Permit CITY O F TIGARD ELECTRICAL PERMIT
PERMIT # : ELC2008 -00640
COMMUNITY DEVELOPMENT DATE ISSUED 11/26/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135DA-03500
SITE ADDRESS: 11481 SW HALL BLVD 101 ZONING: C -P
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: HEALTH TOUCH
Project Description: Health -care facility.
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: 1 W /SERVICE OR FEEDER: 14 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
L N PROPERTIES, LLC RC COSTELLO ELECTRICAL CONTRATING
12725 SW 66TH AVE PO BOX 336
PORTLAND, OR 97223 AURORA, OR 97002
Phone: Contact #: PRI 503 - 982 -7400
FAX 503- 982 -7401
FEES
Description Date Amount Reg #: ELE 3344C
[ELPRMT] ELC Permit 11/26/200! $173.40 LIC 87402
[ELPLCK] ELC Pln Rev 11/26/200! $43.35 SUP 3934S
[TAX] 12% State Surchar 1 1/26/2001 $20.81
REQUIRED ITEMS AND REPORTS
Total $237.56
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 days. NTION: • egon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 95 01 -0010 through • • r 952 -40 :100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issue By: , 1�� Permittee Signature: �C v
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.
Electrical Permit Application FOR OFFICE USE ONLY
Cl of Tigard \Y) Received I ! _ \
`J ��'` Date /By: ! I��/ Permit No.: �'`��f ! T (/(J
l
r• V 13125 SW Hall Blvd., Tigard, OR 97223 Y Y Plan Review / �� � y r/crvn i"� c
Phone: 503.639.4171 Fax: 503.598.196 1� ® ® Date/By: r Other Permit: G �(/ )8,. "v �/
)) T/ 7
TIGARD D Inspection Line: 503.639 O `1 1 1 ° Date Ready /By: �1 �p/�� �' ��, luris,� 65 See Page 2 for
Internet: www.tigard - or.gov N V ts sal oh i t et
a : f c "' / Supplemental Information
,
GZ1G .. 0 `- / ��'�� ��
.- _ r.. ^. TYPE ;OF'` WORK ""T-.;. � '� / :, REVIEW . ', s
El New construction ZAddition /alteration /re $ktOi Please check all that apply 2 sets of plans whtems checked below): `
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
' CATEGORY' OF `.CONSTRUCTION ^'�- `, ' " :" : ' i' ' y ,° exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder []Other: I 'I ❑ Fire pump ❑ Installation of 75 KVA or
r _ , �, ❑ Emergency system. larger separately derived system.
' • • SITE °.INFOR ° _ -L O " , �
CATION " "` ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: I Job site address: 1 I q 81 SJ fqct a s 3 I UGt 100 or more. occupancy.
❑ S or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ' t ° g 01 r0) U 7 q C) 2 2 3 ealth -care facilities. ❑ Supply voltage for more than
J ❑ Hazardous locations. 600 volts nominal.
uit 1d /a p t. no.: Project name: 7 ❑ Service or feeder 600 amps or more.
. r FEE,,,SCHEDULE' ,-
m i. -
Cross street/directions to job site: Description I Qty. I Fee- I Total I "
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less - j 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
n�,' " " DESCRIP,TION OF WORK.., ` , 75.00 2
�� _,t �, '' (with above sq. ft.)
J a "Ti mited energy, multi - family
S U1) 1001"4,1 a nA (DOnC, IN C 4;ccu [A•k -4 t , i residential (with above sq. ft.) 75.00 2
_ Services or feeders installation, alteration, and/or r l ocation
8
Fb ON1 %� c�o(L b +' cd • ,.,,/ 200 amps or less / 80.30 (j�, •iL 2
:'', ❑ ; ' PROPERTY O NER,;. ;[ -, .f ' TEN / ; v -
,�-�-, ' 201 amps to 400 amps 106.85 2
Name: r 401 amps to 600 amps 160.60 2
�n C CI t11t'P_ 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
r _❑ _ APPLICANT y" ❑ 'CONTACT PERSON', . -„ . ` - above service or feeder fee, 19 6.65 CO 2
circuit each branch
Business name: B. Fee for branch c rcuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
° 3
, , - „, - CONTRACTOR:' . , - Sign or outline lighting 53.40 2
J � Signal circuit(s) or limited -
Businessname:TC C A., E )eCi /1L4,7 0„.„4t°sC+ ,S - ” ,, energy panel, alteration, or
Address: ?Q! -g .3 3 6 extension. Describe: Page 2 2
City/State /ZIP: 't rait. , Q q l oot Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (co, ) q$Z- r ictoo I Fax: ( ) qs2 • f Lt 1 Investigation per hour (1 hr min) 62.50 _
CCB Lic.: E lectrical Lic.: Suprv. Lic.:
�,� -3 yyCI p ,y--/ s Industrial plant per hour 73.75
_ELECTRICAL•. PERMIT ;FEES = i • Suprv. Electrician signature, required: e! Subtotal: L - � b (
--
Plan review (25% of permit fee): t ' ✓
Print name 7 Date: pip-7 /06 State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 0 21 5 1
Print name: Date: This permit application expires if a permit is not o e hin
m .
days after it has been accepted as complete.
* Number of inspections allowed per permit.
P\Building\Permits\ELC- PermitApp.doc 05/23/06 c h t, S Soy - 6 7 Ssf 440- 4615T(11/05/COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
.e MIVIERCIAL; WQRK..ON_ LI':
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I'\ BuildingWermits \ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUIL:RIIV DIVISION PERMIT #: ELC2008-006410
13125 S11s''Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11060 008
Phone: (503) 639 -4171 641414t,�
Inspection Requests (24 Hrs.): (503) 639 -4175 ^'I,_
INSPECTION WORKSHEET FOR DATE: 1/80009 TIME: 7 :00AM PAGE: 8
SITE ADDRESS: 114t1 SW HALL BLVD 101 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HEAL TH TOUCH l
DESCRIPTION: f- le: lth -case tactility.
OWNER: L N PROPERTIES, LLC, PHONE #:
CONTRACTOR: RC COSTELLO ELECTRICAL CONTRATING PHONE #: 559837400
Inspection Request Scheduled For: Date: 1/8/2009 Pour Time:
Code # spection Descrip I on Confirm # Contact # Message
109 Electrical fin; 0705101 503 - 504-6758 N
Correction • u s /Instructions:
(
1
i�J ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
,ector: Date: Phone #: (503) 718-
CITY OF TIGARD
BUILDINt DIVISION PERMIT #: EIC2008110C40
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/2noo8
Phone: (503) 639 -4171 • �
Inspection Requests (24 Hrs.): (503) 639 -4175 .. '_� '-
INSPECTION WORKSHEET FOR DATE: 1/7/200') TIME: 7:01AM PAGE: 14
SITE ADDRESS: 11481 SW HALL BLVD 101 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HEALTH TOUCH
DESCRIPTION: Health -care facility.
OWNER: L. N PROPERTIES, LLC, PHONE #:
CONTRACTOR: RC COSFEL I O ELECTRICAL CONTRATING PHONE #: 503-9017400
Inspection Request Scheduled For: Date: 1/7/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 079468-01 503 -504 -6758 N
Corrections/Comments/Instructions:
jA g• '.
1 — - P-.OS/1) 4 g � _ N 6 f E - '66 p_.2--avkgr
Z- w — niw r o - _. s 2g 1A P L
1_ UQ2 sug Qit.N L,.
---....s. ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL `CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: NI Ng L Date: V1 e ll Phone #: (503) 718- ),'iik .,
/. • , - ..
CITY
TIGARD
BUILDING' - ~~ "USUON ' �• PERMIT #: BC2000-00640
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/20Q008
Phone: (5U3)G3O'4171 '
Inspection Requo�a(24Hmj:(503)G3Q'4176 .�0�' °�--,
INSPECTION WORKSHEET FOR DATE: 12/16V2008 TIME: 7:0OAKX PAGE: 1
SITE ADDRESS: 11481 SW HALL BLVD 101 CLASS OF WORK:
SUBDIVISION: ' LOT #: TYPE OF USE:
PROJECT NAME: HEALTH TOUCH
DESCRIPTION: Health-care facility.
\]VVNER: L N PROPERTIES, LLC, PHONE #:
CONTRACTOR: RC COSTELLO ELECTRICAL CONTRATING PHONE #: 503-982.-7400
.
Inspection Request Scheduled For: Date: 12/16/2008 Pour Time:
Code # Inspection Description Conbuc # Message
130 Ceiling cover 01 503'504-6750 N
Corrections/Comments/Instructions: `^~' -- ^/
-~
•
PASS '
| 1 PARTIAL APPROVAL D CANCEL El NO ACCESS .
' 0 - |L E] CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED
Inspector: G- • N 6A L6 1 Z • I k It Date:
CITY OF TIGARD
BU ®IN DVISI®N " �► 4
ii
PERMIT #:
EL.C2008 00610
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: . 11/2G/2008
Phone: (503) 639 -4171 41 'ir,ifil?l
Inspection' Requests (24 Hrs.): (503) 639 -4175 -•-__
INSPECTION.WORKSHEET FOR DATE: 12/1212008 TIME: 7 :00AM PAGE: 3
SITE ADDRESS: 11481 SW HALL BLVD 101 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HEALTH TOUCH
DESCRIPTION: Health - care facility. _ •
OWNER: 1. N PROPERTIES, LLC, PHONE #:
CONTRACTOR: RC COSTELL.O ELECTRICAL, CONTRATING PHONE #: 503- 982-7400
Inspection Request Scheduled For: Date: 12/12/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
180 Ceiling cover 079024 -01 • 503 -504 -6758 N
Corrections /Comments /Instructions: •
Ch tesPliCrttlit A u p 14 q vNC 6e
%o A 00 0 P(toa Dr c. \) f t4)
6'4 ` 4 Vie ANA lq/k.
7 PWie (TED ost.Rate06t,
1rki w ; i--1^ 1 ML
Fes. 6 _4,
\,_______,,,
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
A FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED , y ,
Inspector: G t 1) (SQ L - Date: i 1 Phone #: (503) 718- iti ii:,
CITY OF TIGARD
BUILDING DIVISION . y . - r` , PERMIT #:
ELC2000 -00640
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/25/2000
Phone: (503) 639 -4171 1111I�I.
Inspection Requests (24 Hrs.): (503) 639 -4175 ' __..
INSPECTION WORKSHEET FOR DATE: 12/3/7008 TIME: 7:00Am PAGE: 14
SITE ADDRESS: 11481 SW HALL BLVD 101 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HEALTH (OUCH
DESCRIPTION: Health -care facility.
OWNER: L N PROPERTIES, LLC, PHONE #:
CONTRACTOR: RC COSTELLO ELECTRICAL CONTRATING PHONE #: 503 982 -7400
Inspection Request Scheduled For: Date: 12/3/2008 Pour Time:
Code # Inspection Description Confirm# Contact # Message
125 Wall cover 078736 -01 \ 503. 6047214 N
Corrections /Comments /Instructions: /
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 3 ; (' S6 L-E Date: 119-3- O Phone #: (503) 718 - 1 2' 1 It