Permit CITY TIGARD ELECTRICAL PERMIT
CITY I
PERMIT #: ELC2008 -00649
COMMUNITY DEVELOPMENT DATE
ISSUED: 11/24/2008
TIGAIt .. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135BD-00300
SITE ADDRESS: 09735 SW SHADY LN 101 ZONING: C -
SUBDIVISION: DRS FAMILY CLINIC LOT : JURISDICTION: TIG
PROJECT: FXR
Project Description: Altering (4) branch circuits in reception area and installing low voltage data cabling.
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: 0
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: 1
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: 3 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:
HAZEL INTERNATIONAL, INC AND BRIDGETOWN ELECTRIC
HIGASHIYAMA HIGHLANDS CO, LTD 22732 NW GILLIHAN ROAD
BY NORRIS + STEVENS REALTORS PORTLAND, OR 97231
PORTLAND, OR 97204
Phone: Contact #: PRI 503 - 621 - 7122
FAX 503 - 621 -7123
FEES
Description Date Amount Reg #: ELE 26 -887C
[ELPRMT] ELC Permit 11/24/2002 $141.80 LIC 103824
[ I'AX] 12% State Surchar 1 1/24/2001 $17.02 SUP 4177S
Total $158.82 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 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: / Permittee Signature: x a/-t/
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 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.
Ncjv 24 2008 3:OOPM Bridgetown Electric 503 - 621 -7123 p -1
` "_ Electrical Permit Application i
� �' t ¢ �1 � [ L .1 � sa u , �i -''� t } • �' a . � I Ul t l'tif•(l \I 1 '' �� a. t• ii'
�... City Off Tigard t v Received . r . : -, e+« t r_ *. 4...`i,-:: M; tf
13125 SW Hall Blvd, Tigard, OR 97223 . ., Date /By: 1// % Permit No. rcc k-....a y, 1
v (, Pl an Review l X
r "0 p', Pfione: 503.639.4 t 71 Fax: 503.598.1960 J �' Other Permit:
�` D ate / By:
t ' ,' R c , Inspection Line: 503.639.4175 0 Pate Ready /By: kris: o. atiette Internet www tt ard-0r oV ® 5ee Page 2 for
g g . F i l iu m o
�4t� l I Supplemental Information
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❑ New construction ►` /alterati in/ eptacemtnt Please check all that apply (submit 3 sets of plans w /items checked below):
❑ Demolition Othe7: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Manna and boatyards
i_: ° _ �. ^ " ,f r Y ' r a } .�, „ 8 t ' � ._ ?. ; t1 ., �9 i i t 1 1 1 1 0 ( > + - .., exceeds 10,000 amps at :50 v iI or ❑ Floating buildings.
:: Commercial /industrial ❑ Accessory building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling
amps for all other installation. building,
❑ MUltf family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
a s i ; i i •* ) t d +< c - 1 ,� 1.'j3' ! ❑ Emergency system.
e r 3t 1, 'i �* @ Y larger separately did system.
a -.r ,.. .....Si' } .c. .... J4 .. ... .. .. _ t r ,l t,<a_..._ll ..w. i w .�a / _ ...;, 5f ❑Addition of new motor load of O., '' <. < - �..
Job no.: �-f� Job site address: 7-3 5 SA f -14-e-- I00HPor more. occupancy.
Six w more residential uoin. ❑ Recreational vehicle parks.
City /State /ZIP: I ( 1 k ) ( A - ❑ Health -care facilities. ❑Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: I / ❑Service or feeder 600 amps or more.
Cross street/directions to job site\ 7_ .wa C I`am < yi 'i;i, Fee real .,_ey { d _ itA r:
neseripii. Qty. P
New residential single or multi- family dwelling unit. •
Subdivision: `_ ,�1� v � / , /]y ( 7- Includes attached garage.
l / [ c no : 1,000 sq. ft. or less _ 145.15 4
Tax map /parcel no.: J / 'C,� 4 1 V�" Ea. add' 1 500 sq. ft. or portion 33.40 I
" ' ,, F r t• , r y . , , S a r , t,. �s. r "a t r Limited energy, residential
..,. < _.._ .3 €!' _.. .rP'. , Vii* "' g' t. 2 a+ r .:, ` ` (with above en. ft) 75.00 2
t Y 4 rC.(- � I)1 le�C -tee j Q �,�, _ Limited energy, multi - family
rrt -'G�- residential (with above sq. R.) 75 2
i DitU VD i • .-e Ge..44.41L. CeatAle Services or feeders installation, alteration, and /or relocation
'
}��� sus , 200 amps or less 80.30 2
4p. "�' t. ^' rM'•+, rJau SE i ' w *i� K. •.^n.F r 4k SIR fl .
_, <.. y ,.._, ,' " . r .;.' ,i, .... .:� ».,i ' . ," .,:1. 201 amps to 400 amps 106 85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 I 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and /or
I relocation
Phone: ( ) Fax: ( ) . 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 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, Per panel
i ¢¢ yy A. Fee for branch circuits with
a_ , .,SY,<. :. ' .. i _ . •_,, :• i � - :i a :al .. „w I r f ,ill .. - ib�zu f d '§ 41�+ above service or feeder fee,
Business name:
_ each branch circuit 6.65 2
B. Fee for branch circuits
Contact name: wirlroul service or feeder fee, i 46.85 lit is 2
first branch circuit
Address: Each add 'I branch circuit 3 6.65 j / 4,4s 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular
dwelling, service and /or feeder
Phone: 90.90 2
( ) I Fax: ( ) Reconnect only 66.85 2
E
Pump or irrigation circle
53.40
0:. _ : A !.: -.- ..... . 3; _ ,i,Yf a f t atili f r l ; :a � , ., 77,-,,�w�_" Sign or outline lighting 53.40 2
Business name: Bridgetown Electric Signal citrottit(s) or limited -
energy panel, alteration, or
Address: 22732 NW Gillihan Road extension. Describe: Page 2 f75" 2
City /State/ZIP: Portland, Oregon 97231 Each additional Inspection over allowable In an of the above
503 621-7122 I Per inspection 62.50 '
Phone:
(503) I Fax: (503) 621 -7123 Investigation per hour(( hr min) 62.50
CC13 Lit.: 103824 Electrical Lic.: 2 -887c Suprv. Lic.: 4177s Industrial plant per hour 73.75
i= wY p i x , s. i }
Suprv. Electrician signature, require /-- � ; : �'^' 2 9 t "' a v ' t :.: » ,
._.l.- .1 Subtotal: ! tI , 66
Print name: Keith Steenslid Date: / f - a f ,0 P, Plan review (25% of permit fee):
3 State surcharge (12% of permit fee): )7, Q
Authorized signature: fo rAL PERMIT FEE: .15 S,By
Print name: Date: This permit application aspires if a permit i3 not obtained within 110
days after It has been accepted as complete.
LVSui ldlnalPermittYELGVermitApp .doe 05 /21f06 * Number of inspections allowed per permit.
440 /05 /COM/WEB
it 3
Nciv 24 2008 3:OOPM Bridgetown Electric 503 - 621 -7123 p. 2
.
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information V (O
LIMITED ENERGY PERMIT FEES: Q .66)
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: 1Building \PermitdELGPermitApp.dve O3 /tiros 3
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UKULbUNG DIVISION
PERMIT #: FLC2008.00619
13'125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/34/2.(l()8
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/11/2009 TIME: 7:00AM PAGE: 10
SITE ADDRESS: 0973b SW SHADY LM 101 CLASS OF WORK:
SUBDIVISION: DRS FAMILY CLINIC LOT #: TYPE OF USE:
PROJECT NAME: DRSCHVVARTZ
DESCRIPTION: Altering (4) branch circuits in reception area and irtallirg k,w voltage dala cabling.
OWNER: tIAZEL INTERNATIONAL, INC AMC>, PHONE #:
CONTRACTOR: BR|DGE]'0\mELEC7R|C _\/8'3 __ PHONE#: 503-621-7122
Inspection Request Scheduled For: Date: 2/11/2009 Pour Time:
' Code # Inspection Description C ir Contact # Message
199 E|ec1riva|Dna! 503'621-7122 ` Y
Corrections/Comments/Instructions: ~~^-----~�
� u_ �
� /y
--___-_-
PASS El PARTIAL APPROVAL II] CANCEL II] NO ACCESS
7 FAIL E CALL FOR INSPECTION E ADDITIONAL FEES ASSESSED
��~` ���x ^ � -�*
Inspector: ��~ ^ ��k�O����� Date: �'v� � Phone #: (503) 718- VA
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008.00EA9
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/24/200E;
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/9/2009 TIME: 7 :00AM PAGE: 16
SITE ADDRESS: 09735 SW SHADY LN 101 CLASS OF WORK:
SUBDIVISION: DRS FAMILY CLINIC LOT #: TYPE OF USE:
PROJECT NAME: [)I:t SCHWARTZ
DESCRIPTION: Altering (4) branch circuits in reception area and installing low voltage data cabling.
OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #:
CONTRACTOR: BRIDGE:f'OWN ELECTRIC PHONE #: 503 -621 -7122
`1 NAV I S
Inspection Request Scheduled For: Date: 2/9/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 080403 -01 503- 621 -7122 Y
Corrections /Comments /Instructions:
\
Rio v 1� c�L!(J Q a� A CAL LL A8 to14
P.-13e■ La - AL.L, (3,1A w \; lS
kig IN QS' el
❑ PASS OVAL ❑ CANCEL ❑ NO ACCESS
FAIL IA CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: , NV3 Le Date: 1 Phone #: (503) 718- ti i f t
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: ELC2008- 0(IG19
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/24/ 1008
Phone: (503) 639 -4171 44414 il,
Inspection Requests (24 Hrs.): (503) 639 -4175 Ag. '''
INSPECTION WORKSHEET FOR DATE: 2/4/2004 TIME: 7. {)(JAM PAGE: 1()
SITE ADDRESS: 09735 SW SHADY LW 101 CLASS OF WORK:
SUBDIVISION: DRS FAMILY CLINIC LOT #: TYPE OF USE:
PROJECT NAME: DR SCHVdARTZ
DESCRIPTION: Altering (4) branch circuits in reception area and installing low voltage data cabling.
OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #:
CONTRACTOR: BRIDGETOWN ELECTRIC PHONE #: 503. 621 - 7122
Inspection Request Scheduled For: Date: 2/4/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final • / 8027: 1 503 -621 -7122 N
Corrections /Comments /Instructions:
9:
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL fI NO ACCESS
X FAIL y CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: i 0 66 • , Date: 2-'V1 Phone #: (503) 718- 1'4"
CITY OF TIGARD
BUILbDIVISION PERMIT #: ELC2008- 00EA 9
131 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11124/2000
Phone: (503) 639-4171 " -71#11t
Inspection Requests (24 Hrs.): (503) 639-4175 „.„,.... ----.
INSPECTION WORKSHEET FOR DATE: 11/26/2008 TIME: 7:00AM PAGE: 35
SITE ADDRESS: 09735 SW SHADY LN 101 CLASS OF WORK:
SUBDIVISION: DRS FAMILY CLINIC LOT #: TYPE OF USE:
PROJECT NAME: DR SCHWARTZ.
DESCRIPTION: Altering (4) branch circuits in reception area and installing low voltage data cabling:
OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #: '
CONTRACTOR: E3RI DGETOWN ELECTRIC PHONE #: 503-621-7122
Inspection Request Scheduled For: Date: 11/2612008 Pour Time:
Code # In e." .• ;: cription Confirm # Contact # Message
126 Wall cover 078530-01 503.621-7122 N
Corrections/Comments/Instructions:
PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
0 FAIL 0 CALL FOR INSPECTION • 0 ADDITIONAL FEES ASSESSED
•
Inspector: Date: -- 26 --.? Phone #: (503) 718-