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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00093 ;t, DEVELOPMENT SERVICES DATE ISSUED: 2/16/2005 13125 SW Hall Blvd., Tislard, OR 97223 (503) 639 -4171 PARCEL: 1S136DA-00100 SITE ADDRESS: 11308 SW 68TH PKWY ZONING: MUE SUBDIVISION: BLOCK: LOT : JURISDICTION: TIG Project Description: Providence Tigard Data Center - remodel, (12) branch circuits. Job # 13131. 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: SIGNAUPANEL: 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: ., 327 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 - 535 -2652 FEES Reg #: LIC 203 SUP 4460S Description Date Amount ELE 26 -95C [ELPRMT] ELC Permit 2/16/2005 $120.00 [TAX] 8% State Surcharge 2/16/2005 $9.60 REQUIRED ITEMS AND REPORTS Total $129.60 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 a re 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 -2344. Issued By: �'( Permit 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 639 -4175 by 7:OOpm for an inspection the next business day • 02 -15 -05 04 :52PM FROM - Oregon Electric Estimating 5032313587 T -572 P.001 /002 F -620 El Permit A.pplica ' FOR OFFICE USE ONLY Deceived ., 7 ,`� Q'Q City of Tigard � Cf � F Received - /6 >S !�J L �' ` Permit No.: 6 13125 SW Hall Blvd., Tigard, 012'97/ Plan Review Other Permit lhl�l�F; ��;A�'�'� Date/By: Phone: 5 Line: 4171 Fax: 503.598.1960 16 200 J .y, ' n'J I L Date Ready/By. luris. I El Sc e Page 2 for Inspection Line: 503.639.4175 F Noti{ed/Method: / G L Supplemental Inforutadnn Internet: www.cLtigard.or.us ^ r� b j i� PLAN REVIEW 57 �> � Ig e m n - Please check all that apply: ❑ Ncw construction A • ❑Service over 225 amps, comm'l ❑Ha'ardous location ❑ Demolition A e 1 er: Builds over 10,000 sq. ft., ❑ Service over 320 arrrDS - rating ❑ S of 1 - and 2- family dwellings 4 or more new residential C � 4 TEGURY -0F CONSTRUCTION" ❑System over 600 volts nominal units in one structure ❑ 1 - and 2 faulily dwelling CotTlmcrcial/indu , tria] 0 Accessory building ❑Building over three stories ❑Feeders, 400 amps or more ❑ Multi - family 0 Master builder ❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or • plan RV park JOB SITE INFORMATION AND LOCATION ['Egress/lighting p ❑Other: []Health -care facility Job no.: 13131 I Job site address: 11308 SW 68th Parkway Submit 2 sets of plans with any of the above. The above are not applicable to temporary construction service. City / State/ZIP: Tigard, OR 97224 FEE SCHEDULE Suite /bldg. /apt no.: 1 Project name: TDC - SIS RIS Remodel nor pnaa 1 Qty, 1 see Tett1 -" New residential single- or multi - family dwelling unit. Cross streeddircctions to job site: _ Includes attached garage. 1.000 sq. ft. or )css 145.15 4 Ea. add'! 500 sq. it or portion 33 Subdivision: 1 Lot no - 1 75.00 2 Limited energy, residential - Tax map /parcel no.: _ Limited energy, non - residential - 75.00 2 • . • ! 'DESCRIPTION OF WORK •' . • - . - Each manufactured or modular 2 _ dwellin • , service and/or feeder 90.90 Tigard Date Center - SIS R1S Remodel _ Services or feeders installation, alteration, and/or relocatio 200 amps or less _ 80.30 2 _ 201 amps to 400 amps 106.85 „„ 2 5:1 PROPERTY OWNER I • El TF,NANT 401 amps to 600 amps 160.60 2 - Name: Providence Health System 601 amps to 1,000 amps 240.60 2 _ 2 Overt ,000 amps or volts _ 454.65 Address: 11308 SW 68th Parkway Reconnect only 66.85 2 _ City /State/ZIP: Tigard, OR 97224 Temporary � services or feeders installation, alteration, and/or _ relocation Phone: (503)216 -0012 1 Fax: (503)216 -0014 200 aTnps or less [ 66.85 i Owner installation: This installation is being made on property that 1 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 i 133.75 2 Owner signature: , Date: Branch circuits - new, alteration, or extension, per panel ❑ CON TACT' PERSON . A. FCC for branch circuits with ® APPLICANT. I _ - service or feeder fee, each 6.65 2 Business name: Oregon Electric Group branch circuit - — B. Fee for branch circuits Contact name: John vitro without service or feeder fee, 1 46 85 440,86 2 each branch circuit Address: 1010 SE 11th Ave Each add'l branch circuit i 1 6.65 73, _ 2 City/ State/ZIP: Portland, OR 97214 NEseellancous (service or teener not included) Pump or irrigation circle 53.40 2 Fax: (503) 234 -1001 - 53.40 2 Phone: (503) 849 -2787 ( ) Sign or outl lighting _ _ E -mail: johnv®oregon- electric.com Signal circuit(s) or Limited- CONTR�►CTOIt energy panel. alteration, or 2 . — extension. Describe: Page 2 Business name: Oregon Electric Group _ Each additional inspection over allowable in any of the above Address: 1010 SE 11th Ave Per inspection 1 62.50 City/ Statc/ZIP: Portland, OR 97214 Investigation per hour (1 hr min) 62.50 Industrial plant per hour — 73.75 Phone: (503) 234-9900 t • • . ELECTRICAL PERMIT FEES*" .. • CCB Lic.: 203 Electrical Lic.: 26-95C Sup - Lic.: 44605 r Subtotal i Plan review (25% of permit fcc) ©DO _ Suprv. Electrician signature, required: / ; . !wit * —' $tats surcharge (8% of permit fee) g Print name: // ` �� /� • ate: 2 - u TOTAL PERMIT )FEE a e) , 6,0 Authorized signature: This permit applieanon expires If a permit Is not obtauud within 180 days after it has been accepted as complete Print name: 1 Date: • Fee rnothodology set by Tti -County Building Industry Service Beard Number of inspections per permit allowed. e\Buitoing mib\E1.C-PnmiiApp.doe 1 =An 440 4615T(lwaiCOM/WEn CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2005 -Q0093 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/l&2005 Phone: (503) 639 -4171 a tA'm�r� 4 � i , li`i� Inspection Requests (24 Hrs.): (503) 639 -4175 ,_' °__.. INSPECTION WORKSHEET FOR DATE: 3/31/2005 TIME: 7:05AM PAGE: 57 SITE ADDRESS: 11308 SW 68TH PKWY CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PROVIDENCE TIGARD DATA CENTER DESCRIPTION: Providence Tigard Data Center - remodel, (12) branch circuits. Job # 13131. 3/7/05: Added (19) additional branch circuits, now (31). OWNER: BENENSON 68TH PARKWAY, PHONE #: CONTRACTOR: OREGON ELECTRIC CONST /GROUP PHONE #: 503- 535 -2652 Inspection Request Scheduled For: Date: 3/31/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 003354-01 503 - 849.2787 N Corrections /Comments / Instructions: \ ' ) 'D ,~l LI,f)y, )(4)\90(\ 1 ( 1 ,,,i ,.., ❑ PASS Ii PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: i. o - Date:3 — / ✓ L Phone #: (503) 718 -