Permit CITY OF TIGARD ELECTRICAL PERMIT
�ua, DEVELOPMENT SERVICES PERMIT #: ELC97 -0829
Ana' �i�'j' DATE ISSUED: 12/18/97
!,L = 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 63 9.4171
PARCEL: 2S1O2CB -02300
SITE ADDRESS... :13200 SW PACIFIC HWY
SUBDIVISION •FREWINGS ORCHARD TRACTS ZONING:C —G
BLOCK • LOT •008 JURISDICTION: TIG
Pro.j ect Description : Mullikan Medical Center signs
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 2
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 ist W/0 SRVC OR FDR.: 0 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..: CLASS AREA /SPEC OCC.:
Owner: FEES
MULLIKAN MEDICAL CENTER type amount by date recpt
13200 SW PACIFIC HWY PRMT $ 80.00 JSD 12/18/97 97- 301884
TIGARD OR 97223 5PCT $ 4.00 JSD 12/18/97 97- 301884
Phone #:
Contractor:
VANCOUVER SIGN COMPANY, INC $ 84. TOTAL
6615 SW HWY 99
REQUIRED INSPECTIONS
VANCOUVER WA 98665 Ceiling Cover Elect'1 Service
Phone #: 360 -693 -4773 Wall Cover Elect'1 Final
Reg #..: 000006
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This per.it 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 0011010 through OAR 952-081 -1987. •oay obtain a copy
of these rules or direct questions to ' by c ing - 987.
/ ■ft
Permittee Signature: , Issued By: �►��
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 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + ++
Id
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # G�C9 -«�
,� I (� ,� ' �
� Date Issued 00' lA .I
�1 ill P hone (503) 639 -4171 ' '��
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
/�,,
Name of Development / r di-l-1 le-iNi AA ft tc444-6'A r Number of Inspections per permit allowed
Address (3AO0 PA -e -/PC /1 Service included: Items Cost(ea) Sum
City /State /Zip TI C9A- re...ib l C 2. `7 ?-.3 4a. Residential - per unit
A,, �[, 1000 sq. ft. or less $110.00 4
Name (or nam o f usiness) (,`U�i k /(A.'�l« 1- Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial Residential CI Limited Energy $25.00
Each Maned Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
(1 ' Contractor kl AiLk.G._Y' � /G� `f) Installation, alteration, or relocation
Electrical C $60.00
GI 200 amps or less 2
Address (it b S 1? 201 amps to 400 amps $80.00 2
City Up QL State tAIA Zip 4 s ' 401 amps to 600 amps $120.00 2
Phone No. -(po (QA 3- q 77 3
601 1000 oe amps $180.00 2
Job NO. Reconnect only
$50.00 2
contractor's license NO. 10- - - 7-q(4 -S 4c. Temporary Services or Feeders
Contractor's Board Reg. No. (0 74S! Installation, alteration, or relocation 2
Signature of Supr. Elec'n X C 200 amps or less 2
License No SZS
4=( Phone No. 34Olo9 3 q 7'13 201 amps to 400 amps $50.00
401 amps to 600 amps $75.00 2
Over 600 amps to 1000 volts $100.00
• 2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting 3 }-- $40.00
Signal circuit(s) or a limited energy C/ 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees: IIIIr'
5a. Enter total of above fees $
NOTICE , 5% Surcharge (.05 X total fees) $ _
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. w°rdlwmd.Adeo- ❑ Trust Account #
pfm.app $ .... .
Balance Due $
Page No. 1 CASE HISTORY FOR CASE NO.: ELC97 -0829
MULLIKAN MEDICAL CENTER
13200 SW PACIFIC HWY
03/04/99
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
-- -- - -- -- - - - - -- - --
ELCC001 Application received / / / / 12/18/97 PASS JSD 12/18/97 JSD
ELCC003 Permit created / / / / 12/18/97 PASS JSD 12/18/97 JSD
ELCC500 (F)Issue permit / / / / 12/18/97 PASS JSD 12/18/97 JSD
ELCC799 Elect'1 Final / / / / 03/16/98 Changed main sign hook -up in front of PASS CD 03/16/98 J *H
building. Pass.
ELCC800 Case Finaled / / / / 03/16/98 PASS CD 03/16/98 J *H
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