Permit l &irirr1 -to add c or Wra r )mQ . se_A ?////b9-
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CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00297
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/24/2007
PARCEL: 1S134BC-00401
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 ZONING: C -N
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: PROVIDENCE
Project Description: Low voltage for HVAC wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PROVIDENCE HEALTH SYSTEM AMERICAN HEATING
4607 NE GLISAN 1339 SW GIDEON ST
PORTLAND, OR 97213 PORTLAND, OR 97202
Phone: 503- 215 -6282 Contact #: PRI 503- 239 -4600
FAX 503- 239 -7038
FEES Reg #: ELE 26- 993CRE
LIC 33135
Description Date Amount SUP 2640LEB
[ELPRMT] ELR Permit 7/24/2007 $75.00
[TAX] 8% State Surcha 7/24/2007 $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
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 these
rules or direc • - stions to OUNC at 503.246.6699 or 1.800.332.2344.
Issue = // ,;/ // 4' . l Permittee Signature: \Tef
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.
1111. t
,iuL.1.7.200710:47AM 503239]038 NO. 2551 P. 2/3
201!` �/
Electrical'Permit A ' 6E1 ir: FOR OFFICE USE ONLY
R f p Received 7 9 per ecitN .: /) ♦ ' lf)A A
City of Tigard Dater■e 13125 SW Ha(l Blvd., Tigard, OR 97223 .Plan Review prher Permit Ins Phone: 503.6394171 Fax: 503.598.1960 JUL 2 J. + ', 1 ,,,,, ` ;1 1 1 Dale Ready /B ,, lam • t EI see lPaeat (e'
Inspection Line: 503.639.4175 !'� 'p � �' -'s/� U 12i Supplemental Sec tarormagoq
p www. lid `L.� d r OF \ • Naga/m.0.4
Ot tl or -u re � . r , a Cj�`y '
• z , { Z P ,r ' f t . [J .. "L �. ' 'L: : !'i; , 1 j , r : - 1 ,. - . 7 2-,. T r �. � M f .j .. _
i!! -�!? : - ' ' � ru l . ,.. ...I...4' .: .1.�. , � . I please check all that apply: ■
1:1 New construction �� Additiort/alttu & tion/repls a • 1' �'I Ell- Ianrdous location
❑ Service over 2ha amps,
O Other ❑Servi over 320 amps -rating ❑ Buildng ovar10,000 sq. ft,
12 Demolition
r v l , 4 p � n e /§1`',' t k ~ 1 I ' t ' • 1 i ' r ,` of 1 -and 2- family dwellings
4 or mare net/residential LI.: , -- .'%4:.': - - �_.. QSystem over 600 volts nominal units in oncs/ei
ideide
res
= 1 -and 2- family dwelling ►;, CommereipUindusCtial [] Accessory building []Building over three stories ❑Feeders, 400amps or more
Ej Multi farraly • ❑ Master builder 0 Other r ❑Oecupant load over 99 persons QMMa actuted structures or
E s/ii hting p lan park
t d rr "],rY11 L -•i[ tIt,i, , ' •• , ' i r r t .. '� ti-,:L, , i;.1 :, � ❑ 8 g ❑Oth
'� 4.:-_-_ , ` t� �I) t_ F l 7 � .v_ • :�._. / . ��_a .. _ era.,..: ,
_Li_ l- I �(EIESI[h<;sre�elllty
• Job no.: Job Bite address: / 2 1/2 5 W Sc o 1)5 !r f Submit 7 sets of plans with any of the above.
p 3 The above arc not applicable to temporary construction service.
City/State/ZIP: - G r � 0 I �ZZ *, , I I °` �F.i I ` -= r/NoL "f ".; 4.- -
SuitelbldgJapt. no.: 1O 1, Project name: ? VI c c e Description Qtr• "� ate
Sc t 11 s F r ! r M O S New residential single. or multi- Family dwelling ua(t
Cross street/directions to job site; Includes attached gangs. --
1,000 sq• tt. err less 145.15 4
Ea. add'' 500 sq. ft- or portion 33.40 l
Subdivision: Lot no.:
Limited energy, , residential 2 al
Tax reap /parcel no Limited energy!, non - residential 75.00 2
.. ! ". '1 , 7 �l Il :1-1,-i ' i 1'_11.1 r f ❑r , ' -._ E " �_ . :'1..1., Each manufactured 0T modular 90.90 Z
". _ _ .. _. j ..� .., . 1 r .,_.W -_.._ dwelling. service and/or feeder ,
0 W V 1 e -. f IVA c .7 ~$-f W I x 117 Services or feeders Installation, alteradoIt, end/oirelocation
200 amps or less 80.30 2
_• ; 201 mps of 400 amps ' 106 . 2 ,
, r T ii l it .,..,_. . of 160.60 Z
.. ..r 4 1 .. . .. n I. r. {�.. , rs. . e I ..1... .._ �.., rl , -...;� , ,. ;. , .. 401 amps to 600 amps 1 6 0 .6
tQar'rte:
601 amps to 1,000 amps 240.60
Over 1,000 amps or volts ___=_, 454.65 2.
Address: Rtconheet only 66.85 2 _.
.City/State'Zll: 'Temporary services or feeders installation, alteration, and /or
_ rotocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner fps':ellation: This installation is being made on property that I own which U is not 2 01 amps to 400 a mps 10030 2
- 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and , , , t t amps 133.75
Owner signature Date: Branch circuits - new, altcriet1014 or eztearioot Per Panel
} A- Fee for branch circuits •W
e.t'1,:,7i t :, v c el f,4� r I. : ::?, d ;u� :, ° _. ,: � !� 2 •
l il J'i .rl. ] , .:., service or (ceder tea, each 6.65
• ' " ... _ . branch circuit �
Business Heine: � 1 (I _ t� �� B. Fee for branch circuits
Contact nattte: e tic G is---1 y, I C without service or feeder fee, 46,85 2
each branch circuit
Aass: ddr ti 3 G, 1 E 1 • ' iiii Bach add'' branFtt circuit r 6.65 2
City /State/ZIP: IDO y'4 I, 0-r1 a OP- on ? 6'a• Nil ascel, ae ons (service err feeder not iuc ltidad)
Pump or irrigation circle 53 "40 2
Phone: ') D3_ 1 _ , pc, Fax:: ejjb )C1 sign or outline lighting 53.40 2
Signal circult(s) or limited -
' ,'+ c t r IA f, I j energy panel, alteration, Or' 2
u. ...':Z,j F �_ , t tILL.. - !7 „?.,.n.S..ii. 2',' __ - Pe e2
�,,,, _•.,�,. , �.._... extension. g
Business n i ' I l r fi 't a' ! -
Lack additional inspection over allowable in any of the above
Address: G ■ i � I Per,inapecrion 62.50
City/State/ZIP: Pipe _ '() r • '1'3U ' Investigation per hour (1 hr rein) 62.50
73.75
�.y/ - /) `7 J�� �J'[y Industrial lent per hour 1
V r� V F� ) / lLitJv l q p' »Li (,- ,,_ • IZf i� ,, r7't �Ulf_
subtotal 7 ,
Phone: ( ) /y _ _.�, , - -
_ Electrical Lit.: , c q3 (� Sup Lie.: ( p (j �'�"j
required r �� • _,�� Plan review (25% of permit fee) _
Suprv.131eclrician sigtia(vre, e4 _ I o
�I.� 7 - D l State surcharge (8% of permit fee) lG .
Print name: : 5.4e 4 . Q _ i Date: 'TOTAL PERMIT FEE • g' 1.00
r
Authorized signature: N, t I APA 1 ` '� ---- This pe rmit application expo 1f a permit's not obtriaaa within 1E0
• � days otter It has been accepted as complete
- . Q7 ' Pee mschodolo y set by Tri t:ormty Building Industry Service Board
�� Date: •• Number of inspections per pertain allowed.
u n.f,, I err inmair.'nt t1WSB •
CITY OF TIGARD __
BUILDING DIVISION PERMIT #: ELR2007-00297
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/24/2007
Phone: (503) 639 -4171 'a'
Inspection Requests (24 Hrs.): (503) 639 -4175 I �I
INSPECTION WORKSHEET FOR DATE: 10/10/2007 TIME: 7 :01AM PAGE: 66
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE
DESCRIPTION: Low voltage for HVAC wiring.
OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 503215 -6282
CONTRACTOR: AMERICAN HEATING PHONE #: 503 238 -4600
Inspection Request Scheduled For: Date: 10/10/2007 Pour Time:
Code # Inspection Description Coonfir Contact # Message
'l °8 Electrical final 6c7251 -01 503 - 209 -6607 N
Corrections /Comments/ Instructions:
\ -'-,
Q .
m ,
/V
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/".. 71/4/
Inspector: Date: I Olt Q (r) Phone #: (503) 718-
,