Permit CITY OF TIGARD ETRICALPERMIT
PERMIT LEC #: ELC2005 -00900
DEVELOPMENT SERVICES DATE ISSUED: 11/17/2005
'�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S101AC - 01300
SITE ADDRESS: 07105 SW HAMPTON ST ZONING: MUE
SUBDIVISION: BEVELAND NO. 2 LOT : 018 JURISDICTION: TIG
Project Description: Install (2) under cabinet lights, relocate nurse call station, replace plugmold w /cut in boxes. Job #88758.
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:
KAISER FOUNDATION HEALTH OREGON ELECTRIC GROUP
PLAN OF THE NORTHWEST #838 1010 SE 11TH AVE
ATTN: PROPERTY ACCOUNTING PORTLAND, OR 97214
PORTLAND, OR 97227
Phone: Phone: 503 - 234 - 9900
FEES Reg #: LIC 203
Description Date Amount SUP 4460S
ELE 26 -95C
[ELPRMT] ELC Permit 11/16/200` $46.85
[TAX] 8% State Surcharge 11/16/200' $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
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 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 -2344.
Issued By: L n 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.
11` =15 -05 09:57AM FROM - Oregon Elect is E t 5032313587 T -449 P.001 /002 F -669
City of Tigard g plainni&W Permit No 4 aQ �0
13125 SW Hall Blvd., Tigard, OR 97223 - --=
Phonc: 503.639.4171 Fax 503.598.1960 NOV 1. 5 200 4.41 • 1, Plan Review
Ai Date/By: Other Permit:
Inspection Line: 303.639.4175 "_ Dar IteadyBy: >n Sce Pa g e 2 for
Internet: www.ci.tigard.orms CITY OF TIGP r�
No
tine d/ M eth o d : [! sou P : MaiInrormalion
�„ r'strIC= Dl1/IRION _
T OF WORK .
TOP. PLAN REVIEW
❑ New construction ® Addition /altetation/IeplACement Please check all that apply:
❑service over 225 amps, eomttt'I ['Hazardous location
CI Demolition ❑ Other:
❑Service over 320 amps — rating 0Buildng over 10,000 sq. It.
CATEGORY. OF CONSTRUCTION of 1- and 2-family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial/industrial 0 Accessory building ['System over 600 volts nominal units in one slructurc
ID Multi-family ❑ Muster builder ❑ Other: ['Building over twee stories ❑Feeders,, 400 amps or more
❑ Occupant load over 99 persona ❑Manufactured structures or
' ' JOB SITE ..INFORMATION .AND LOCATION ['Egon/lighting plan RV park
Job no.: 88758 Job site address: 7105 SW Hampton St l health-care facility ❑Other:
Submit 2 acts of plans with any of the above.
City /State/ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: ( Project name: Kaiser Dental FEE* SCTEDULE
Description j QU 1 sec. I r.ran"
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
_ Includra attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: ESL add% 500 sq_ ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non-residential 75.04 2
•
•
DESCRIPTION OP WORK Each manufactured or modular
Install (2) under cabinet lights. relocate nurse call station, replace ptugmold dwellin service and/or feeder 90.90 2
Services or feeders installation, alteration, :Ind/or relocation
with cut in boxes 200 amps or less 80.30 ' 2
. ❑ PROPERTY OWNER 1:1 TENANT 201 am 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
Reconnect only 66.85 r 2
City/State/ZIP: Temporary services or feeders tostdllation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
Made on property 200 amps or less 66.55 1
Owner installation: This installation is being p perty 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
❑ APPLICANT. • I ❑ CONTACT ;PERSON A Fcc for branch circuits with
service or feeder fee, each
6.65 2
Business name: brunch circuit
Contact name; B. Pee for branch circuits
without service or feeder fee, I 46.55 c/G�S 2
Address: each branch circuit
Each add'! branch circuit 6.65 ^ 2
City/State/ZIP:
Miscellaneous neous ( serviice or feeder not included)
Phone: ( ) Fax :: ( ) Pump or irrigation circle 53.40 2
E -mail; Sign or outline lighting 53.40 2
Signal circuit(s) or limited:
.
•
' CONTRACTOR energy panel, alteration, or
Business name: Oregon Electric Group extension llcacribs Page 2 2
Address: 1010 SE 1 1th Ave Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Portland, OR 97214
Investigation per hour (I hr min) 62.50
Phone: (503) 234 -9900 [Lax..: (503) 535 -2763 Industrial plant per hour 73.75
CCD Lie.; 203 Electrical Lic. : 26-950... I - r , ELECTRICAL PERMIT FEES^
L. �
! L 44 605 Subtotal
!G _ ers
Suprv. Electrician signature, required: i •., J e Plan review (25% of permit fee) , ;
Print name: J J . te: 11 /14/05 State surcharge (8% of permit ice) 3'. 7s
Authorized signature:
'' /' TOTAL PERMIT I EE 5O, Ga
! % .r� J / � Thi permi ypptieadi expires Ire permit is not obtained within 1$tI
Pent na;nc l days idler it has been accepted as complete
_ G ' r /� /'j 1-t7 P7 e, I a 1 /14 /i5 • Fee methodology sot by fti- CotattyBttildiag industry service Boerd
. **Number of inspections ner oemat allowed.
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELC2006-00900
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/170005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 9/19/2006 TIME: 7 PAGE: 16
SITE ADDRESS: 07105 SW HAMPTON ST CLASS OF WORK:
SUBDIVISION: BEVELAND NO. 2 LOT #: 018 TYPE OF USE:
PROJECT NAME: KAISER DENTAL
DESCRIPTION: Install (2) under cabinet lights, relocate nurse call station, replace plugmold w/cut in boxes. Job
#88758.
OWNER: KAISER FOUNDATION HEALTH, PHONE #:
CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503-239800
Inspection Request Scheduled For: Date: 8/19/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 036803-01 603-535-2644
Corrections/Comments/Instructions:
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Bcucqt.\ Rtarik Q2Z,Oi
‘cZ.N\Ze4 cA,Wo rT
PASS fl PARTIAL APPROVAL 1 CANCEL I I NO ACCESS
El FAIL fl CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: G Date: C I Phone #: (503) 718- 2*