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Permit ELECTRICAL PERMIT q CITY OF TIGARD PERMIT #: ELC2007 -00508 COMMUNITY DEVELOPMENT DATE ISSUED: 7/24/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134BC -00401 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 ZONING: C - N SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: PROVIDENCE Project Description: TI - (4) branch circuits. Job No. 14096 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: PROVIDENCE HEALTH SYSTEM BROADWAY ELECTRIC - COCHRAN INC 4607 NE GLISAN 626 SE MAIN PORTLAND, OR 97213 PORTLAND, OR 97214 Phone: 503 - 215 - 6282 Contact #: PRI 503 - 234 - 6564 FAX 503 - 238 -2098 FEES Description Date Amount Reg #: ELE 37 -546C [ELPRMT] ELC Permit 7/24/2007 $66.80 LIC 72942 [TAX] 8% State Surcharge 7/24/2007 $5.34 SUP 3447S Total $72.14 REQUIRED ITEMS AND REPORTS 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 -0: -.0 • • ou• • R 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued ; y: .' Otti/yuaki Permittee Signat ,•, s' ', O �� 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: ' .iiv iLL 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. 1 .. "vet it Electrical Permi - p Ti iat n _F F UR OFFICE I:SE O \i.Y City of Tigard D s 7 2LI 07 O• _% Permit No.: Ec_e a-ei0? -405-68 13125 SW Hall Blvd., Tigard, OR 97223 J L 2 ii. 2007 P�i:�ew Other Permit Phone: 503.639.4171 Fax: 503.598.19 "- '. f' • Date./0 . Inspection line: 503.639.4175 g t � : @ J 4 '� i , Date Reedyi8y: ® See Page 2 for Internet: www.ci.tigard.or.us �R •I' 1 X1_ . a` Notified/Method: Supplemental Information . y L . I '.'i, 74 f . -.. I 1 ! 1 i i: I . '•; R.> l''. � -t FB R _ "� .,°N+r^7.T 7 ' - 4,,r/ -.. J 9 c i ' l I { r H " l r f. •S^. ',k' 3 - c, M • ,_ ' n I " -1 rs' r 11 -- c ? :' • , • - J j _ n . _y, ' 1L tr: i .,a - Li - i . dam , „ r r.� �% _ • ! L1 4 x' v.r1 , a , - . " - 7�.i: N _ � r . J ' � A `y WJ r �.�� V " 4��4�Y, h'W4r�1�'�t�r.. �tl'. r..:� ❑ New construction ® Addition /alteratitm/eeplaceimnt Please check all that apply: ❑ice over 225 arms, commit ❑Hazardous location ❑ DetrsohttoII ❑Other 5 J ; t N7 < h � i �w� i , a ,, : r ^: ❑['Service ft., Sece over r 320 amps -rating ❑Bulldog over 10,000 sq. ., , __a : tJ�a J . fi t '. 5;' ', , ' 1 , T ,.e. I U U , . I_ �. I y . - _ } .t ! r 7 1 ./J1 r ' ;t ' 'r ` 5 ; of 1 - and 2- family dwellings 4 or more new res ❑ 1 and 2- family dwelling Commercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure ❑Building over three stories ['Feeders, 400 amps or more ❑ Minh farmly ❑ Master builder ❑ Other atxtinres or ❑Ot:cupmrt load over 99 persons ['Manufactured e y - P f . 1r �, �. 1. il f part! r•,2. i i �r,: i ^ I l ; I-! III y `. �) u . l�l ,..- M c. � '.i ' I 7 - , i I ❑�gressiltghtingPlan RV park tR r- �•r]. 1., 1'.: f ". 1 �._.'.a u!! • -.. _ -.. . _ ,.,. . -_�{ - Id/lean-care factiity ❑Other. Iob no ` _ Job site address: Z. „ - ," . • Submit 2 sets of plans with any of the above. City/StateJZlP: •• / ' ' The above are not applicable to temporary construction service. - Suite/bldg./apt. no.. _ _ ; i� l Project name: :..• . '.r ', ..I , 1_' 1 � ` .... • • . • ., - f Qty. Fee. e Total Cross street/directions to job site: New residential single- or mold- family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 - Subdivision: Lot no,: 6a. add'l 500 sq. R or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no Limited energy, non- residential 75.00 2 I.l',i 7 _(.,;J_.•c, _ �� ,1 4 _w . ,.,r _. . i .. i, : ; . :!. . . r;., L .a.i:_ . _�.. � .sl . � . t__- ..1 . . r : ;, -..1.1-_,,. l .. Each rrtanufacbincd Or alodular dwelling, service and/or feeder 90.90 2 Services or feeders Installation, alteration, and/or relocation 200 amps or less 80.30 2 r P I i ?I }' i i J� " I'' , of r� l r : l , I �� , A , r '0, 201 amps to 400 amps 106.85 2 .. q . s u , r 1,NI,I,� k v9sf,f' , ,,— , z .J,__ . J, „�Iltv_,r ,._'1. I r � . �..,. I , ,_r -. r.._. •r..-: 401 amps to 600 amps - 160.60 2 Name: ► a - . _ _ . : L . S r 601 amps to 1,000 amps 240.60 2 Over 1,000 amps or volts 454.65 2 Address: ( • -, • , Reconnect only 66.85 2 City/State/ZIP: i t, 4 b 1 ,' Temporary services or feeders installation, alteration, and/or relocation Phone: (5b3) z Av., i 4: ; Fax: ( ) ir t 6 7 O • 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 2 intended fo sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. . 401 amps to 600 amps 133.75 I 2 Owner S „ Date: Branch circuits - new, alteration, or extension, per panel 1";52'0.1 F 1 ' I r D l -' "1- ''- , s M ,, T,. " +I. f - ; A - Fee for branch circuits with l ) f � � ,'r . -',, . - ._._r ' •, .. .. : -:;i ��.�F� - --� I -..,,- J I.: ..! J 1'Ii?s o., _,`...,�. _ u _ ,.� . ._. �� " _ I.. , 9 ... service or feeds fee, each Business branch circuit 6.65 2 . B. Fee for branch circuits Contact . • ∎ : without service or feeder fee, / each branch circuit �� 46.85 v 2 Address: Each add'! branch circuit 3 6.65 5 2 11 • . Miscellaneous (service or feeder not included) - �ilreln Pump or irrigation circle 53.40 2 Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2 ESL Signal circuits) or limited - ;10_5'1,1, 6 :iii, li-.F j4-5 ': j 7 If 1 i . , ear y l. , I yy , . � f it r, Panel' alteration, or - a`] ut a1 .8 I , I.i L " ii:l;'L..�Y4 r.. .. ∎ . S� ~J „r. R tensi . .f , _ ,].i. .�. _ui, _.d,.:r,. -� � itu �i.� F„ 2 extension. Describe: Page 2 Business n artgliffillINIMIZINIMMIIIIIIIII Address ' Each additional inspection over allowable in any of the above Per inspection 62.50 , i' y . OR - -1 Zl Investigation per hour (1 iv min) 62.50 , Phone: (go IIIMIESPallil Fax: (5•43) L3% --2c.. $ industrial plant per hour r 73 �5- . u :.,6:... . s_ ,,:ice,,, tL3&,� ., . CCB Lic.: EMI Electrical Lit.: 3/-5 loG Suprv. Lic.: 344 d5 Subtotal 66 , 80 Suprv. Elec , 'clam signature, required: _ ' Plan review (25% of permit fee) Print name: !Nh k a Cs Date: State surcharge OM of permit fee) ,6"',35/ TOTAL PERMIT FEE ` 7p, • i r. Authorized signature: This permit application expires tf a permit b not obtained within 180 days after It has been accepted as complete Print name: Dale: • Fee methodology set by Trt- County Building Industry SWAGS Board •• Number of inspections per permit allowed. isVM9rsmtnrrnhr\P.[l�Famiweadae 12103 4404611T(1010)JCOMIWEB CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007 -O05OB 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/?4/2007 Phone: (503) 639 -4171 1.k` Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/9/2007 TIME: 7 :00AM PAGE: 55 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PROVIDENCE DESCRIPTION: TI - (4) branch circuits. Job No. 14096 9/24/07, ADDING (1) BRANCH CIRCUIT IN PATIENT, PLAN REVIEW DONE. OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 503-215.6262 CONTRACTOR: BROADWAY ELECTRIC-COCHRAN INC PHONE #: 503 - 2346554 Inspection Request Scheduled For: Date: 10/90007 Pour Time: Code # Inspection Description Confirm/4 Contact # Message 199 Electrical fikal 057 1-01 503-522-7360 N Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: ICt I`1131 Phone #: (503) 718- 144) --4 -.q CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007 -00508 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7124/2007 Phone: (503) 639 -4171 te +,� Inspection Requests (24 Hrs.): (503) 639 -4175 ���� `__— INSPECTION WORKSHEET FOR DATE: 10/8/2007 TIME: 7 :00AM PAGE: 80 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PROVIDENCE DESCRIPTION: TI - (4) branch circuits. Job No. 14096 9/24107, ADDING (1) BRANCH CIRCUIT IN PATIENT, PLAN REVIEW DONE. OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 503 - 215 -6282 CONTRACTOR: BROADWAY ELECTRIC-COCHRAN INC PHONE #: 503 - 234 -6564 Inspection Request Scheduled For: Date: 10/8/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 13 0 Ceiling cover 057106 -01 503.519.3965 Y Corrections /Comments /Instructions: � j PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS • FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Cr , [1' 6 Date: 1 0 1 ( 1(0'1 Phone #: (503) 718- 1.1-1q k CIT ■ OF ■ IGI _RD BUILDING DIVISION - PERMIT #: ELC2007 -00508 .13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7124/2007 Phone: (503) 639 -4171 • . Inspection Requests (24 Hrs.): (503) 639 -4175 ` 'I�� ' INSPECTION WORKSHEET FOR DATE: 9/24/2007 TIME: 7:00AM PAGE: 54 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: • PROJECT NAME: PROVIDENCE DESCRIPTION: TI - (4) branch circuits. Job No. 14096 OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 503-215 -6282 CONTRACTOR: BROADWAY ELECTRIC - COCHRAN INC PHONE #: 503 - 234 -65641 Inspection Request Scheduled For: Date: 9124/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 056146,0 503- 927 -1547 N Corrections /Comments /Instructions: • el •zo - Or) . • • 1A . - r 1 ak)E tct.rAI ka 12 . • , ',:\.PASS ❑ PARTIAL APPROVAL ❑ CANCEL • ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: `3 ` Koe) L Date: �. Phone #: (503) 718 - }1 4 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007 -00508 13125 SW Hall Blvd., Tigard, OR. 97223 DATE ISSUED: 7/24/2007 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 9/17/2007 TIME: 7:00AM PAGE: •3 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PROVIDENCE DESCRIPTION: TI - (4) branch circuits. Job No. 14096 OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 503 215 6282 CONTRACTOR: BROADWAY ELECTRIC-COCHRAN INC PHONE #: 503 - 2346564 Inspection Request Scheduled For: Date: 9/17/2007 Pour Time: Code # Inspection Description - = *j�rrrq,; Contact # , Message 125 Wall cover 055777 -01 503-519-3965 \ Y Corrections/Comments/Instructions: Uth 1 -255 6S0, - • ? W `P Qfkat • • • • ❑ PASS PARTIAL APPROVAL ❑ CANCEL • • ❑ NO ACCESS j i4 FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED • Inspector: G tAtitt "- Date: , Phone #: (503) 718- 2-4LN