Permit CITY OF TIGARD ELECTRICAL PERMIT
° PER #: LC2008 -0006
l: COMMUNITY DEVELOPMENT DATE IS SUED: 7 /17/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY BASEMENT ZONING: MUE
SUBDIVISION: TRIANGLE CORPORATE PARK LOT : 002 JURISDICTION: TIG
PROJECT: HEALTHNET
Project Description: (4) branch circuits for TI. Job No. 3216
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):
SERVICEIFEEDER 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: 3 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:
HEALTHNET OREGON PHOENIX ELECTRIC
13221 SW 68TH PARKWAY PO BOX 14037
TIGARD, OR 97223 PORTLAND, OR 97293
Phone: 916 - 935 -1690 Contact #: PRI 503 - 886 -9930
FAX 503 - 266 -8394
FEES
Description Date Amount Reg #: ELE C89
[ELPRMT] ELC Permit 7/17/2008 $66.80 LIC 162753
[TAX] 12% State Surchar 7/17/2008 $8.02 SUP 5169S
Total $74.82 REQUIRED ITEMS AND REPORTS
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 e - - • •ugh OAR • 2 - 001 - 0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 • 1. 0.332.2344.
lss - d By: , _41j`4 4 /1 / Permittee Signature: A_
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:
C0141. CTOR INS rAL ION ONLY
SIGNATURE OF SUPR. ELEC'N: . i / DATE: 7-/7-or
LICENSE NO: s - /4'9S
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.
J,ua 16 08 03i, -37p. Terry Koch 503 -266 -8394 p.1
...:" -, • .. celi)
Electrical Permit Application FOR OFFICE 1151 OiNLI ,� j , .
1. i. a l . i - `.
City of Tigard 16 I Received 7 D //
N„,
eBy Permit No.: y .- �1 d
• 13125 SW Hall Blvd., Tigard, OR 972 3 Review
M Phone: 503.639.4171 Fax: 503.598.1960 \� G1" ace/B OtherPennit:
r( � Y
T I G A R D vv Inspection Line: 503.639.4175 A' O� . S\\ Date Ready/By: Iris: 13 See Page 2 for
• Internet ww.tigard- or.gov .rC� 'U� Notified/Method: � � Supplemental Information
E OF WORK � PLAN REVIEW
❑ New construction Addltlon/alterat on/r lacement Please check all that apply (submit 2 sets of plans whims checked below):
❑ Demolition
ID Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current ❑ Marinas and boatyards.
CATECOPY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1- and 2- family dwelling Commercial/industrial El Accessory building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fin pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1.2 ", "1 -3 ",
Job no.: 3 pZ j ( J Job site address: / 3Z?. / 0 10� 100 or o e rte. occupancy.
J ❑ Six or more ore. residential units. ❑ Recreational vehicle parks.
City/Statez>P: 7. fi2D . 7?-.7,3 ❑ Supply voltage for more than
❑ Health-care facilities.
O�' 0 Hazardous locations. G00 volts nominal.
Suite/bldg. /apt. no.: ( Project name: , , j AA% 'f em ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 iy. Fee. 1 Total 1 •
New residential single- or multi -family dwelling wtit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft or portion 33.40 1
TeX map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
biA la- Q it}� d ah
i" e-e LI7 �i £ye i h t.) D residential united energy denDtiaal ( with above s sq. y 9.)
ri 75.00 2
l (q.
Q j/6, �J/ �,," ^ J �. Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
■ 601 amps to 1.000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and/or
City /State/ZIP: relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 strips to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or ex tension, per panel
A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee / 46.85 4{p ' 2
first branch circuit
/
Address: Each add'I branch circuit 3 6.65 /9. 55 2
Miscellaneous (service or feeder not included)
City/StateJZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( )
Reconnect only 66.85 2
E - mail: Pomp or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: yi�oF,0X 4-4 J _ e energy panel, alteration, or
Address: p D t ,x f1Q37 extension. Describe: Page 2 2
City /State2IP: / / A , T � 1i �'7 O . 97 93 Each additional inspection over allowable in any of the above
b 4J[1✓ l� Per inspection 62.50
Phone: (6 123 ) v 1.3 /- fop (,, I Fax: ( 9)3 )„,235--1.300 Investigation per hour (1 hr min) 62.50
CCB Lic.: go x'753 I Electrical Lic.: Cie, , Supry Lic.: J 3769 . s • Industrial plant per hour 73.75
V/ h ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �J� Subtotal: 6/p , tV
/ / Plan review (25% of permit fee):
Print name: VV fF,e2 / D - 0I
27, State surcharge (12% of permit fee): . 02
s,
Authorized signature- O G /� TOTAL PERMIT FEE: 7j g.i,p..
�^ This application expires if a permit is not obtained within 180
Print name. ?2 =•• / e ms Date: 7-/S
Of( s permit
after it has been accepted as complete.
CITY OF TIGARD __.
BUILDING DIVISION PERMIT #: ELC2008. 00406
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/17/2000
Phone: (503) 639 - 417 ���������
Inspection Requests (24 Hrs.): (503) 639 -4175 -_..
INSPECTION WORKSHEET FOR DATE: 7/18/2008 TIME: 7:OOAM PAGE: 31
SITE ADDRESS: 13221 SW 68TH PKWY BASEMENT CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 002 TYPE OF USE:
PROJECT NAME: FIEALTHNET
DESCRIPTION: (4) branch circuits for TI. Job No. 3216
OWNER: HEALTHNET OREGON, PHONE #: 916-935-1690
CONTRACTOR: PHOENIX ELECTRIC Te R v PHONE #: 503886 -9930
Inspection Request Scheduled For: Date: 7/18/2.008 Pour Time:
Code # Inspection Description Con ' - • Contact # Message
199 Electrical final 072862 -01 503-477 -0962 Y
ZAN Lpv,)
Corrections /Comments/ Instructions:
a
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr ---1 N 06 ---G Date: 1 l i 01 t Phone #: (503) 718-
1 111