Permit •
CITY OF T ELECTRICAL PERMIT
, ; DEVELOPMENT SERVICES PERMIT #: ELC97 -0324
VIY/ DATE ISSUED: 06/16/97
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL: 2S112DA -01300
SITE ADDRESS...:06640 SW REDWOOD LN
SUBDIVISION •MLP96 -0002 ZONING:I —P
BLOCK • LOT • JURISDICTION:
Project Description : INSTL 1 SIGNAL CIRCUIT/LIMITED ENERGY PANEL // JOB * J -743
- -- 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 • 1
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/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
PACTRUST type amount by date recpt
15350 SW SEQUOIA PKWY PRMT $ 40.00 TAT 06/02/97 97- 295319
STE 300 5PCT $ 2.00 TAT 06/02/97 97- 295319
TIGARD OR 97224
Phone #:
Contractor:
G B MANCHESTER CORP $ 42.00 TOTAL
5012 NE 42ND AVE
REQUIRED INSPECTIONS
PORTLAND OR 97218 Ceiling Cover Underground Cove
Phone #: 287 -1112 Wall Cover Elect'l Service
Reg #..: 000648
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 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -8010 thro .,,,, -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (5031246 -1987.
Permittee Signature: ���!/'!�N,(.Qel, Issued By: , .t _ _ .4 0
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: /(2 7
LICENSE NO: f Olv,7LE
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
ra
Community Development ELECTRICAL PERMIT APPLICATION
• 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # ,t-(7 - b, 2
.7r. l l w' I ;,
.� II Phone (503) 639 -4171 Date Issued (gt/97
''` FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by - 11
Inspection (503) 639-4175
1, Job Address: thw YI LL 4. Complete Fee Schedule Below:
Name of Development , JI B .fr/n.:!' .I �� � ;"! %' Number of Inspections per permit allowed
Address t / / ..1/,p Rs PI AA (eJ kr . , Service included: Items Cost(ea) Sum
City/State/Zirrr ,l, / 0 97 4a. Residential - per unit 4
/ / _ ` 1000 sq. tt. or less $110.00 -
Name (or name f business) �: =!�= Each additional 500 sq. ft. or
ii�i���ii� portion thereof $25.00 1
Commercial Residential ❑ ' 7413 Limited Energy $25.00
Each Maned Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
�
-n I alteration, or relocation 2
Electrical Contractor 5 ,i� / " n/J9?
Qr l_. 200 amps or less $60.00 2
Addre
(/ 201 amps to 400 amps $80.00 2
i , 401 amps to 600 amps $120.00 - 2
City ( i .. _ i ,♦�!� State � Zip 601 amps to 1000 amps $180.00 2
Phone No. _ .`' - /1/ Over 1000 amps or volts $340.00 2
-
Contractor's License No. ■ Aggf_ /1J Reconnect only $50.00 -
Contractor's Board Reg. No. , ! /.Z,. 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n .,,,, _ . - , ` 200 amps or less $50.00 2
-
License No. / 0631- • / Phon- No. frie - 201 amps to 400 amps $75.00
- 401 amps to 600 amps $100.00
• Over 600 amps to 1000 volts
2b. For owner installations: see 'b' above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip Each branch circuit or feeder fee. $5.00 2
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service O1 feeder fee. 2
First branch circuit $35.00 2
not intended for sale, lease or rent.
Each additional branch circuit $5.00
Owner' 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 $40.00
Signal circuit(s) or a limited energy ! 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension / $40.00 10, t>)
4 or more residential units in one structure M inor 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: ,/
NOTICE 5a. Enter total of above fees $ 4 O
5% Surcharge (.05 X total fees) $ ,2 do
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. ❑ Trust Account # $
Balance Due $ 4v.
rad`oanMN .. pm..pp
Page No. 1 CASE HISTORY FOR CASE NO.: ELC97 -0324
PROVIDENCE CLINIC
06640 SW REDWOOD IN •
05/13/98
Action Description Req/ Scbd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
---- - -- -- - - - - -- - --
ELCA001 Application received 06/02/97 / / 06/02/97 06/02/97 TAT
ELCA003 Permit created 06/02/97 / / 06/02/97 06/02/97 TAT
ELCA500 (F) Issue permit / / / / 06/16/97 PASS TAT 06/16/97 TAT
ELCA700 Ceiling Cover 06/02/97 / / 08/06/97 PASS MJR 08/06/97 MJR
ELCA799 Elect'l Final 06/02/97 / / 01/26/98 PASS BRP 01/26/98 J *H
ELCC800 Case Finaled / / / / 01/26/98 PASS BRP 01/26/98 J•H
•