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Permit
CITY OF T I G A R D ELECTRICAL PERMIT PERMIT #: ELC1999 -00762 Ao p .. * DEVELOPMENT SERVICES DATE ISSUED: 12/28/1999 -� 13125 SW Hall Blvd.. Tiaard. OR 97223 (503) 639 -4171 c PARCEL: 1 S 134BC -00401 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 206 SUBDIVISION: ZONING: C -N BLOCK: LOT : JURISDICTION: TIG Project Description: Electrical TI 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 HMI 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: 5 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 ELECT CONSTRCTN /GRP INC BY STEVE FOSTER 1010 SE 11TH PO BOX 13993 PORTLAND, OR 97214 . PORTLAND, OR 97213 Phone: . Phone: 234 -9900 Reg #: SUP 2841S LIC 0026 -9 ELE 001302 -S FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT BON 12/28/199£ $64.25 99- 320695 Elect'l Final 5PCT BON 12/28/199£ $5.14 99- 320695 ORIGINAL Total $69.39 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -1987. PERMITTEE'S SIGNATURE 1 o j e - h _ d ISSUED BY: � '� � ,_. 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: MA CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: MA DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day CITY OF TIGARD RECEIVED Electrical Permit Application Plan Che # 13125 SW HALL BLVD. Rec'd By 11/4-) TIGARD OR 97223 DEC 2 3 1999 Date Recd 12 - LYE l9 Phone (503) 639 -4171, x304 Date to P.E. NiTY DEVELOPMENT Date to DST Inspection (503) 639 �ru Print of Type Permit # FCC- t - 00 7(Qi Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called 1. Job Address: • 4. Complete Fee Schedule Below: Name of Development Providence Scholls Clinic Number of Inspections per permit allowed Name (or name of business) Dr _ TWA sty() Service included: Items Cost Sum •I' Address 1 2442 SW Scholls Ferry Rd. *_ 20(' 4a. Residential - per unit City /State/Zip Tigard OR 97223 1000 sq. ft. or less $ 117.75 4 Each additional 500 sq. ft. or portion thereof $ 26.25 1 Commercial E21 Residential ❑ Limited Energy $ 60.00 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2 (Prior to permit Issuance, applicants must provide contractor license 4b. Services or Feeders information for COT data base). Installation, alteration. or relocation Electrical Contractor Oregon Electric Group 200 amps or less $ 64.25 2 Address 1010 SE 1 11-11 AVP 201 amps to 400 amps $ 85.50 2 City Portland State OR Zip 97214 401 amps to 600 amps $ 128.50 2 601 amps to 1000 amps $ 192.50 2 Phone No. 234-9900 Over 1000 amps or volts $ 363.75 2 Job No. 84007 Reconnect only $ 53.50 2 Elec. Cont. Lice. No. 2 6-95C Exp, Date .4c. Temporary Services or Feeders OR State CCB Reg. No. 203 Exp.Date - Installation, alteration, or relocation COT Business Tax or Metro N Exp.Dat :I1 g II 200 amps or less $ 53.50 2 201 amps to 400 amps $ 80.25 2 Signature of Supr. EIec'n �.. J 111 401 amps to 600 amps $ 107.00 2 Over 600 amps to 1000 volts, • License No. 20645 Exp.Date sea "b" above. Phone No. 234-9900 4d. Branch Circuits New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. Print Owner's Name Each branch circuit $ 5.35 2 Address b) The fee for branch circuits without purchase of service City State Zip or feeder fee. Phone No. First branch circuit 1 $ 37.50 37.50 Each additional branch circuit $ 5.35 26.75 The installation is being made on property I own which is not 4e. Miscellaneous intended for sale, lease or rent. (Service or feeder not induded) Each pump or irrigation circle $ 42.75 Owner's Signature Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited energy . 3. Plan Review section (if required):* panel, alteration or extension $ 60.00 f �, Minor Labels (10) $ 107.00 Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over 4 or more residential units in one structure the allowable to any of the above Service and feeder 225 amps or more Per inspection $ 50.00 Per hour $ 50.00 System over 600 volts nominal In Plant $ 59.00 Classified area or structure containing special occupancy as described in N.E.C. Chapter 5 5. Fees: 5a. Enter total of above fees $ 6 4 . 25 * Submit 2 sets of plans with application where any of the above apply. 8%* Surcharge (.0BX total fees) $ 5 . 14 Not required for temporary construction services. Subtotal $ Sb. Enter 25% of line 5a for NOTICE Plan Review if required (Sec. 3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION 0 - WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 S O ❑ Trust Account It AT ANY TIME AFTER WORK IS COMMENCED. 4 0 # Total balance Due $ 6 9 _ 3 9 is \dsts \forms \electric.doc 2/16/00 Activities for Case #: ELC1999 -00762 • 3:09:28 PM Assigned Hold Updated . Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ELCC001 Application received 12/27/99 BON RECD No Hold BON 12/28/99 Incorrect fees mailed in. ELCC003 Permit created 12/28/99 BON DONE No Hold BON 12/28/99 ELCC730 Elect'I Service 12/28/99 12/28/99 • No Hold BON 12/28/99 ELCC799 Elect'I Final 12/28/99 12/28/99 2/4/00 BRP PASS No Hold AKJ 2/6/00 • ELCC500 (F)Issue permit 12/28/99 BON DONE No Hold BON 12/28/99 ELCC700 Ceiling Cover 1/13/00 . 1/13/00 1/12/00 BRP PASS No Hold AKJ 1/13/00 ELCC720 Wall Cover 1/13/00 1/13/00 1/12/00 BRP PASS No Hold AKJ 1/13/00 ELCC720 Wall Cover 1/19/00 1/19/00 1/19/00 BRP FAIL No Hold AKJ 1/19/00 boxes must be rigidly mounted install bracket on far side of box to prevent hinging action ELCC720 Wall Cover 1/20/00 1/20/00 1/20/00 BRP PASS No Hold AKJ 1/20/00 ELCC700 Ceiling Cover 1/25/00 1/25/00 1/25/00 BRP PASS No Hold AKJ 1/25/00 ELCC800 Case Finaled 2/6/00 AKJ DONE No Hold AKJ 2/6/00 • • Page 1 of 1 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP i1 Date Requested "I ©D AM PM BLD Location 2 .I • i// S to W 2 MEC Contact Person r L DI/ / P 2,3y —acis9ez PLM Contractor Ph SWR � ;e Q BUILDING Tenant/Owner CITC 99- o67 (a Z. Y�J 1 ELC 1 / Retaining Wall EL 1/1q -/ — 00 3/7 Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing ! YrJ Insulation 1 Drywall Nailing ro v/ de grid' / JD / Firewall Fire Sprinkler ( / 1 w 1&__s Q 7 1/ e Fire Alarm V h / _ Susp'd Ceiling N� J' - Q h 5 LJ � � v S Roof Misc: D e- Final PASS PART FAIL PLUMBING Post & Beam Under Slab 11-7 144 / — S S Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL IZECTRIC Service Rough In UG /Slab Fire Alarm ASS ART FAIL SIT Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: ] Unable to inspect - no access ADA Approach /Sidewalk Other Date og-190 Inspector '` aiiQA �EXt Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.