Permit CITY OF T ELECTRICAL PERMIT
PERMIT #: ELC2000 -00123
(n DEVELOPMENT SERVICES DATE ISSUED: 03/22/2000
- 13125 SW Hall Blvd., Tiaard, OR 97223 (503) 639 -4171
PARCEL: 1 S136DA -00100
SITE ADDRESS: 11308 SW 68TH PKWY
SUBDIVISION: ZONING: MUE
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of two (2) 200AMP service /feeders and four (4) branch circuits.
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/ SVCI 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:
BENENSON 68TH PARKWAY OREGON ELECTRIC CONST /GROUP
KEYLLC,THE 1010 SE 11TH AVE
BY FIRST AMERICAN TAX PORTLAND, OR 97214
WORSESTER, MA 01615
Phone: Phone: 234 -9900
Reg #: LIC 203
SUP 1302S
ELE 26 -95C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT GEO 03/22/200C $149.90 0000848 Wall Cover
5PCT GEO 03/22/200C $11.99 0000848 Underground Covv RIGINAL
Elect'I Service
Total $161.89 Elect'l Final
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
AD 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 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: , - DATE: 3 .pd
LICENSE NO: o Z 6G `i 5.
Call 639 -4175 by 7:OOpm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARb OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # Ro°0 ' 00 la3
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Tigard Data Center Number of Inspections per permit allowed
Name (or name of business) Providence _ _ Service included: Items Cost Sum
Address 11 308 SW 68th Parkway 4a. Residential - per unit
1000 sq. ft. or less $ 117.75 4
City /State /Zip T i ga rd , OR Each additional 500 sq. ft. or
❑ portion thereof $ 26.25 1
Commercial El Residential
Limited Energy $ 60.00
Each Manul'd 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 200ampsorless 2 $ 64.25 128. 2
Address 1 01 0 SF 1 1 th Avr� 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. 3 03 6- 9 5 C Reconnect only $ 53.50 2
Elec. Cont. Lice. No. Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. 2 03 Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro No Exp.Dat-� 200 amps or less $ 53.50 2
Li , 201 amps to 400 amps $ 80.25 2
2
Signature of Supr. EIeC'n Ll 1101, 401 amps to 600 amps $ 107.00
d Over 600 amps to 1000 volts,
• see "b" above.
License No. 2 0 64 S Exp.Date
Phone No. 234- 9 9 0 0 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 $ 37.50
Each additional branch circuit 4 $ 5.35 21 _ 4 0
The installation is being made on property 1 own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
panel, alteration or extension $ 60.00
3. Plan Review section (if required): * 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 in any of the above
Per inspection $ 50.00
Service and feeder 225 amps or more 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 $ 149.90
* Submit 2 sets of plans with application where any of the a • . .e = • • ly. 8 %1 % Surcharge (.05 X total fees) $ 1 1 . 9 9
Not required for temporary construction services. Subtotal $ 1 61 .. 8 9
p
O c0 5b. 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 OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 1 61 . 8 9
is \dsts \forms \electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 • Business Line: 639 -4171
- BUP
Date Requested 7/3 AM PM BLD
Location / 1 S Su.) Cob Pkwy Suite MEC
Contact Person 0 S CX� C a d l Aciz Ph -(CQ 0-0 (- PLM
Contractor 6iD 1 h . 5 C 7f c z-S' WR
BUILDING Tenant/Owner ELC -�(�3
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain 1 �•ectlo C�O�t �S:/ SGT
Slab rP' V LCQIl1r
d L'.n'L^ Lae " 4 IQ (01.1 SIT
Post & Beam /
Ext Sheath /Shear • yw to✓�'S
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof /
Misc: [ �C' -S)
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab _
Top Out
Water Service t k \\V
Sanitary Sewer
Rain Drains VVV
Final
PASS PART FAIL
MECHANICAL di
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fir- • larm
11114= PART FAIL
• Backfill /Grading
Sanitary Sewer
Storm-Drain [ ] Reinspection fee of $ required before spection. 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 Date — � v Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.