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Permit A �- CITY OFTIGARD DEVELOPMENT SERVICES ELECTRICAL PERMIT 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT #: El_C 97 -0092 DATE ISSUED: 02 /14/97 PARCEL: 2S102CB -02300 SITE ADDRESS...: 13200 SW PACIFIC HWY SUBDIVISION • FREWINGS ORCHARD TRACTS ZONING:C -G BLOCK LOT .............:8 Project Description: INSTL 1 BRANCH CIRCUIT JOB # 56944 - -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- - -- - -- MISCELLANEOUS 1000 SF OR LESS • 0 0 - 200 amp • 0 PUMP /IRRIGATION • 0 EACH ADD'L 500SF...: 0 201 - 400 amp • 0 SIGN /OUT LINE LTG..: 0 LIMITED ENERGY • 0 401 - 600 amp • 0 SIGNAL /PANEL • 0 MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0 - - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- - 0 - 200 amp : 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0 201 - 400 amp • 0 1st W/O SRVC OR FDR.: 1 PER HOUR • 0 401 - 600 amp : 0 EA ADD'L BRNCH CIRC: 0 IN PLANT : 0 601 - 1000 amp • 0 PLAN REVIEW SECTION 1000+ amp /volt : 0 ) =4 RES UNITS > 600 VOLT NOMINAL_..: Reconnect only • 0 SVC /FDR >= 225.AMPS..: CLASSAREA /SPEC DCC.: Owner: -------- - - - - -- -- - FEES - -•- MULLIKEN MEDICAL type amount by date recpt 13200 SW PACIFIC HWY PRMT $ 35.00 TAT 02/14/97 97- 290431 5PCT $ 1.75 TAT 02/14/97 97- 290431 TIGARD OR 97223 Phone #: Contractor: FRAHLER ELECTRIC CO $ 36.75 TOTAL 11860 SW GREENBURG RD REQUIRED INSPECTIONS TIGARD OR 97223 Ceiling Cover Undergroi_+nd Cove Phone #: 503- 639 -4627 Wall Cover Elect'1 Service Reg #..: 000374 This perrit is issued subject to the regulations contained in the 41.1 Tigard Municipal Code, State of Ore. Specialty Codes and all other Permit e e S i gnat ' - - applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within l80 days of issuance, or if work is suspended for sore - £2. , 4 / L f1f than l80 days. I s s ' ed By -� -- -OWNER INSTALLATION ONLY The installation is being made „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, for inspection..- 639 -4175 - - - -- - - . - - - - - - CITY OF TIGARD Electrical Permit Application Plan Check # 13125 SW HALL BLVD. Rec'd By , TIGARD OR 97223 Date Rec'd Date to P.E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print or Type Permit # AIMPErfeaff Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development M U L L I K E N MEDICAL Number of Inspections per permit allowed Name (or name of business) M U L L I K E N MEDICAL Service included: Items Cost Sum Address 1 3 2 0 0 S _ W _ PACIFIC HIGHWAY 4a. Residential - per unit City/State/Zip TIGARD, G A R D, O R E G O N 9 7 2 2 3 Each ad it o l 5 s $110.00 4 ty p Each additional 500 sq. ft. or Commercial © Residential El Limited thereof $25.00 1 Limited Energy $25.00 - Each Manuf'd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: (Attach copy of all current licenses) 4b. Services or Feeders Electrical Contractor F R A H L E R EL EC T R I C C O. Installation, alteration, or relocation Address 11 860 SW GREENBURG ROAD 200 amps or less - $60.00 2 201 amps to 400 amps $80.00 2 City T I G A R D State 0 R Zip 97 2 2 3 401 amps to 600 amps $120.00 2 Phone No. 639 -4627 601 amps to 1000 amps $180.00 2 Job No. 56944 Over 1000 amps or volts $340.00 2 Reconnect only $50.00 2 Elec. Cont. Lice. No. 34 Exp.Date 1 0/ 1/ 97 OR State CCB Reg. No. 37410 Exp.Date 7/2/97 4c. Temporary Services or Feeders COT Business Tax or Metro No. 1987 Exp.Date 1 2 / 1 / 9 7 Installation, alteration, or relocation 200 amps or less $50.00 2 201 amps to 400 amps - 75.00 Signature of Supr. Elec'n /�� ./e9iJ.4 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License No. 1816 S _ Exp.Date 10/1/98 see "b" above. Phone No. 639 - 4627 4d. Branch Circuits New, alteration or extension per panel 2b. For owner insilr: APPLICATION a The fee for branch circuits with ��tt �� purchase of service or Print Owner's Name feeder fee. Address E branch circuit $5.00 2 b) The fee for branch circuits City State COP1p without purchase of Phone No. service or feeder fee. First branch circuit 1 $35.00 35.00 2 The installation is being made on property I own which is not Each additional branch circui $5.00 2 intended for sale, lease or rent. 4e. Miscellaneous (Service or feeder not included) Owner's Signature Each pump or irrigation circle $40.00 2 Each sign or outline lighting $40.00 2 3. Plan Review section (if required):* Signal circuit(s) or a limited energy panel, alteration or extension $40.00 2 Minor Labels (10) $100.00 Please check appropriate item and enter fee in section 5B. 4 or more residential units in one structure 4f. Each additional Inspection over Service and feeder 225 amps or more the allowable in any of the above System over 600 volts nominal Per inspection $35.00 Classified area or structure containing special occupancy Per hour $55.00 as described in N.E.C. Chapter 5 In Plant $55.00 * Submit 2 sets of plans with application where any of the above apply. 5. Fees: Not required.for temporary construction services. 5a. Enter total of above fees $ 5% Surcharge (.05 X total fees) $ NOTICE • Subtotal $ 5b. Enter 25% of line 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $ NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ❑ Trust Account # 3 6 . 7 5 Total balance Due $ 1: \DSTS \ELC96.APP Rev 9/96 Page No. 1 CASE HISTORY FOR CASE NO.: ELC97 -0092 MULLIKAN MEDICAL CENTER 13200 SW PACIFIC HWY • 03/04/99 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By - - -- --- -- - - - - -- - -- ELCC001 Application received 02/14/97 / / 02/14/97 02/14/97 TAT ELCC003 Permit created 02/14/97 / / 02/14/97 02/14/97 TAT ELCC500 (F)Issue permit / / / / 02/14/97 PASS TAT 02/14/97 TAT ELCC799 Elect'1 Final / / / / 03/19/97 PASS MJR 03/19/97 MJR ELCC800 Case Finaled / / / / 03/19/97 PASS MJR 03/19/97 MJR •