' AcI
❑ ❑
No PARTIAL APPROVAL CANCEL NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � ' 14 V 4 Date: 6f 5 09 Phone #: (503) 718- ZTFO
I\
CITY OF TIGARD ELECTRICAL PERMIT
71 �� PERMIT #: ELC2007 00026
° . COMMUNITY DEVELOPMENT DATE ISSUED: 2/6/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DA-00100
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL ZONING: MUE
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: PROVIDENCE HEALTH SYSTEMS
Project Description: Alternate feeder and switchboard. Located in 1st floor main electrical room.
Job No. 188159 3/19/07 ADD 6) 201 to 400 amp & 2) 601 to 1,000 amp.
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 HMI 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: 6 1st W/O SRVC OR FDR: 2 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: 2 PLAN REVIEW SECTION
1000+ amp /volt: 2 >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: X CLASS AREA/SPEC OCC:
Owner: Contractor:
BENENSON 68TH PARKWAY BROADWAY ELECTRIC - COCHRAN INC
KEY LLC, THE 626 SE MAIN
BY FIRST AMERICAN TAX VALUATIO PORTLAND, OR 97214
WORCESTER, MA 01615
Phone: Contact #: PRI 503 - 234 - 6564
FAX 503 - 238 -2098
FEES
Description Date Amount Reg #: ELE 37 - 546C
[ELPRMT] ELC Permit 2/6/2007 $922.60 LIC 72942
[ELPLCK] ELC Pin Rev 2/6/2007 $230.65 SUP 3447S
[TAX] 8% State Surcharge 2/6/2007 $73.80
(additional fees not listed here) REQUIRED ITEMS AND REPORTS
Total $2,719.72
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 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 an 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OA 952 - 001 -0010 through OAR 2- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Iss ed By: G II r/ ,/ / , Permittee Sign. i,� /� „/ . ,_ _/
OWNER INSTALLATION ONLY f
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.
1N i 1 Permit App g kb��i ! y- FOR OFFICE USE ONLY
. 2 igard Date/By / , 7 8 ' Pemtit No 1 •-O
N.'iall Blvd., Tigard, OR 97223 J AN 1 0 2007 Plan Revie t
2 /u;z; ; df,..,:,�; \ 4 . 4 s. Other Permit:
. 503.639.4171 Fax: 503.598.1960 �h�'��'� Date � ( ,
Date Read /B Jw s ® See Page 2 for
:Coon Line: . igard. .4175 Q , t " Notifed/Method: , ,c p i . Supplemental Information
curet www.ci.tigard.or.us tLij u t - j j '
.., a " a ...+; -.=Y * a : f'y' "" Z i c -. a ■ a° ti : t ", yi . 4i «: S 3 '., ,-,
y i ,r pVi.u-�",. ''', ' 4 � " ` ' 1 w .- ' c 1 ' : t ,.:x 4 _ t P..I 2 . „ . . F
J >f *[L',i�!,��iG +'�' `.f's.'t .+'s;'.: fn=s s,�a ] . • t • t.: .I � .... "5.. ' ,. ... � .i"
:l - '. - :
' ► 0 + e the t pply:
❑ New construction ❑ Addition /alteration/replacement
t i1 1 .. o • 25 amps, comm'l ['Hazardous location
❑ Demolition ❑ Other: ..
1 ' ce ov 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
- hl V {� �,,. l 1 :, -1�i TE!e 4 ; 7 ^ ` . 0 r{ R7J FI'Ol z - , ; r ,,„ ! . J � _ 1 - and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ■ stem over 600 volts nominal units in one structure
• : ilding over three stories ®Feeders, 400 amps or more
❑ Multi-family ,� ❑ Master builder ❑ Other: • Occupant load over 99 persons OManufactured structures or
5. ❑ t.t^i -.,1 ~ 3r �. . a N,.,. .. w,. H"'' •4^ , ej'._� +x..a f RV ark
. 3 ■lt: - '10,1;`; r 9' �� *1751.. I .1 i::-,...17 l • D„ .:4 � '.. 4., �`.` � , .,�^
P Egress lighting Plan
Job no.:188iS Job site address: / S4 � M ' - / f.'r � ❑Health -care facility any ❑Other:
t /'t' Submit 2 sets of plans with an of the above.
City /State /ZIP: ...774,17,z, L�l� The above are not applicable to temporary construction service.
. no.: Project name // A "- iK ti .iPti*SCHED ii.* '
Suite/bldg./apt. 0/ /`./✓0 `1 ,,,- A Descripdoo Qty. I Fee. I T ..
Cross street/directions to job site: /57 /*SliAl eG 1 ,r, • New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no _ Limited energy, non - residential 75.00 2
�� . { , a ' i 3 T h +c. t . �i •r J - -. J Gk.' , '
li a A li y" r. ''„ V, '^' ' i+ bES i TI:�1 QFr Ogie.c '° : 1 `= •:l - 4,,,•;,, °` � , Each manufactured or modular
3+ --.01: r i, a- ,t - iY6. %,,'404/ . -•,.. ` ' • . z ••* ..
dwelling, service and/or feeder 90.90 2
• 'AVi'VO + J' / cee c"(,- 4.A/el U L ✓ /yle . r1.Qref Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
y M .. tr lir p y r C .*:.. "- t + '- s•, 1V 1I
. '. y >r4Y y k 201 amps to 400 amps 6 106.85 � - 2
, f-, n p 1" •I • iY' ±� 47,-t 'v. "4.1 - f : - .x' :.rte . ` -- , .. �=
401 amps to 600 amps 160.60 2
Name: r - 601 amps to 1,000 amps Z. 240.60 yam 2
Address: 97Q & a ye- Z 4..cA -, Over 1,000 amps or volts 1 454.65 90r f( 2
Reconnect only 66.85 2
City/State/ZIP: po ,./l ,,,d Of 92/3 Temporary services or feeders installation, alteration, and/or
� 3) Zn J F
rFax: 3) (�f 6� 70 s. _ 200 amps or less _ 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
.,, i; "4" 1 1: c t ;rA , li 0 IiA '.rliggir* A. Fee for branch circuits with
�" '� =' .r? `' service or feeder fee, each
Business name: branch circuit Z 6.65 1 �0 2
B. Fee for branch circuits f
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle L 53.40 2
Phone: ( ) l Fax :: ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
9 y y r ; 9" .3 f _ 1 .1 ` `. c , r : ` ?,� . " ''r ``'/ ` energy panel, alteration, or
extension. mot. =-z__4 t -c t ::' a3`�.xtC I F[t� l'OQt ' - v. s _ .;.,. :...- Describe: Page 2 2
P
si
S` � ro 4• w o. � � `< c_^4- Business name: ,c_ -
Each additional inspection over allowable in any of the above
Address: Z (. 5 (_ M a\.r. Per inspection 62.50
City /State/ZIP: - po.- 1 , \ d.., o9- \ 2 L-1 Investigation per hour (i hr min) 62.50
Phone: (So3) 23{ .-C.5" y t Fax: (S Z3 2 c - `1$ Industrial plant per hour 73.75
CCB Lic.: 7 2 • 42. Electrical Lic.: 31-5 ( Suprv. Lic.: 3 -5 SubtotP'
i
Suprv. Electrician signature, required: Plan review (25% of permit fee) -
-
l �� State surcharge (8% of permit fee) -
Print name: . _ t�h� 6- O Date:
TOTAL PERMIT FEE
Authorized signature Thi permit app lication expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Pemits\ELC.PermilApp.doc 12/03 440- 4615T(I0/02/COM/WEB