Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00434
i DEVELOPMENT SERVICES DATE ISSUED: 7/14/2005
" "II� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 •
PARCEL: 1S136DA-00100
SITE ADDRESS: 11308 SW 68TH PKWY 2ND FL ZONING: MUE
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Upgrade of 2nd floor equipment room: (8) 250 amp feeders, plan page no. E8.13.
Job No. 13225
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: 8 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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: 503 - 234 - 9900
FEES Reg #: LIC 203
Description Date Amount SUP 4460S
ELE 26 -95-95
C
[ELPRMT] ELC Permit 7/13/2005 $854.80
[ELPLCK] ELC Pin Rev 7/13/2005 $213.70 REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcharge 7/13/2005 $68.38
Total $1,136.88
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 - orth in — 0)\R 952 -181 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions.to OUNC at
503-24. •699 or 1 -800-
Issued = L �� �� �� —!� _! � Permittee Signat te ,
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: �"�— �d"'*f� 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 FOR OFFICE USE ONLY
City of Tigard Received PermitNo.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /4 ""! v 11 � t� Date/B : Other Permit:
Inspection Line: 503.639.4175 r "1 Date Ready/By: BM El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental lnformation
.3''., . OF PLAN REVIEW . ,
❑ New construction ® Addition/alteration/replacement Please check all that apply:
El Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
• , - .CATEGORY' OF CONSTRUCTION• ". - of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ®Feeders, 400 amps or more
❑ Multi - family ❑Master builder 0 Other:
JOB SITE INFORMATION AND LOCATION - ark
['Occupant load over 99 persons ['Manufactured tured structures or
❑Egress/lighting plan park
no.: /3225 I Job site address: 11308 SW 68 Parkway ❑Health -care facility ❑Other:
_ t � Submit 2 sets of plans with any of the above.
��LUL(JU:.i",t jr,,-(5..k-
- �-
City/State/ZIP: Tigard, OR 97224 �T �- - The above service.
4: - hc c h = r.. are not applicable to temporary construction
• Suite/bldg. /apt. no.: Project name: TDC Comp Rm Upgr. Ph 1 &II • , {(. FEE* SCHEDULE
am-
L t P "Deseriptlon I Qty. I Fee I Total I"
Cross street/directions to job site: 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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK " ' • Each manufactured or modular
c I - n ^ t i / � • � /� dwelling, service and/or feeder 90.90 - 2
�'1�6�► ( G u�J ( ) Services or feeders installation, alteration, and/or relocation
- i � 4Q0 �'.- ..ei � t .., 2 00 amps or less 80.30 2
~ + 'El PROPERTY OWNER 201 amps to 400 amps $ r 106.85 65
❑ TENANT ,
401 amps to 600 amps 160.60 2
Name: Providence Health System 601 amps to 1,000 amps 240.60 • 2
Address: 11308 SW 68 Parkway Over 1,000 amps or volts _ 454.65 i , 2
Reconnect only 66.85 2
City/State /ZIP: Tigard, OR 97224 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( )
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
0 APPLICANT ' .- • , ' . . ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Oregon Electric Group branch circuit
B. Fee for branch circuits
Contact name: John Vitro re /' 5 0 �_ ' s::q _ 2 t without service or feeder fee, 46.85 2
Address: 1010 SE 11 Ave each branch circuit
Each add'l branch circuit 6.65. 2
City/ State/ZIP: Portland, OR 97214 Miscellaneous (service or feeder not included)
Phone: (503) 849 -2787 Fax: : (503) 234 -1001 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
.. - . CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Oregon Electric Group
Address: 1010 SE 11th Ave Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Portland, OR 97214 Investigation per hour (1 hr min) 62.50
Phone: (503) 234 -9900 Fax: (503) 535 -2763 Industrial plant per hour 73.75
` ELECTRICAL PERMIT ,FEES"
CCB Lic.: 203 Electrical Lic.: X 26 - 95C Suprv. Lic.: 4818S Subtotal 85 y. 80,
Suprv. Electrician signature, required: .. �� 'v' I A , ajt,/ Plan review (25% of permit fee) / 3. 70•
Print name: ' nn ,/ '(/o/� � , " Date: 5/25/05 State surcharge (8% of permit fee) 01 t/O $ • 3s —
1
Ma rla C~ /Lied 17 "` H F� TOTAL PERMIT FEE //3(o. 88 —
Authorized signature' : This permit application expires if a permit is not obtained within 18u
6/141/ days after It has been accepted as complete
Print name: /fj L� � �- � �� � e` er Date: 5/25/05 * Fee methodology set by Tri -County Building Industry Service Board
'° Number of inspections per permit allowed.
is\ Building \Permits\ELC- PcrmitApp.dos 12/03 440 -4615T(10 /02/COM/WEB -
l
CITY OFTIGARD JP
BUILDING DIVISION PERMIT #: ELC2005 -00434
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/14/2005
Phone: (503) 639 -4171 moo'
Inspection Requests (24 Hrs.): (503) 639 -4175 "'! I..
INSPECTION WORKSHEET FOR DATE: 11 /10/2005 TIME: 7:02AM PAGE: 112
SITE ADDRESS: 11308 SW 68TH PKWY 2ND FL CLASS OF WORK: / "-
SUBDIVISION: LOT #: TYPE OF USE: 1 G /—
PROJECT NAME: PROVIDENCE DATA CENTER
DESCRIPTION: Upgrade of 2nd floor equipment room: (8) 250 amp feeders, plan page no. E8.13.
Job No. 13225
OWNER: BENENSON 66TH PARKWAY, PHONE #:
CONTRACTOR: OREGON ELECTRIC CONST /GROUP PHONE #: 503. 535.2652
Inspection Request Scheduled For: Date: 11/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 020634 -01 503 - 849.2787 N
Corrections /Comments/ Instructions:
•
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
)1/41 i
Inspector: Date: // - 4 - Phone #: (503) 718-