Permit AviT .
' •
, .
Y OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004- 00639
1 1P DEVELOPMENT SERVICES DATE ISSUED: 10/5/2004
'� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134BC-00401
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 100
SUBDIVISION:' ZONING: C -N
•
BLOCK: LOT : JURISDICTION: TIG
- Project Description: Install (1) branch circuit for bone density receptacle.
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: _ W /SERVICE OR FEEDER: . PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 • 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:
• SISTERS OF PROVIDENCE IN OR OREGON ELECTRIC CONST /GROUP
BY STEVE FOSTER ' 1010 SE 11TH AVE •
PO BOX 13993 PORTLAND, OR 97214
' PORTLAND, OR 97213
Phone: Phone: 503 - 535 -2652 •
R eg #: 1 1 1C' 203 '
. SUP 4460S '
FEES ELE ,26-95C
Description - Date , Amount -
Required Inspe ctions . .
[ELPRMT] ELC Permit . 10/5/2004 $46.85
[TAX] 8 % Surcharge 10/5/2004 $3.75 Rough -
Elect'I Final -
• ' Total $50.60
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 direct questions to OUNC at (503)
246 -6699 or-1 -000 332- 44. '
Issued By: Permit Signature: All ) //°L -i L' }- j lo/N./
- 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 7:00pm for an inspection the next business day
OCT -04' M FROM - Oregon Electric Estimating 5032313587 T -602 P.001 /002 F -606
Exec
City b nun AREA \ b RC Geived . .
� / �� le/1
Cary o r Date/By; /Of Y lNe 'G,100 ` —00031
13125 S W Hall Blvd., Tigard, OR 97223 Plan Review
Phone; 503. 639.4171 Fax: 503.598.190L I 'y 2004 '' , ' ti ; i' � t 'ik DatcBV: Otter Pernik:
Inspection Linc: 503.639.4175 ' 1 Date Ready /ay: Jags. la See Page 2 for
Internet: www.ci.tigar'd•or.ts CITY OF TIGARD Nodficd/Metbod: Supplemental Information
',�.t±.IsIOrv, .... • 1'1iiAN. PREVIEW • ,
❑ Ncw construction ED Addition/alteration/replacement Please check all that apply:
[] Demolition 171 other ❑Service over 225 amps, comm'l Hazardous location
['Service
• . • • • • ' . ' ECAT'EGORY; OB.'CONSTR;[TCFIUN:.,. .. ' : of I- rating ❑
I- and 2 family dwellings 4 ordmore over new residential d
1:1 1 an 2- family dwelling ® Comrrlercial/industrial ❑ Accessory building ❑System over 600 voila nominal units in one structure
❑ Multi-family ID Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
. ,_ ❑Occupant load over 99 persons OManufactered structures or
' • ' : J(OB .STFE INFORMATION'•i1NR: X. OC TION :'" • ❑Egressnighting plan RV park
Job no.: 19969 I Job site address: 12442 SW Seholls Ferry Rd ['Health-care facility ['Other:
Submit 2 sets of plans with any of the above. ,
City /State/ZIP: Tigard, OR 97223 The above arc not applicable to temporary construction service.
Suite/bldg. /apt_ no.: 100 I Project name: Providence PMG Sciolls Bone . ' FEE! 'SCHEDULE . • • _
v- tai+-• Doeerfptron I Qry. I Bee I Tend ] --
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Include% attached garage.
1,000 sq. fr. or less 145.15 4
Subdivision: J Lot no.: En. add'l 500 sq. ft. or portion 3340 1
Limited energy, residential 75.00 2
Tax map/parcel no.: Limited energy. non - residential 75.00 2
. .'DECRBTION .0F..::WORIC : • • .,.• ... Each manufactured or modular
Install dedicated receptacle for bone density dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
. • 201 amps to 400 amps 106.85 2
.❑ 'PROPERTY'i'OWNER, • ,.•, . ..a
TENANT ,..TENAtN ...
-- _ 401 amps to 600 amps 160.60 2
Name: Providence PMG 601 amps to 1,000 amts 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Recormect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: (503)216-9241 I Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is nor 201 amps to 400 amps 1 0030 2
_
intended for sale, ]ease, 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
0 APPLICANT .. . I ❑. CONTACT PERSON :. • A. Fee for blanch circuits with
service or feeder fcc, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits �i
Contact name: without service or feeder fee, 2 46.85 % � 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax :: ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
' • ' ' ' ' ", C7O1`I.TR'6`CTOR..•: • ' ' ;;r• .. l' •. energy panel
• ,alteration, r o
extension. Describe: Page 2 2
Business name: Oregon Electric Group
Address: 1010 SE 11th Ave Each additional inspection over allowable in nny of the above
Per inspection 62,50
City/ State/ZIP: Portland, OR 97214 Investigation per hour (1 lir min) 62.50
Phone: (503) 535 -2652 7/i' 0 CP Fax 503) 231 -3587 /Di1/0 Industrial plant per hour 73.75
S ' _ ELECFRICA'L PERMIT FEES *.
CCB Lie.: 203 i Elec j/` ' . 6- . C Suprv. Lie!: 44605
1 _ _ 1i/6�
Suprv. Electrician si attire, r ut .4r -/-Fr p get eQ , Plan review (25% of permit fee)
Print name: itfilifi , 1 '/ I ef f6 / G j State surcharge (8% of permit fee) c.
}
`.. TOTAL PERMIT FEE . (,) 4, U
Authorized signature: ,/ This pernnit ;molten don expires if a permit Is not obtained within 180
�) // days after it has been accepted as complete
Print name: 1 /,� Z J ` .. 7 /i/7 / J7 Date: > t J /� • Fcc methodology set by Tri -County Building Industry Service Scant
•• Number or inspections per permit allowed.
i. Building \rconite\ELC- PcmitAppAoc 12/03 440.4613T(tOIO2/COM/WPu
CITY RD
24-Hour ,.
Inspection Line: (503639 -4175
INSPEC ISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / Q _ Z Z AM PM BUP
•
Location cps P— / uite b b MEC
Contact Person Ph ( ) t 9 - x-7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 7)0 6°
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam •
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam _
Rough -In
Gas Line
Smoke Dampers V
Final
- PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab V A /
Low Voltage /" i .l
Fire Alarm •
S'►y PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
/
Approach/Sidewalk Date ` U �y Inspector IEXt
Other:
Final DO NOT REMOVE this inspection record from th job site.
PASS PART FAIL