Permit •
Yy
C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2006 -00164
� y � DEVELOPMENT SERVICES DATE ISSUED: 7/10/2006
13125 SW Hall Blvd., T igard, OR 97223 503 - 639 -4171 PARCEL: 1SI34BC -00401
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 201 ZONING: C -N
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Limited energy for voice and data. Job No. 53123 •
A. RESIDENTIAL B. COMMERCIAL
• AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PROVIDENCE HEALTH SYSTEMS OREGON ELECTRIC GROUP
4700 NE GLISAN ST 1010 SE 11TH AVE
PORTLAND, OR 97213 PORTLAND, OR 97214
Phone: Contact #: FAX 503 - 535 - 2763
PRI 503- 234 -9900
FEES Reg #: ELE 26 -95C
LIC 203
Description Date Amount SUP 4460S
[ELPRMT] ELR Permit 7/10/2006 $75.00
[TAX] 8% State Surchart 7/10/2006 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other pe • . ble laws. All work will be done in accordance with approved plans. This permit will expire if work is not
star d within 180 e - ys of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
yo to follow rules as • p • • by Oregon Utility Notification Center. Those rul a et forth in OAR 952 -001 -0010
th ough OAR 952 -00 0101 • may obtain copies of these rules or , dire • - ti• • to OUN -t 503- 246 -6699.
Iss ed By: 1 0 ' V A L Permittee - 'gnature: i' _L, d
—
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.
JUL -06 '006 03 :50PM FROM -OR ELECTRIC SVC 5035352763 T -419 P.001/002 F -733
4MielIkrical rermlt A lie "on 1 ,
r(llt Ol i l( F: I'S1: 0 . \1.1
City OINTigard E
I II .r i Received
13125 SW Hall Blvd., Tigard, OR 97223 '� Date( �0�0 Peemit Na rCL/li
Phone: 503.639.4171 Fax: 503.598,1960 �», �• Plan nevi
teveelw
Inspection Line: 503.639.4175 111 ..� Ij Date/11x : Re i' Other Permit:
www.ci,lilpud,orais � (� _ Non'Hed/Metlwet ®gK nent 2 for
/� r3upplemaatal
•
TM,V* 3 ffl ( : !.�Jf 1. ... • • PLAN REVIE
D New construction 0 Addifi rWalt iliorihepla ni 't fa 1 i Please cheek all that apply:
❑ Demolition ❑ Other: DServicc over 225 amps, comm'l ❑Hazardous location
• CATEGORY .OF CONSTRUCTION ❑Service over 320 amps — rating OBuildng over 10.000 sq. ft..
- of 1- and 2 -family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ® Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one smictu t
['Building over throe aroric ❑Feeders, 400 amps or more
❑ Multi - family 0 Master builder ❑ Other:
—
JOB SITE INFORMATION AND • LOCATION ❑Occupont load over 99 persons ['Manufactured structures
❑
Job no.: 53123 /lighting plan RV perk
I Job site addtes's:12442 SW Scholia Ferry Rd. OHealth facility DOtber:
City/State/ZIP: Tigard, OR 97223 The 2 sets of plans with any of the above.
7 he above are not applicable to temporary construction service.
Suite/bldg./apt no.: 0/ l Project name: Providence Scholia FEES SCUEDULE
Cross stir er/directions to job site: °eQiPa°° B" r� »
New residential single- or multi - family dwelling unit.
Includes attached garage.
1.000 sq. R or less 145.15 4
Subdivision: 1 cot no,: . • _ Ea. add'I 500 sq. R or portion 33,40 1
Tax map/parcel no.: • ■ Limited energy, residential 75.00 2
DESCRIPTION OF WORK Limited energy, non-residential 75.00 2
Each manufactured or modular _
Low Voltage voice and data cabling 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 • In TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps
Name: Providence Health Systems _ 160.60 2
601 emps to 1.000 amps 240.60 2
Address: 4700 NE Glisan St. Over 1,000 amps or volts __ 454.65 2
City/State/ZiP: Portland, OR 97213 Reconnect only 66.85 2
Temporary services or feeders installation, alteration. and/or
Phone: ( ) 1 F ax: ( ) relocation
Owner installation: This installation is being made 201 amps to less 66.85 1
ge, g e oa according property that I own which is not 201 amps w400 amps 100.30 2
intended for sale, lease, tent, or exchange, 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 I I • 0 CONTACT PERSON A. Fee for branch circuits with '
service or feeder fee, each 6.65 2
Business name: circuit
branch Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 _ 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pwnp or irrigation circle 53.40 2
E -mail:
Sign or outline lighting 53.40 2
Signal citcuit(s) or limited-
CONTRACTOR energy panel, alteration, or
Business name: Oregon Electric Group extension. Describe Page 75° 2
Address: 1010 SiJ 11th Ave Each additional Inspection over allowable in any of the above
Per w 62.50
City/State/ZIP: Portland, OR 972I4
Investigation per hour (I hr min) 62.50
Phone: (503) 234-9900 535 -,91,q y I Fax: (503) 535 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* •
CCB Lic.: 203 Electrical Lic.: 2 . '5 I . up ie.: 4460S subtotal 15. 5. 0 O
Suprv. Electrician signature, required: ! J Plan review 5 %of
R permit fee)
Print name: !'i J 6M � h, Da c: (0/ p/,, State surcharge (8% of permit fee) (p . 0
TOTAL PERMrr FEE I gi. C O
Authorized signature: , J — This rmit n (radon wetter If a
permit PPl paints is not ebDdned Wad
Print name: NA a j' I s , . _ 7/6061 • dm's s terlr i- Dona a Buildi d m complete
a Fee methodology set by 'iti.Cowny liurldiug Indeatry Senn Boarq
��
Number of inspc ions per permit allowed J J
i:\2ui1dios PertniuEELc- ramiiAppdoe 1203 • ---* 4404615T(I0/O2/COM/WE6
CITY OF TIGAR.D_ ..
BUILDING DIVISION A PERMIT #: ELR2006.00164
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7 /10/2006
Phone: (503) 639 -4171 , � 1 ° 1 b��1
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 7/12/2006 TIME: 7 :05AM PAGE: 51
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 201 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE HEALTH SYSTEMS
DESCRIPTION: Limited energy for voice and data. Job No. 53123
OWNER: PROVIDENCE HEALTH SYSTEMS, PHONE #:
CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503- 2:34.
Inspection Request Scheduled For: Date: 7/12/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 032942 -01 503-793 -5912 Y
Corrections /Comments /Instructions: " K C M
'V
z IK N PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Q' 68 Date: 1 ( 12 40 ( Phone #: (503) 718- 2 f) •