Permit lot CITY OF TIGARD " ` ELECTRICAL PERMIT
PERMIT #: ELC2004 -00014
4 V ii SERVICES DATE ISSUED: 1/14/04
� II 13125 SW Hail Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 110AA -00300
SITE ADDRESS: 14145 SW 105TH AVE
ZONING: R -12
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Reconnect (1) branch circcuit to new dishwasher. Job No. 77884
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: 1 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:
BEVERLY ENT TIGARD CARE CTR OREGON ELECTRIC CONST /GROUP
BY GEORGE MCELROY + ASSOC INC 1010 SE 11TH AVE
PO BOX 565048 PORTLAND, OR 97214
DALLAS, TX 75356
Phone: Phone: 503 - 234 -9900
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/14/04 $46.85
[TAX] 8% State Surcharge 1/14/04 $3.75 Rough -
Elect'l Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 -33 44.
Issue B y: i , i cticttLNUTA jig Permit Signature: L AQ� alf i A,,L.,.,
'Y
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: t - , i DATE:
LICENSE NO: LOO
Call 639 -4175 by 7:00pm for an inspection the next business day
JAN - - 08:37AM FROM - Oregon Electric Estimating 95032313587 T -028 P.001 /002 F -721
_ DZ
/ /
f lectirical Per' �� ...
„ , .i y Uri OFFICE USE ONLY
- .
A to City of Tigard Date received: / /4/ , Permit no- :f.Le) - AZ/
13125 SW Hall Blvd Project/appl. no.: E - ate:
* t, tl phone: (503) 539 -4171. FAX: (8 �oo' Date issued: y: !Receipt no.:
Internet address: www.CLtIgerd.or.us Case file no.: F ayment type:
24 - Hour Ins •ection R • u .,!,; y_,: V., ■ Multi - family ❑ Tenant improvement
1] 152 family Dwelling Or accessory 1 1 l i f _ rep a meet CI Other: ❑ Partial
la New construction J °"”'
JOB SITE INf-'ORMATI0N
Bldg. Job Address: 14145 SW 105th
Bld No.: Tax map /tax lot/account no.:
Lot: Block: Subdivision
Project Name: TIgard Medical and Rehab Cntr Description and location of work on premises: reconnect circuit to new dishwasher
Estimated Date of completion/inspection: 50g 849.2823 Phone
Will au call for ins action within 24 hours? Yes 0 No ❑ Pro'ect Contact Ste hen Kel
la m.
Description Qty Fee (ea.) Total imp
Job Na.: 77884 New ruaraenUaketngre at
multkfamily per dwelling
Business name; Oregon Electric Group unit. Includes attached
garage. Service Included:
Address: 1010 SE 11th Ave. loco SO. ft or less 5 145.15 5 - 4
City: Port)andlState: OR ZO: 97214
Ea Aedl 500 SF or Perron $ 33.40 $ - 1
Phone: (503) 234 -9900 Fax; (503) 234 -1001 I E -mail: Ltmdcd Ener0Y.1 82 Family S 75 .00 $ 2
CCB no.: 203
El c, • S. lie. n0.: 26-850 Limited Energy, t lrf Family -1-- $ 7$.00 5 - 2 -
Cit /111:4'.•• 0 ' "5 Each manufactured home or
r mogul&dweiiing. Service
Jr__ , 1/14/2004 and/or feeder. S g0.00 S -
sr. " "" " ° r •• Service or Feeders -
Su • , Elect. Name M M " License no: 44605 Installation, Alteration or
Relocation:
P •P R • E- 200amnsorless $ 80.30 $ - 2
Name (print): -
201amps- 4003me5 5 106.65 5 2
Mailing Address: 40lamps • 600amps $ 160.60 $ • 2
C_V State: Zip: 6o1amps- 1000amp: - $ 240.60, $ - 2
Phone: y Fak:
E -mail Over 1o00A or Vells $ 454.65 $ - 2
Reconnect Only $ 6645 $ ,
Owner Installation: The installation is being made on property I own which is Tom per�r Services • or •
not intended for sale, lease, rent, or exchange according to ORS 447, 455, Feeders • installation,
479, 670, 701, Alteration or Relocation: -
Owner's signature=
Date: 200 am s or to s $ 88.85 $ 2
20lamps- 400arnpa
S 1 00.30 $ - 2
Over 401amps - 60cernes 5 133.75 $ a
Name: Branch circuits - New,
Alteration or Extension Per
Address: Panel• A. Rao for branch
Ci : State: ZI.: dreuita wilt+ purchase of seMce
or feeder fee, each branch
Phone: Fax: E -mail: circuit 6.55 $ - 2
B. Fee for branch circuits
wrout Purchase of Service or
PLAN REVIEW Feeder. 1st Branch Ckt 1 $ 46.85 5 46 - 2
O Service over 225 amps -comm ❑ Health -care facility Each additional branch circuit 5 6.55 $ -
ID Service over 320 amps -rating of ❑ Hazardous location Misceilaeeeus - (service or
feeder not included}
1 &2 family dwellings ❑ Building over 10,000 square feet four or Eaeh pump or irripallon circle $ 53.40 $
❑ System over 600 volts nominal more residential units in one structure Each Sign or Outline Lighting $ 53.4o 5
❑ Building over three stories ❑ Feeders, 400 amps or more si on or Extension
Limited Energy
O Occupant toed over 99 persons ❑ Manufactured structures or RV park 5 75.00 . - $ , 2
❑ Egress/lighting plan O other:, - - *Description
Submit 2 sets of plans with any of the above. - —
The above are not applicable to temporar +tconstruction service. Each Additional inspection over
the Allowable in any of the
Notloe: This permit application Above Per Inspection _ $ 6250 $
expires If a parM _ lf Is not Invesli alien fee;
obtained within 180 days after it g
has been accepted as (Other
complete. $46.85
Permit Fee
Plan review 25% $0.00 1
State Surcharge 8% 33.75 '9
Total $50'60
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
1-2/-0 BUP
_
Received �e) ; J�ZDate Requested AM PM BUP
Location ,/ � S 7n � � Suite MEC
Contact Person 1 - t'�1rP4 ( 0 , 1 Ph ( SO �) f S " 2& 23 PLM
Contractor OP eep-e . Ph ( ) SWR
BUILDING Tenant/Owner i - 'T f:85V21_46j 1 V
Footing (J
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear RC-Cc' Yv CJ
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler (1/
Fire Alarm "oott.
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab ✓�
Low Voltage l� /
Fir rm
• Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S RT FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date/ — 0 2 - l — Inspect • a, Ext
Other:
Final DO NOT REMOVE this inspection record from the b site.
PASS PART FAIL