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Permit q A.. CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2008 -00017 COMMUNITY DEVELOPMENT DATE ISSUED: 1/9/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S101AC 01300 SfEADDRESS: 07105 SW HAMPTON ST ZONING: MUE SUBDIVISION: BEVELAND NO. 2 LOT : 018 JURISDICTION: TIG PROJECT: KAISER DENTAL Project Description: (2) branch circuits. Job No. 51 -045 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: 1 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 O'NEILL ELECTRIC INC PLAN OF THE NORTHWEST #838 1212 SE GIDEON ST ATTN: PROPERTY ACCOUNTING PORTLAND, OR 97202 PORTLAND, OR 97227 Phone: Contact #: PRI 503 - 493 -6045 FAX 503 - 460 -0956 FEES Description Date Amount Reg #: ELF 26 -1003C [ELPRMT1 EEC Permit 1/9/2008 $53.50 LIC 129027 (TAXI 12% State 1/9/2008 $6.42 SUP 4385S Total $59.92 REQUIRED ITEMS AND REPORTS 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 ra a set forth,in O 952- 001 -0010 through OAR 952 -001 -0100. You may obtain copies bf these rules or direct questions to OUNC at 503.246.6699 or 1.800.3 \ 234 (. -. Iss ed By: ( Permittee Signatu r c a-1/4_. - 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 l SIGNATURE OF SUPR. ELEC'N: ( - .eA 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. • Eleeti al Permit .A, 1i ( I • � dV ED >•�tll2 OFFICE USE ONLY of Tigard Received 13125 SW Fall Blvd., Tigard, OR 22223 Plan R Date/Br c g v (� Permit No.: e g 0/ 7 i Phone: 503.639.4171 Fax: 503.4 p I , Review 60 P 2008 Other Permit Inspection Line: 503,639.4175 Date/p T I C. A R >) P , IT Date Ready /By: ' .turi Internet www.tigard- or.gov (S,/ S sae Pa z fur , Notified oth , In fo mason O F /M a r I 1 5u 1e ants ,+t yq� ''rr J,,�,p�I, p m r ' aA W l�. :: -',. .,I. ;'��� l l : i 1 1' i `. '' '.i ,i, „r , h�' Rlr,'�WRR'J0 I Please check alt that apply (submit 2 sets of plans w /items checked below); El New construction V,Addit loft /alteration /replacement 12 Service or feeder 400 amps or more El over three stories. © Demolition ❑Other: current ❑ Marinas and boatyards. ,.. .... `° .. .., ... tore '� :: e u ... .. .. . ..... ; � "��' "�. ::r ;�M ;� r exceeds or v, ,,, .. Y.. g , ..: , I, , accessory building a 10.000 snipe et t 50 volts o ❑ Floating buildings. ❑ 1 - and 2-family dwelling �. Commercial/industrial loss to ground, or exceeds 14,000 ❑ Commercial-use agricultural ng a1ttpS for all other installations. buildings. ❑ Multi - family ❑ Master builder Li Other: ❑ Fire pump. 0 Installation of 75 ICVa or JOB s1rl')g'rIYkORItr, o 'fvri .z,a.0 Tr —„,. Ad load of larger separately derived system. agency cyst lax • ... :' : •: � � :: :, �•. , ' : '' '� ` � d,non of n ew m otor oa o Q ,<A» "r", ., ., _ � lob site address: 1001 or more. Job no.: occupancy. S ti d six or more r esidential units. ❑ Recreational vehicle parks. City /State /ZTp: -. • dip --� ❑ H -c are facilities. 0 Supply v _„.11. , ._w { I u0P ol oltage for more titan ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: • .-' El Service or feeder 600 amps or more. J New r esidential single multi ' � Cross street /directions to - job site: ". 1 dwelling � To unit. Nt¢. tal I 5 $ t. Includes attached garage. Subdivision: • Lot no.: 1,000 sq. ft. or less 145.15 4 Ea, add SQO s ft. o r p ortion el no.: 33.40 1 , Limited d DIJSG .... Tax map pare ”' � i anus IN 75 00 energy, . . ..... . .... . :. ,. ,... �li,�TlclQ , �;tY'ayltti . ;, rt3Y _ 2 . ;�, .:.. , ,., ... ..,. :•: ; ;:::.. , r ;" , N ��,' • . et-VNA _1 , ^ 1- iX l t�47 • L imited with above s.. R. energy, multi - family 75.00 2 Ze ( 1 residential with above a.. fi. Services or feeders installation, alteration and /or relocation I RtptRTY' 0 lO ., lil L t`il4N' ' ! rt : s 106.85 2 l Nam e: A-/ 5- t k- (/Olt 7ON /-, f� — J 401 amps [0 600 amps Ib0,60 i T Address: I �/ r • Over 1,000 amps or volts 454.65 2 City /State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66,85 I Owner installation: This installation is being made on property that I own which is not 20 1 amps to 400 amps 10030 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: i3raneh circuity - new, alteration, or extension, per panel , A. Fee for branch circuits with • C ' APPLiTcANT- C t4'T,k0,;:k• 4i : ,., ,, above service or feeder e .. . .... � �� " + i . J ',' , :( e, 2 Business name: each branch circuit 8.65 B. Fee for branch circuits Contact name: without service or feeder fee y 46,85 I 2 Address: first branch circuit � (rj Each add'I branch circuit 1 6.65 j p(t5 2 ' Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular Phone: ( ) I Fax:: ( ) dwellin_ service and /or feeder 90.90 2 Reconnect only 66.85 2 E-mail: ... ....:1i,'; CONTIt ... . ..., ' > ; " .... �, � „ Sign or outline ion circle 53.40 2 •,,•;,:..; . ... �r:,c::' $ lighting 53,40 Sine5s name: 17+1 1i I f (�,� / Signal circuits) or Iimitcd- (� ` , ...L 4 ' t `�-. energy panel, alteration, or Address: ,1 , + extension, Describe: Page 2 2 City/State/ZIP: O „ � tii��` L ' • Each additional inspection over allowable in any of the above Phone: ( , 6J i _ as Fax: ( S) �? i 6 Per inspection 2.50 E "1 & ^, Investigation per hour (1 hr min) 6,2.50 CCB Lic.: ' c Suprv. Lie.: r�37 Industrial plant per hour 73.75 1✓1 tr . r ` ..,,: 1, ;; ::: ,• i ii'C'1';T, ' . Suprv. ec ature, required. .: ' 7 t o '. �, jp l , ::': " .. ..::.... ... .... _ 1 :! Pk r t S 1 ubto tal 1J 5':' :',.. Subto Ta RC late: i1... r Plan review (25 %ofpotmitfee): / • State surcharge (12% of permit fee); 1 , I 1 Authorized sigt re. ' A � / I, i . • _ ' 4aL -. ra a TOT AL PERMIT FEE; �� �'� print sortie, i Date: 1 This permit application expires if a permit is not obtained within 180 ,J• • -'� 3 i 1 days after it has been accepted as complete. t .doe 05/23 /06 • Number of inspections allowed per permit. 1 :1 440- 4615T/ 1 /a 5 /CO M/w55 . _ . CITY OF TIGARD BUILDING DIVISION AA PERMIT #: ELC2008- 00017 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/912008 Phone: (503) 639-4171 eadoiteili'r Inspection Requests (24 Hrs.): (503) 639-4175 -aa -- li- DATE: 1/17/2008 INSPECTION WORKSHEET FOR TIME: 7:00AIVI PAGE: 71 SITE ADDRESS: 07106 SW HAMPTON ST CLASS OF WORK: t SUBDIVISION: BEVELAND NO. 2 LOT #: 018 TYPE OF USE: PROJECT NAME: KAISER DENTAL DESCRIPTION: (2) branch Circuits. ..I»b No. 51-045 • \ OWNER: KAISER FOUNDATION HEALTH, PHONE #: CONTRACTOR: ()WEILL ELECTRIC INC PHONE #: 503-493-6045 Inspection Request Scheduled For: Date: 1/17/2008 Pour Time: Code # Inspection Description Cortfirrn Contact # Message *199 Electiical final 063361-01 503-493-6045 N Corrections/Comments/Instructions: (/\( i kQi t.— '311 R - k--04Akr 7 Z AdA4s _ ."-- ■k \ i PASS fl PARTIAL APPROVAL fl CANCEL El NO ACCESS AIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: c) N (Se) L-E" Date: I — In ' 011 Phone #: (503) 718- VI% L . , •