Permit _ ! CITY OF TIGARD ELECTRICAL PERMIT
/4,,, DEVELOPMENT SERVICES PERMIT #: ELC97 -0840
M'� �' DATE ISSUED: 01 / 13/98
=:_.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 1S136DA -00100
SITE ADDRESS...:11308 SW 68TH PKWY
SUBDIVISION • ZONING:MUE
BLOCK • LOT • JURISDICTION: TIG
Project Description : Tenant improvement to an existing office building. Adding 9
services, 231 branch circuits & 1 limited energy panel.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION : 0
EACH ADD'L 500SF...: 0 201 — 400 amp - 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 1
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp . 8 W /SERVICE OR FEEDER:231 PER INSPECTION 0
201 — 400 amp • 0 1st W/0 SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 amp • 1 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS • > 600 VOLT NOMINAL..:
Reconnect only • 0. SVC /FDR >= 225 AMP'S..: CLASS AREA /SPEC OCC.:
Owner: FEES
BENENSON CAPITAL COMPANY type amount by date recpt
708 3RD AVE PRMT $ 1855.00 DRA 12/24/97 97- 302050
NEW YORK NY 10017 PLCK $ 463.75 DRA 12/24/97 97- 302050
SPCT $ 92.75 DRA 12/24/97 97- 302050
Phone #:
Contractor:
OREGON ELECTRIC CONST /GROUP $ 2411.50 TOTAL
1010 SE 11TH AVE
REQUIRED INSPECTIONS
PORTLAND OR 97214 Ceiling Cover Underground Cove
Phone #: 234 -9900 Wall Cover Elect'). Service
Reg #..: 203
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 foll. hi rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 9521 -0010 through OAR 4 You may obtain a copy
of these rules or direct questions to by calling (503)246 -1987.
AIMME40
Permittee Signature: ,L Issued By
Alf
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 639 -4175 by 7:00 p.m. for an inspection needed the next business day
' 1 1 1 1 1 1 1 1 1 I t t l i t l f 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1+ 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 I I++ + * '�"*' ♦ ♦ ♦ ♦ ♦ T ♦ T'T'
CITY TIGARD Electrical Permit Application Plan Check
13125 SW HALL BLVD. Recd By v ' MO! f
TIGARD OR 97223 i & p7-05-6/ Date Recd 1 L - 2- i f '
Date to P.E. Ia -D 1
Phone (503) 639 -4171, x304 Date to DST 0l 0 7 S
Print or Type
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # ��� -97 O iO
Fax (503) 684 -7297 Called Q /OW S. �
1. Job Address: 4. Complete Fee Schedule Below : /'
Name of Development Providence Health Dat - Number of Inspections per permit allowed
Name (or name of bu ness) Providence Health System Service included: Items Cost Sum
' I I
A
1
ddress Waft, SW 68th Parkway - 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State/Zip Tigard , Oregon Each additional 500 sq. ft. or
Commercial D Residential ❑ portion thereof $25.00 1 - Limited Energy $25.00
-
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor Oregon Electric Group Installation, alteration, or relocation
Address 1010 SE 11th Ave . 200 amps or less 8 $60.00 480.00 2
201 amps to 400 amps $80.00 2
City Petri 1 anA State nP Zip 97? 1h 401 amps to 600 amps $120.00 2
Phone No. 507/934-9900 601 amps to 1000 amps _T $1so.00 18U. UU 2
Job No. 131(179 Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 26 -95C Exp.Date_ to-1 -�14
OR State CCB Reg. No. 703 Exp.Date 7-1- 9 $ 4c. Temporary Services or Feeders
COT Business Tax or Metro No 995 Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
- Signature of Supr. Elec n 401 amps to 600 amps $100.00 2
G " .295 5 Over 600 amps to 1000 volts,
License No. 2841S Exp.Date /0 see "b" above.
Phone No. 503/234 -9900
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit 231 $5.00 1,155.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy 40.00
panel, alteration or extension 1 $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional Inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
)( Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: 1855.00
Not required for temporary construction services. 5a. Enter total of above fees $ 9'2 .
5% Surcharge (.05 X total fees) $ 194/. / 5
NOTICE • Subtotal $ yto
5b. Enter 25% of line 5a for 00'03 � , S
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $
\ Total balance Due ay II , 5? zrayEze
dC96.APP Rev 9/96 a�� `�
ELECTRICAL PLAN REVIEW CHECKLIST
Job name pApopE'Nc /1E09 -L7 N O#7 Permit no. EL, c `1 - o ' ' o
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Service and Feeders Ex /s f/ �q
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Plan examiner
Date / — 9
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