Permit , lg ._ t.,.. CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00184
COMMUNITY DEVELOPMENT DATE ISSUED: 4/1/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112AB-02300
SITE ADDRESS: 14150 SW MILTON CT ZONING: I -L
SUBDIVISION: BONITA INDUSTRIAL PARK LOT : 005 JURISDICTION: TIG
PROJECT: NORTHWEST MEDICAL TEAMS
Project Description: Installing (2) branch circuits for HVAC system connection and service plug.
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:
SHEININ - MENDENHALL LLC I BOB'S ACTION ELECTRIC INC
BY PARROTT PARTNERHIP 2700 NE BURTON ROAD #A
12725 SW 66TH AVE #202 VANCOUVER, WA 98662
PORTLAND, OR 97223 •
Phone: Contact #: PRI 360 - 254 -7200
• FAX 360- 254 -8219
FEES
Description Date Amount Reg #: ELE 37 - 43IC
[ELPRMT] ELC Permit 4/1/2008 $53.50 LIC 53136
[TAX] 12% State Surchar 4/1/2008 $6.42 SUP 4322S
Total $59.92 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 - 001 -0010 through OAR 952 - 001 -0100. • - • • .- in copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By f� _ - • • -e Signature: Q ��` /�.�
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.
•
Electrical Permit Application ` ' GO FOR OFFICE USE ONLY
CI of Ti and V ` v Received `
`� g C � Date /B : �� , l
13125 SW Hall Blvd., Tigard, OR 9 I Plan Review
C Phone: 503.639.4171 Fax: 503.598. l a .. .' �� �� Date /By: Other Permit: 15C � �rr}
T I G A R D Inspection Line: 503.639 PQ� • `.t ate Ready /By: Juris: Ed See Page 2 for
Internet: www.tigard - or.gov 1 ^ c .1\Gp∎ „ ed/Method: Supplemental Information
TYPE OF WORK 0 , v � h ,', PLAN REVIEW '
❑ New construction ❑ Addition/alteration� n
'° t Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
' CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling KJ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire 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 ", "I -3 ",
Job . J ob site address:
100111' or more. occupancy.
ob no
0 8_354 14150 G W Milton C t . ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97224 ❑ Health-care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: i/] y�f ail j es� - ( re4ice or feeder 600 amps or more.
(/" / ' ' FEE SCHEDULE
Cross street/directions to job site: • Desedptioa
I Qrv. I Fee. ► Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
.. • . DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
HVAC Split system connection & service plug residential
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. ❑ PROPERTY OWNER . ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Medical Terms Tnternat i nnal
601 amps to 1,000 amps 240.60 2
Address: 14150 SW M i 1 t nn Ct _ Over 1,000 amps or volts 454.65 2
City/State /ZIP: Tigard, OR Temporary services or feeders installation, alteration, and/or
�! 9 7 2 4 relocation .
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property 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 599 amps 133.75 ' 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel .
A. Fee for branch circuits with
❑ APPLICANT . I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.85 4 6 . 8 5 2
first branch circuit
Address: Each add'I branch circuit 1 6.65 6.652
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( )
Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
•
C ONTRACTOR Sign or outline lighting 53.40 2
Business name: ignal circuit(s) or limited -
Bob's Bob ' s Electric energy panel, alteration, or
Address: 2700 NE Burton Rd., Ste. A extension. Describe: Paget 2
City/State/ZIP: Vancouver, WA 98662 Each additional Inspection over allowable in any of the above
Per inspection 62.50
Phone: (3 6 0) 254-7200 Fax: (3 6 0) 254-8219 Investigation per hour (1 hr min) . 62.50
CCB Lic.: 53136 Electrical Lic.: 3-7_,. 1C Suprv. Lic.: 4 3 2 2 S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv: Electrician signature, required: - d Subtotal: 53,50
Plan review (25% of permit fee):
Print name: Kevin B r o s e l l e Date: 3/27/08 State surcharge (12% of permit fee): 6.42
Authorized signature: • TOTAL PERMIT FEE:
_ 59_9
This permit application expires If a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
. * Number of inspections allowed per permit.
1:\ Building \Permits \ELC- PermitApp.doc 05/23/06 440 -4615T(11 /05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: ELC2008- 00184 111
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1/7.008
Phone: (503) 639 -4171 A
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/9/2008 TIME: 7:00AM PAGE: 20
SITE ADDRESS: 14150 SW MILTON CT CLASS OF WORK:
SUBDIVISION: E3ONITA INDUSTRIAL PARK LOT #: 005 TYPE OF USE:
PROJECT NAME: NORTHWEST MEDICAL TEAMS
DESCRIPTION: Installing (2) branch circuits for HVAC system connection and service plug.
OWNER: SHEININ - MENDENHALL LLC I, PHONE #:
CONTRACTOR: BOB'S ACTION ELECTRIC INC PHONE #: 360 - 7200
Inspection Request Scheduled For: Date: 4/9/2008 Pour Time:
Code # Inspection Description �C- c�lifirm�# . Contact # \ssage
1 93 Eloctiical final 0680913-01 360 -254 -7200 Y
Corrections /Comments /Instructions:
9 41 \ I 1--L ,4
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CT . IJ LE Date: Ai tit Phone #: (503) 718-