Permit CITY ,'O F• TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00837
DEVELOPMENT SERVICES DATE ISSUED: 10/27/2005
`' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S 102CB -02300
SITE ADDRESS: 13240 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT : 008 JURISDICTION: TIG
Project Description: TI Job No. 05.863
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: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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 DEKORTE ELECTRIC
BY MARTIN JOHNSON PO BOX 12379
13200 SW PACIFIC HWY PORTLAND, OR 97212 -0379
TIGARD, OR 97223
Phone: Phone: 503 - 288 - 2211
FEES Reg #: ELE 34 -54IC
LIC 159954
Description Date Amount SUP 4075S
[ELPRMT] ELC Permit 10/27/200' $86.95
[ELPLCK] ELC Pin Rev 10/27/200' $21.74 REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcharge 10/27/200: $6.96
Total $115.65
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
susp- • - • o - than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
ru • s are set forth in 0 ' 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of the - les or direct questions to OUNC at
5 3- 246 -6699 or 1- 800 -33 344. 1
I sued By: o , � Permittee Sig J.
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:
JGONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: / at DATE:
LICENSE NO:
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
This permit cardshall 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.
DEKORTE ELECTRIC LLC 5032882231 10/26/05 OS:00pm P. 004
�+[-•"*` ri- -e...c r Cz"�� V .. KArW I
Electrical Permit Application ,i t.'�' .FO!? 'I.IIC E: USE ON I,\
City of Tigard �' xere,.T: O �1 ?unlit N° &c ao€s 'oo'37
13125 SW Hall Blvd, Tigard OR 97223 Plan Review
Phone: 503.639.4171 Fax 503.598.1 c� q
NAP,' - • �, I Date/By: Other Permit
Inspection Line: 503.639.4175 C� Ga 1 _ ! I I - Date Rcady/By: t ® See Page 2 For
Internet www.ci.tigardor.hu (
5ttb .It p pF94tR, NahiflcA/Mcthod: 1 (Sr I Supplemental Information
TYPE !1�
' s bnt � 1ts1 PLAN REVIEW.:: .
❑ New construction I Addition /replacement Please check all that apply:
1.3 Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY'. OF CONSTItUCI ION of 1- and 2- family dwellings 4 or more new residential
1- and 2 - family dwelling Z Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
Multi family ❑ Master builder [] Other: ['Building over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE . INFORMATION AND LOCATION ■ . ighting plan RV park
lk. Job no.06. x(03 Job site address: f -3 2 5 -C/<ciL 4 W tf4 H th -care facility ❑o�
u , mht ,_ sets of plans with any of the above.
City/State /ZIP: j IJ I 0K ( '7 3 �� a above are not applicable to temporary construction service.
Suite/bldg. /apt no.: Project name: v. i ., �.n
FEES SCl DIJLE
I • ■ /J De: aiming' f Qty. I FM ' Total Cross street/directions to job site: /,/XIIA, 2 J New residential single- or multi -family dwelling unit.
� luel a ttached ga rbage
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 , 2
Limited energy, non - residential 75,00 2
. DEACR1PTION OF WORK • Each manufactured or modular
V „ - - t (- - ' n 1 1 � C ' ` f _ LA LIrt O ,' 4/ i
dwelling, Services service r s ins allati 90.90 _ 2
I
���J �( , �'i l/ J fjl`� � ..� 'f'1�•� Services or feeders installation, alteration, and/or relocation
- I h 1(v C.h ( ;U. CA AA.4 200 amps or less 1 80.30 ir0 , ) 2
, I3 PROPERTY OWNER . : ❑ . TENANT 201 amps to 400 amps 106.85 2
• 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2 _
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
CI . APPLICANT . • Fee for branch circuits with
1 ❑ CONTACT PERSON A. service or feeder fee, each
Business name: branch circuit I 6.65 1') , 0 2
B. Fee for branch circuits 1]!
Contact name: _ without service or feeder fee, • .
each branch circuit 46'85 2
Address: . '
Each add'! branch circuit 6.65 2
City/StateJZIP: Miscellaneous (service or feeder1duded)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: DeKorte Electric one •
Address: PO Box 11379 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Portland, OR 97212 Investigation per how (I hr min) 62.50
Phone: (503) a- 8$- e10'1\ \ I Fax: (503) 288 -2231 Industrial plant per hour 73.75
.ELEC IMICAL PERMIT FEES* .
CCB Lic.: 159954 Electrical Lic • 3 54 15 pr■ Lic.: 75S Subtotal $ to . CT
Suprv. Electrician signature, required: /� Plan review (25% of permit fee) +2-& e - � `�
a ��. �� State surcharge (8% of permit fee) 5-, l(,
Print name: 1 'ex... _ke Date: ( 0 f- t TOTAL PERMIT FEE
I ttp6 -
Authorized signature: This permit applieatiou expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: I Date: • Fee methodology sa by Tri-County Building Industry Service Board
F ,fl Dla 1012:5_12:5—
CITY OF TIGARD .
BUILDING DIVISION - PERMIT #: E1.C2005•00837
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/27/2005
Phone: (503) 639 -4171 t
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/10/2006 TIME: 7:00AM PAGE: 92
SITE ADDRESS: 13240 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FREW1NGS ORCHARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: PACIFIC MEDICAL GROUP
DESCRIPTION: TI Job No. 05.863
OWNER: PACIFIC PROPERTIES, PHONE #:
CONTRACTOR: DEKORTE ELECTRIC PHONE #: 503
Inspection Request Scheduled For: Date: 1/10/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 024463 -01 503- 288.2211 N
Corrections/Comments/Instructions:
The electrical installation defects noted •
on this report shall be corrected and
an Inspection request made within 20 .
calendar days per OAR 918-271-0030
IM v ST 4vzsvo YY1 A t .5 €F
Eta. Acrilf■tJE e ILt)e-44
i N `Mi•`V1E •1..pc.f2r,tsN arm N(57
(t.s2■Vt 2c v1/44 p S e.szm
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v 'n I' t Date: lO" 0 V Phone #: (503) 718- 1:110
CITY OF TIGARD ' .
BUILDING DIVISION PERMIT #: ELC200S.fl0l3i7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/210.005
Phone: (503) 639 -4171 aep lil
Inspection Requests (24 Hrs.): (503) 639 -4175 °`__—
INSPECTION WORKSHEET FOR DATE: 2/6/2006 TIME: 7 :02AM PAGE: tg
SITE ADDRESS: 13240 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FRFWNGS ORCHARD TRACTS LOT #: 003 TYPE OF USE:
PROJECT NAME: PACIFIC MEDICAL GROUP
DESCRIPTION: II Jo: o. 05.863
OWNER: PACIFIC F ' PERTIES. PHONE #:
CONTRACTOR: DEKORTE EL CTRIC PHONE #: 503 - 288 -2211
Inspection Request Scheduled For: Date: 2/6/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 026167 -01 603-288-2211 V°
Corrections /Comments /Instructions: \n^
A\ 1Y
PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G-Aa Af 76 Lk
Date: 21b 01) Phone #: (503) 718 - -wig