Permit ELECTRICAL PERMIT -
�, CITY OF TIGARD RESTRICTED ENERGY
pr DEVELOPMENT SERVICES PERMIT #: ELR2003 -00034
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/5/03
SITE ADDRESS: 12442 S W SCHOLLS FERRY RD * * ** PARCEL: 1S134BC-00401
SUBDIVISION: S u/ re s l O I t Off. ZONING: C -N
BLOCK: LOT: JURISDICTION: TIG
Project Description: Ins -k1( d a-L +e I¢ca ►-, 0-1.Nicam -f, -0 n. s ysfe w..s
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:
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: 503 234 - 9900
Reg #: LIiO3 53520878
SEIB 23444K
ELE 26 -95C
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/5/03 $75.00 Elect'I Final
[TAX] 8% State Tax 2/5/03 $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 i' " e-- Permittee Signature DA/ ff "Pi-/ "9 J
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
1 l k .
9
EYectr�icalP �� OFFICE USE ONLY
,{�
, � l 1.� �•+ Date received: aAT O 3 P r p.: E� l i.3 i/ /al
n4 ,� i City of Tigard Projccuappl. no.: Expire date
City o f T igar d Address: 13125 SW Hall Blvd, Tigard 90S1 2003 Date issued: By: 1 Receipt no.:
Phone: (503) 639 -4171 •
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: ' BUILDING DIVISION I/vo200a? -00S/ ?
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 1l Commercial /industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction M Addition /alteration /replacement ❑ Other. _ ❑ Partial
JOB SITE INFORMATION
Job address: 12442 SW SChola.s Ferry RoadBldg. no.: Suite no 9 Tax map /tax lot/accountno.:
Lot: I Block: Subdivision:
Projcctnamc: Pro. Scholls RehlEggscription andlocationofworkonpremises: 1 limited energy system for
Estimated date of completion/inspection: ' • -
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 63553 Fee Max
O Description Qty. (en.) Total no -lusp
Business name: Oregon F1 ectr ri j 1
Address: 1010 SE 1 th AVe • t_ avuwreOde°tint- sinKteormuai- famity
dNellingunit. Includes attacked garage_
City: . _ State: w . ZIP: • Serviceincluded:
- - ■
Phone• Fax: k mail: 1000 al. A. or leas 4
234 9 9 0 0 2 34 -10 (' T ' Each additional 500 sq. ft, or portion thereof
CCB no.: p I Elec bus: lie no: 9 ti_ g 5 r —
� Limited energy, residential 2
5/ t i no.: ? Li m i ted energy, non- residential _ 2
-t Q r 4 , 2 /3 / A Each manufactured home or modular dwelling
Si , r e of supery s ng a t ieio (required) y a ^ � Date Service and/or feeder 2
. elect name t: Services or feeders- Installation,
ark Ke 1 a • Li cense no: 4 4605 niteruiob orrelocaiion:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
Prnvi r3Pnr -P H PaI th C A r P ( 401 amps to 600 amps 2
Mailing address:
7 601 amps to 1000 amps 2
City: I State: I ZIP: over 1000 amps or volts 2
Phone: I Fax: : I E -mail: Reconnect only I
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to allatlon, alteration. arrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2 -,
201 amps to 400 amps _ 2
Owner's signature: Date: 401 to 600 amps 2
ENGIN R Branch circuits- new, alteration,
or extension per panel:
Name: •
A. Fee for branch circuits With purchase of
Address: • service or feeder fcc, each branch circuit 2
City: State: ZIP: B. Fcc for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fec. first branch circuit: 2
Each additional bench circuit:
PLAN REVIEW(tiease check all that apply) M lie. (Service or feeder not included):
❑ Service over 225 amps-commercial 0 Health-care facility Each pump or irrigation circle _ 2
❑ Service over 320 amps- rating of 1 &2 ❑ Haandous location Each sign or outline lighting 2 -
family dwellings ❑ Building over 10.000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more nnidential units in one structure alteration. or extension' 1 75 . 2
❑ Building over three alarm. Cl Feeders, 400 amps or mere 'Description:
-
Cl Occupant load over 99 persons Cl Manufactured structures or 2V park Each additional inspection over thy allowable hi any o(the above:
❑ Egress/lighting plan Cl Other
Per inspection I I F I
Submit _ sets of plans svith:atay of the above. Invcstiration fec
The above are not applicable to temporary construction service. Other
Permit fee S75.
Nut all jrtriulieriona accept credit ards. pleas[ call jurisdretiun fur more infannPtion. Notice: This permit application
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at — %) $
Credit card numb= / / within 180 days after it has been State surcharge (8 %) ,...,$
E "'r` accepted as complete. TOTAL $
Name of ranlholder as shuum un ] if card
$ ■
Cardholder signature Amount 440 -16I (IiJOo/COM)
20£ -d Z00 /l00•d 6ZZ -1 -MOH ZI :OI £0- £0 -93d
,'" CITY - OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 • MST
BUP
Received Date Requested 2- J `3 AM PM BUP
Location I a- q 1 a- 1 /I.r e fLa 12 r S /\1() kN I � MEC
� J
Contact Person
P h ( K Ph ) g (Q9 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access:' ELR 3 604 3
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing r'.
Firewall
Fire Sprinkler
Fire Alarm J
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
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
_G /Slab
Low Voltage]
Fir- Alarm
111 PART FAIL
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA 0
Approach/Sidewalk Date -2-- - Inspector A :J. t�.s Ext
Other:
Final DO NOT REMOVE this Inspection record from the 1, site.
PASS PART FAIL
•