Permit CITYOFTIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
i;6 DEVELOPMENT SERVICES PERMIT #: ELR2005 -00040
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 3/2/2005
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL PARCEL: 1 S136DA -00100
SUBDIVISION: ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Project Description: RIS - Cube remodel, voice & data.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BENENSON 68TH PARKWAY OREGON ELECTRIC CONST /GROUP
KEY LLC, THE 1010 SE 11TH AVE
BY FIRST AMERICAN TAX VALUATIO PORTLAND, OR 97214
WORCESTER, MA 01615
Phone: Phone: 503 - 535 - 2652
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 3/2/2005 $75.00
[TAX] 8% State Surchart 3/2/2005 $6.00
Total $81.00
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.
Issued by Permittee Signature .e_
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:
Cali 639 -4175 by 7:00 P.M. for an inspection needed the next 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.
03 -S2 -05 10:31AM FROM -Or- .n liv 50323 13587 T -687 P.004 /006 F -745
s:xa.aa mere i ca MAIL ra T ': ;.: Qt_:— ;cit� bf Ti and --c._.. PermitNo L
1312 SW Hall Blvd, Tigard, OR 97223 Plan Revs 3 D� Ida? s �� 0 `/ (.
Phone: 503.639.4171 Far 503.598.196N AR 02 20 05 > °" ?:r ' r �" »ter :
Inspection Line 503.639.4175 " Date Ready /Ay: ltuw a Seo Page 2 tar
Interact www ci.tigatdor us
Notified/Method _......71 Sapplementnl Information g .
",• ' 1 r VI SION PLAN REVIEW
a .
0 New construction � i - • i ' u . n a1 a : • o n / r e p l a c e m e n t Please check all that apply:
❑ Demolition 171 Other: ❑Service over 225 amps, conun'I ['Hazardous location
_ ['Service over 320 amps - rating ❑Buildng over 10,000 sq. 11.,
• CATEGORY OF COP1STItVCrION • ' . of 1- and 2 -family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ❑hem over 600 volts nominal tests in one snucnac
❑Building over Once stories ❑Feeders. 400 amps or mora
13 Multi ❑ Master builder ❑ Other:
❑Occupant load over 99 persons ❑Menufacmind stnictmcs or
JOB SITE INFORMATION AND LOCATION ❑Egrss/lighting plan RV park
Job Ito.: 69328 Job site address: 11308 SW 68th Parkway OHralth -are facility ❑Other. '
Submit 2 sets of plans with any of the above.
City/State/ZIP: Tigard, OR 97224 Du l G The above are not applicable to tempormy construction service.
DTC (`nhn t� ' o bl i / FEE" SCHEDULE em Tit •
Suite/bldg,./apt. /a no Project name �.,...n, Phd
Cross strcc directions to job site New residential single- or mu lti- family dwelling mule
Includes attached garag
1.000 sq. R. or less 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax may/parcel no.: Limited energy. residential 75.00 2
Limited energy, non-residential 75.00 2
. DESCRIPTION, OF 'WORK • Each manufamucd or modular
Low Voltage / Voice & Data — �1 l �:�.1g �0o/ L dwelling service and/or feeder _ 90.90 2
Services or feeders iavtalln ea. alteration. and/or relocation
200 amps or less 80.30 2
. N PROPERTY OWNER . . ' ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Providence Health System 601 amps to 1,000 amps 240.60 2
Address: 11308 SW 68th Parkway Over 1.000 amps or volts 454.65 2
- - Rcconnect only 66.85 2
City /State%ZTP: Tigard, OR 97224 Temporary services ur feeders installation, alteration, and/or
l'itolne: (503)216-0012 Fax_ (503)216 -0014 relocation
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 10030 2
intended for sale, lease, tent, or exchange, according to ORS 447, 449, 670, and 701. 40I amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
® APPLICANT 1 . . • ) . ❑ • CON2T•A1CT PERSOM a Fce for branch circuits with
service or feeder fee, each 6.65 2
Business name: Oregon Electric Group branch circuit -
B. Fee for branch circuits
Contact name: Kyle Cooper without service or feeder fee.
each branch circuit 46.85 2
Address: 5000 NE Columbia Blvd Each add'1 branch circus 6.65 2
City /State13>k: Portland OR 97218 Mbcdlemeom (service or feeder not included) -�
Phony. (503) 849 I Fax: : ( 503) 535 - 2810 Pimp or irrigation circle 53 2
Sign or outline lighting 53.40 2
E - mail: kylec®isg Signal circuits) or limited-
CONTRACTOR . energy panel, alteration. or �
Business name: Oregon Electric Group etdmsion Describe voice/ data Page 2 �S 2
Address: 1010 SE 11th Ave Each additional Inspection over allowable to any of the above
Per inspection 62.50
City /State/ZIP: Portland, OR 97214 Investigation per hour (1 lu mm) 62.50
Phone. (503) 234-9900 ax (503)535 Industrial pIaal per hour 73.75 •
~ ELECTRICAL PERMIT FEES-
CCB Lic.: 2 0 3 I E l e c t r i c a l Lic.: 26-95C I Suprv. L i c . : 4460S Subtotal - - 7 S - c"
Suprv. Electrician signature, required: 6,41 Plan review (25% of permit fcc)
Print name: / p Stara surcharge (8% of permit foe) — ( r - (-
*A-. TOTAL M PERrt• PET!' ir / - t''v
Authorized sr trite: This �
P�r sp8>k ro
°tiOn gg4s ire permit re not obtained within 150
e days alter it hos been nmeptcd as cwupletc
Print name: Date: - Fee mahodolojy set by Tri- County Building Industry Smvico Board
to Number of inspections ter permit allowed
:. • CITY OFTIGARD .
BUILDING DIVISION ._ PERMIT #: ELR2 Q6413Il4u
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3K42006
Phone: (503) 639 -4171 M
Inspection Requests (24 Hrs.): (503) 639 -4175 ��.
INSPECTION WORKSHEET FOR DATE: 4 /W2( TIME: 7:1 PAGE: in
SITE ADDRESS: 1.3048 SW ii83TH PKWY 1 ST F CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE _
DESCRIPTION: RIS C:ube remodel, voic P� C, t • �� 1
OWNER: FJENENSON 68TH PARKWAY, \ 7 PHONE #:
CONTRACTOR: OREGON ELECTRIC CONST /GROUP \. .% PHONE #: !. +O3.53f -2
Inspection Request Scheduled For: Date: 4/4j2006 . Pour Time:
_Code Code # Inspection Description Confirm # Contact # Message
199 003576•61 5034149-2W) N
_
. Corrections /Comments /Instructions: / \
• f �\
. . .
PASS ❑ PARTIAL APPROVAL ' ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
., ��� v r
Inspector: Date: / C Phone #: (503) 718 -