Permit C ITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00087
° COMMUNITY DEVELOPMENT DATE ISSUED: 4/1/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S136DA 00100
SrrE ADDRESS: 11308 SW 68TH PKWY ZONING: MUE
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: PROVIDENCE HEALTH SYSTEMS
Project Description: add panels and (31) branch circuits
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: 0 SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: 0 SIGNAL/PANEL:
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: 31 PER INSPECTION:
201 - 400 amp: 4 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: 2 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: X CLASS AREA /SPEC OCC:
Owner: Contractor:
BENENSON 68TH PARKWAY BROADWAY ELECTRIC - COCHRAN INC
KEY LLC, THE 626 SE MAIN ST
BY FIRST AMERICAN TAX VALUATIO PORTLAND, OR 97214
WORCESTER, MA 01615
Phone: Contact #: PRI 503 - 234 - 6564
FAX 503 - 238 -2098
FEES
Description Date Amount Reg #: ELE 37 -546C
[ELPRMT] ELC Permit 2/19/2008 $874.85 LIC 72942
[ELPLCK] ELC Pin Rev 2/19/2008 $218.71 SUP 34475
[TAX] 12% State 2/19/2008 $104.98
(additional fees not listed here) REQUIRED ITEMS AND REPORTS
Total $1,308.01
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 mor- • - . 80 days. • ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those rules - - set forth in O • ; 9 -01 -00 0 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246.6 or 1.800.332.2 • ,
7
Issued y: s ✓t Permittee Signature: )
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:
ONTRACTOR INSTAL ,• TION ONLY
SIGNATURE OF SUPR. ELEC'N: k. % / _i DATE:
LICENSE NO:
Cali 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.
((Q S� C F Q� .
e
Electrical Permit Application Q / FOR OFFICE USE ONLY
City of Tigard IV E D Dat ed a , a /377_ Permit No.: � — � r
13125 SW Hall Blvd., Tigard, OR 97223 Y
g Plan Review
Phone: 503.639.4171 Fax: 503.598.1
P 4 " " ' r Date/By: Other Permit:
1
Inspection Line: 503.639.4175 FEB t LL 4� ��
0 ' i Date ReadyBy: l uris: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method:3. 3' / Supplemental lnformation
Y r T 0 ` SPY AN "REVIEW
Ne construction dittiorl/alterationlre lac ent Please check apply:
❑ p PP Y
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'I DHazardous location
EService over 320 amps - rating ❑ Bui1dng over 10,000 sq. ft.,
. CATEGORY. OF 'CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling gCommercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
/❑ Master builder ❑Building over three stories weeders, 400 amps or more
❑ Multi - family
❑ Other: ❑Occupant load over 99 persons ['Manufactured structures or
'JOB SITE INFORMATION AND LOCATION ❑ Egress/lighting plan RV park
Job no.: /99O/, I Job site address / //J AA a�LAl DHealth-care facility ['Other:
�'� Submit 2 sets of plans with any of the above.
City /State /ZIP: G 4, d The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
G �� Description I Qty. I Fee. Total `.
Cross street/directions to job site: ' "7/4) , f �'ei ao New residential single- or multi - family dwelling unit.
�7 Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map parcel no.:
Limited energy, non- residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
�� v -7.---.) dwelling, service and /or feeder 90.90 2
xih io ;41 iP ...r - XV 'kb, ac' / e /f Services or feeders installation, alteration, and/or relocation
704..) /JO 200 amps or less 80.30 2
fa PROPERTY OWNER . a - TENANT. 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 7h/3"" 601 amps to 1,000 amps 240.60 2
Address: �f gide, Over 1 ,000 amps or volts 454.65 2
� / (!'" Reconnect only 66.85 2
�
City /State /ZIP f / �L1I Q l'� '24 Temporary services or feeders installation, alteration, and /or
,��
Phone: ) a F ax: (SD.: ) /f �� 200 200 camps mps or less 66.85 1
3
.� Z�.����(J w� ° -
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps Y 100.30 %V a) 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 2, 133.75 2475132
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
. ❑ APPLICANT . ❑ CONTACT PERSON A. Fee for branch circuits with
• service or feeder fee, each 3/ 6.65 46,5 � 2
Business name: . branch circuit w
B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 2
each branch circuit
Address:
Each add'l branch circuit .3 6.65 /7g, 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR • energy panel, alteration, or
extension. Describe: Page 2 2
Business name: �c c.v.. w 4`} ` � 4 \C.
Address: p Each additional inspection over allowable in any of the above
�O 2 S �= I " G\� Per inspection 62.50
City /State /ZIP: ?,..1 Cs. Ch9---. c\.-1 21L4 Investigation per hour (1 hr min) 62.50
Phone: (5o3) 23t —( ( y Fax: (9 3) 234E8 - 2.� c1$ Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 7 2Cci 2__ Electrical Lic.:31- 5`t(,c Suprv. Lic.: 3 5 Subtotal 8, r
Suprv. Electrician signature, required: ,... - Plan review (25% of permit fee) 0/
\Z surcharge�o of permit fee) / Q.
Print name: �Ge ,,,,,.,eN -h �6.X-0 Date:
TOTAL PERMIT FEE //
Authorized signature: This permit application expires if a permit is not obtained within 1 0
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
:.....:,.__n._:._,n. r n__:.. __ •__ ,nm� .en A4 I crn nin,irnflnx'co
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008 -00087
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1/2008
Phone: (503) 639 -4171 Au t
Inspection Requests (24 Hrs.): (503) 639- 4175ill
INSPECTION WORKSHEET FOR DATE: 5/8/2008 TIME: 7:01AM PAGE: 36
SITE ADDRESS: 11308 SW 68TH PKWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE HEALTH SYSTEMS
DESCRIPTION: add panels and (31) branch circuits
OWNER: BENENSON 68TH PARKWAY, PHONE #:
CONTRACTOR: BROADWAY ELECTRIC - COCHRAN INC PHONE #: 503
Inspection Request Scheduled For: Date: 5/8 /2008 Pour Time:
Code # Inspection Description Co • irm Contact # Message
199 Electrical final 069576-01 503.730 -7012 Y
Corrections /Comments/ Instructions:
Ca LL 45S'
PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G" t N6 e Date: 61101 Phone #: (503) 718- 2,1
t
3
CI 'Y OF TIGARD r --A ,
BUILDING DIVISION PERMIT #: El 02008.00087
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1/2008
Phone: (503) 639 -4171 A in
Inspection Requests (24 Hrs.): (503) 639 -4175 ,.7.41- J 1.
INSPECTION WORKSHEET FOR DATE: 4/8/2008 TIME: 7:00AM PAGE: 18
SITE ADDRESS: 11308 SW 68TH PKWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE HEALTH SYSTEMS
DESCRIPTION: add panels and (31) branch circuits
OWNER: BENENSON 68TH PARKWAY, PHONE #:
CONTRACTOR: BROADWAY ELECTRIC - COCHRAN INC Vh \ \L 6,( l PHONE #: 503-234 -6EM
Inspection Request Scheduled For: Date: 4/8/2008 Pour Time:
Code # Inspection Description Confirm# Contact # Message
1 5 Electrical service 068036.01 503- 730 - '7012 Y I
Corrections/Comments/Instructions:
J
,,
,.i _ ___
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G- 1 V V g L z Date: 4 li 1 Phone #: (503) 718 - Vilf‘ '
I
CITY OF TIGARD - _
BUILDING DIVISION PERMIT #: F_LC200$ 00087
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1/20(iB
Phone: (503) 639 -4171 i
Inspection Requests (24 Hrs.): (503) 639 -4175 ..- .4 , 1J2.
INSPECTION WORKSHEET FOR DATE: 4/212008 TIME: 7:OOAM PAGE: 28
SITE ADDRESS: 11308 SW 68TH PKWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE HEALTH SYSTEMS
DESCRIPTION: add panols and (31) branch circuits
OWNER: BENENSON 68TF PARKWAY, PHONE #:
CONTRACTOR: BROADWAY ELECTRIC - COCHRAN INC \ \ c) PHONE #: 503
Inspection Request Scheduled For: Date: 4/2/2008 Pour Time:
Code # Inspection Description "on irm • Contact # Message
115 Electrical service . 067722 -01 503 - 730 -70 Y
Corrections /Comments /Instructions: J0 ( iO : ?G
a�a�� D-ecLi o 1 C E.
v�
s fftil■• 23Z. 3o .
O WOvi0it C:olz,e IV iCiaZ \f°4!) s+ &' 4 uLM . ASP 110.3 ( )
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL , CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: '----• NbQL Date: 11' 2 GI) Phone #: (503) 718-149/0