Permit C ITY OF TIGARD ' ELECTRICAL PERMIT
PERMIT #: ELC2005 -00562
DEVELOPMENT SERVICES DATE ISSUED: 9/20/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102CB -02300
SITE ADDRESS: 13200 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT : 008 JURISDICTION: TIG
Project Description: Installation of (3) branch circuits for plugs.
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: 2 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:
PACIFIC PROPERTIES OREGON ELECTRIC CONST /GROUP
BY MARTIN JOHNSON 1010 SE 11TH AVE
13200 SW PACIFIC HWY PORTLAND, OR 97214
TIGARD, OR 97223
Phone: 503 - 234 -6381 Phone: 503 - 234 -9900
FEES Reg #: LIC 203
tion Date Amount SUP 2
Description ELE 26 -95C
[ELPRMT] ELC Permit 8/12/2005 $60.15
[ELPLCK] ELC Pin Rev 8/12/2005 $15.04 REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcharge 8/12/2005 $4.82
Total $80.01
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 thes rules or direct questions to OUNC at
503 - 246 -6699 or 1-800-33.2344.
Issued By: !D, /Cm flzsi Permittee Signatur • 1) -91/2-0-4-4-tt
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.
-04 -2005 03:57PM FROM -OR E LECCT SERVICE 5035352763 T -674 P.002/005 F -656
v i1Gt.it at-g1 J. ci warn ,ts i l;V •
ity of Tigard Da dsv ' 5 - 7 '- PrnnitNo. ; C,/7(3 0 O,� D�
13125 SW Flail Blvd., Tig nl, OR 97223 v"
Phone: 503.639.4171 FaX 503,598.1960 ' ' 2QO
At fi3' I �`� Date/By �' B. a( 6-14.1 ptherPemut
Impaction Line: 503.639.4175 'I , Date Ready/Br l/�/y 1 !i7 Soo Page z roe
Internet: www.ci.tigard.or.ua CITY OF TIGARD Notified/Method: // )S' .r L,q � , Supplemental Information
u(I;it 14 1 War: UN PLAN REVIEW
❑ New construction ® Additionhdteration/replaccment Please check all that apply:
❑ Demolition ❑ Other ❑Service over 225 amps, comm'l ❑HazArdous locution
❑ Service over 320 amps — rating ❑ Bating ovcr 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ® Commercia]/mdustrial ❑ Accessory building ['System over 600 volts nominal units in one &eture
❑ Building over three stories ❑Foodera, 400 amps or more
❑ Multi family ❑Master builder ❑ Other.
QOccupant load over 99 persons ❑1blomfaettaed structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: 87083 [ Job site address: 13200 SW PACIFIC HWY ®A` ► - Caro facility [Other; _
Submit 2 acts of plans with any of the above.
City / State/ZIP: TIGARD, OR The above are not applicable to temporary construction service.
Suite/bldg./apt no.: Project name: PACIFIC MEDICAL Ira scHEDULE
Demripa Qty . Fm Tarim
Cross street/directions to job site: New residential single- or could- family dwelling unit.
Includes attached garage.
1,000 sq. R or ices 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. R or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.: 02 S'/ • ., GQ — o a 10o _
Limited energy, non-residential 75.00 2
DESCRIPTION OF WORI( Each manufactured or modular
INSTALL PLUGS dwelling service and/or feeder 90.90 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
0 PROPERTY OWNER
I q TENANT 201 amps to 400 amps 106.85 2
/ 401 amps to 600 amps 160.60 2
V, /Name: PACIFIC MEDICAL 601 amps to 1,000 amps 240.60 2
/Kl t
Address: 13200 SW PACIFIC HWY Over 1,000 amps or volts 454.65 2
"""fff "` Reconnect only _ 66.85 2
City /State/ZIP: TIGARD, OR Temporary services or feeders Installation, alteration, and/or
Phone: (503)234 -6381 I Fax: ( ) relocation 200 or loss 66.85 ' 1
Owner installation: This installation is being made on property that I on which is not 201 amps to 400 amps 10030 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 circa —new, alteration, or extension, per panel -
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
- B. Fee for branch circuits
Contact name: wfthor service or feeder fee, / la -�s
46.85 2
Address:
each branch circuit •
Each add'l brunch circuit a 6.65 $ / 3..56 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax ; ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
— 7 extension. Describe: Page 2 2
Business name: Oregon Electric Group
Address: 1010 SE 11th Ave Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Portland, OR 97214 Investigation per hour (1 hr min) 62.50
Phone: (503)134 -9900 I Fax: (503) 535 - 2763 Indagtrial plant per hour _ 73.75
ELECTRICAL PERMIT FEES"
CCB Lic.: 2 0 3 E l e c t r i c a l Lic..,,26- , . S .. • .: 4460S 6 i r Subtotal e 0 . / .t
Suprv. Electrician signature, required: -,:..< J Trrnir I 3-, oil Plan review (25% of permit fee) /S. (j t
•
Print name: � l + s ate: 08/04 1 1 • / 4. g Z State surcharge (rive of permit foe) Y ff Z.
- $ 0.01 TOTAL PERMIT FEE rO . (j /
Authorized signature: mu permit application expires Ira permit Is not obtained within 180
days after It has been accepted as complete
Print name: G r /G He__ h l. ! ate: os /o4/05 Pea methodology sat by Tri -County Suiidipg industry Service Board
/ /‹.9" ie. Y ..• N umber o ia9pet per parmit allowed. ®,
Q!Y OF TIGARD 6
BUILDING DIVISION PERMIT #: ELC200Er00562
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/20J2005
Phone: (503) 639 -4171 Tia J n
Inspection Requests (24 Hrs.): (503) 639- 4175`'I I�
INSPECTION WORKSHEET FOR DATE: 9/28/2005 TIME: 7:08AM PAGE: 61
SITE ADDRESS: 13200 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: PACIFIC MEDICAL GROUP
DESCRIPTION: Installation of (3) branch circuits for plugs.
OWNER: PHONE #:
PACIFIC PROPERTIES, 503-234 -6381
CONTRACTOR: OREGON ELECTRIC CONST /GROUP PHONE # : 503- 234 -9900
Inspection Request Scheduled For: Date: 9/28/2005 Pour Time:
Code # In • - • • n Description Confirm # Contact # Message
199 Electrical final 016836-02 503-849-2594 Y
Corrections omments nstructions: ® D bQej
•
I t<ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
� �� / �D it
Inspector: 1 Date: � Phone #: (503) 718- Z�