Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
��,� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00011
13125 SW Hall Blvd.; Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/16/03
SITE ADDRESS: 12442 S W SCHOLLS FERRY RD * * ** PARCEL: 1S134BC -00401
• SUBDIVISION: ZONING: C -N
BLOCK: LOT: JURISDICTION: TIG
Project Description: Job No. 70060
Fire Alarm
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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SISTERS OF PROVIDENCE IN OR L H MORRIS ELECTRIC INC
BY STEVE FOSTER 7051 SW SANDBURG ST, #100
PO BOX 13993 TIGARD, OR 97223
PORTLAND, OR 97213
Phone: Phone: 503 639 - 2334
Reg #: LIC 1838
ELE 20 -39C
• SUP 3006S
• FEES Required Inspections
Description Date Amount W FFL L C o VET
[ELPRMT] ELR Permit 1/16/03 $75.00 G E i L I Ncr G o v r✓ IQ
Fit/141
[TAX] 8% State Tax 1/16/03 $6.00
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 throuc
Issued by Permittee Signature % /�/ / 1 ! ,,.
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
Frieetrical Permit FOR OFFICE USE ONLY
�' I I ii D Received Electrical
Date/By: Permit No.€ o?'V 3 -B' //
City of Tigard JAN 15 201' Planning Approval
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIG' RD Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 5031plGG D Post - Review Land Use
` Nfe e r I i Date/By: Case No.:
Internet: www.ci.tigard.or.us ^ ,J�, o!1 I I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply) •
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling n Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: .
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
1 2 4 4 2 SW S CHOLLS FERRY RD The above are not applicable to temporary construction service.
Job site address: FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: SCHOLLS MEDICAL PLAZA Description Qty Fee(ea.) Total
New residential- single or multi- family per 1
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 ; 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 .' 2
Services or feeders - installation, 0 *
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Fax: 201 am to 400 amps 100.30 2
401 to 600 amps
Phone: 133.75 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
• A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: L.H. MORRIS ELECTRIC INC Signal circuit(s) or a limited energy panel, n
7 0 0 6 0 alteration, or extension Page 2 / 2
Business Name: Description:
Address: 7051 SW SANDBURG #100
Each additional inspection over the allowable in any of the above:
City /State /Zip: TI GARD OR 97223 Per inspection per hour (min. 1 hour) 62.50
Phone: 639-2334 Fax: 620-7405 Investigation fee:
CCB Lic. #: 1838 Lic. #: 20-39C Other:
Electrical Permit Fees*
Supervising electrician Subtotal $ 75.00
signature required: Plan Review (25% of Permit Fee) $ .
Print NameGARY P OPLES Lic. #: State Surcharge (8% of Permit Fee) $ 6.00
TOTAL PERMIT FEE $ 81.00
Authorized Noti This permit application expires if a permit is not obtained within
Signature: j� _,. _ Date: 1-1 -0 5 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard -
Page 2 - Supplemental Information \'
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
O Audio and Stereo Systems
E Burglar Alarm
• Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
• Vacuum Systems
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Deck Type of Work Involved:
A ❑ Audio and Stereo Systems
.
❑ Boiler Controls
0 Clock Systems
n Data Telecommunication Installation
X Fire Alarm Installation
0 HVAC a rt (IC.( CAL- ?t m L
❑ Instrumentation
0 Intercom and Paging Systems C L C .0C - c U 3 e.
O Landscape Irrigation Control
n Medical 15 lA D 1 /91 0 3
n Nurse Calls
O Outdoor Landscape Lighting
0 Protective Signaling
n Other
1 Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts \Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested — ( AM PM BUP
Location - _/ /4.4AK Suite MEC
Contact Person Ph ( ) g gU " / - 3/ 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR 3
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire S. er
Su 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
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
. ire Alain
S Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
'
SS PART FAIL
SITE 0 Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line 7J
ADA Dae 2 c�
Approach/Sidewalk t l ` Inspects ' ��_ / "&.► ; i � Ext
Other:
Final DO NOT REMOVE this Inspection record from th Job site.
PASS PART FAIL