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Permit CITY T ELECTRICAL PERMIT ,;��� ; � PERMIT #: ELC98 -0692 • DEVELOPMENT SERVICES DATE ISSUED: 11/19/98 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134BC -00401 SITE ADDRESS.. °:12442 SW SCHOLLS FERRY RD #2NDF SUBDIVISION ZONING:C —N BLOCK. • LOT • JURISDICTION: TIG Proj ect Description : Installation of 2 branch circuits. To be placed in the telephone roou on the 2nd floor. Job No. 78384. - -- 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..: 0 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 1st W/0 SRVC OR FDR.: 1 PER HOUR • 0 401 — 600 amp : 0 EA ADD'L BRNCH CIRC: 1 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 PROVIDENCE HEALTH SYSTEM type amount by date recpt 12442 SW SCHOLLS FERRY RD PRMT $ 40.00 DEB 11/19/98 98- 310943 TIGARD OR SPCT $ 2.00 DEB 11/19/98 98- 310943 Phone #: Contractor: OREGON ELECTRIC CONST /GROUP $ 42.00 TOTAL 1010 SE 11TH AVE REQUIRED INSPECTIONS PORTLAND OR 97214 Elect' 1 Service Phone #: 234 -9900 Elect'1 Final Reg #..: 203 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 -0010 through OAR 952 -001 -1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503)246 -1987. 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 ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + ++ Community Development pECEIV ECTRICAL PERMIT APPLICATION ri 13125 SW Hall Blvd. . Tigard, OR 97223 i.l r tl 1 c lck/Rec. # � ... 1' N• ;' ermit# �.c-C98 -o(PS� ��1 Phone (503) 639 -4171 � o:vaDaterlIssued / / -9 g FAX (503) 684 -7297 CITY OF TIGARD TDD No. (503) 684 -2772 Issued by 1 �..e,�0 • Inspection (503) 639 -4175 1. Job Address: tJ oB NO . 7 8 3 8�4 4. Complete Fee Schedule Below: Name of Development Providence `I 4 Number of Inspections per permit allowed C Address 1 2442 SW Scholls Ferry g- Service included: Items Cost(ea) Sum City/State/Zip Ti gard 4a. Residential - per unit 4 1000 sq. ft. or less $110.00 Name (or name of business) Providence Each additional 500 sq. ft. or ^ portion thereof $25.00 1 Commerciab acx Residential ❑ Limited Energy $25.00 Each Manul'd Home or Modular 2 Dwelling Service or Feeder $68.00 2a. Contractor installation only: 4b. Services or Feeders Installation, alteration, or relocation 2 Electrical Contractor Oregon Electric Group 200 amps or less $60.00 2 - Address 1 01 0 SE 1 1 th 201 amps to 400 amps $80.00 2 Cl Pnrt 1 a nrl State or _ Zip 9 7 2 1 4 401 amps to 600 amps $120.00 2 - City p 601 amps to 1000 amps $180.00 2 Phone No. 2 3 4-9 9 0 0 Over 1000 amps or volts $340.00 2 Contractor's License No. 2 6- 9 5C Reconned only $50.00 - Contractor's Board Reg. No. " 3 4c. Temporary Services or Feeders Installation, alteration, or relocation 2 Signature of Supr. Elec'n ifed4 200 amps or less $50.00 2 - License No. 2 8 41 S hone No. 2 3 4 9 0 0 201 amps to 400 amps $75.00 2 401 amps to 600 amps $100.00 - Over 600 amps to 1 000 vona 2b. For owner installations: Bee 'b' above. Print 4d. Branch Circuits rint Owner's Name New, alteration or extension per panel Address a) The lee for branch circuits with City State Zip purchase of service or feeder fee. 2 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 1 $35.00 3 5. 0 0 2 Each additional branch circuit 1 $5.00 5 _ on 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 $40.00 Signal cirouit(s) or a limited energy 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 Mi nor 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 n n n 5% Surcharge (.05 X total fees) $ 2-00 PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 4 2 _ 0 0 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 $ 42 _ n n warkanciW.Nc-pm.app CITY OF TIGARD BUILDING INSPECTION DIVISION 6-(1.40 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP `1 c2- #/t v 0 4 Date Requested 0- - 30 AM PM BLD Location I? `ic sC4 Oi L JAybuite MEC Contact Person 4 E ?LVY Ph - 7 - 8178' PLM Contractor O/Z et-6C a Ph S SWR / � BUILDING Tenant/Owner (�/eG' 11 T �!4ge g&DC 6 1F r Retaining Wall ELR Footing ACCeS Foundation -� d �+ Aa4td FPS Ftg Drain SGN Crawl Drain Inspection Notes: �L _ /� �� Ca . t _ Slab U l ,�(� -d SIT Post & Beam I� l find E R-06 /sT FtQO/_' Ext Sheath /Shear F Int raming th /Shear N /o� 7330 Insulation / Drywall Nailing Firewall Fire Sprinkler J j) C�� -..� — Alarm Susp'd Ceiling Roof Misc: Final ��� P ASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final FAIL LECTRICAL Se Rough In UG /Slab Low Voltage Fire Ala Fi PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk p Other D Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site..