Permit A CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
--41. ' � �'� DATTE I T 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DA #: ELC 2
E ISSUED: 02/12/97 2
PARCEL: 25110AA -00300
SITE ADDRESS. 141.45 SW 105TH AVE
SUBDIVISION.:..: ZONING:R -12
•
BLOCK LOT
Project Description: instl 19 branch circuits
.job # 6489
-- -- 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 • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- ---- BRANCH CIRCUITS -- -ADD'L INSPECTIONS- -
0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp......: 0 1st W/0 SRVC OR FDR.: 1 PER HOUR : 0
401 — 600 amp : 0 EA ADD'L BRNCH CIRC: 18 IN PLANT • 0
601 — 1000 amp 0 - - -- -- -PLAN REVIEW SECTION
1000+ amp /volt • 0 > -4 RES UNITS > 600 VOLT NOMINAL..:
Reconnect only..... :.0 SVC /FDR 4= 225. AMPS. CLASS AREA /SPEC DCC.:
Owner: FEES
TIGARD MEDICAL & REHAB type amount by date recpt
14145 SW 105TH ST PRMT $ 125.00 TAT 02/14/97 97- 290271
5PCT $- 6.25 TAT 02/14/97 97- 290271
TIGARD OR 97223
Phone #:
Contractor:
ELECTRICAL DIMENSIONS INC $ 131.25 TOTAL
PO BOX 12146
3961 SW WILLAMS AVE REQUIRED INSPECTIONS
PORTLAND OR 97212 Ceiling Cover Underground Cove
Phone #: 503 - 282 -7255 Wall Cover Elect'l Service
Reg #..: 44008
This persit is issued subject to the regulations contained in the 1/4-i' i Q, k,
Tigard Municipal Code, State of Ike. ; Specialty Codes and- all other Perm i ,t e . S i gnat ur
applicable laws. All work will be done in accordance with
approved plans. This pernit will expire if work is not started
within 1110 days of issuance, or if work is suspended for sere t d f '
than i days. I ued 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:
LICENSE NO :
Call for inspection — 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. rr�� (�
Tigard, OR 97223 Permit # G� l7- (V) 3
- o i vl_Nfil i ,i Date Iss . i y i
� � Phone (503) 63 - 4171 _L /
FAX (503) 684 -7297 ��� /// eldei gg'
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: IInn,,�� 4. Complete Fee Schedule Below:
Name of Development T14Apz,l1 rY eD 4 61,46 Number of Inspections per permit allowed
Address (L 46 Z jlJ, I d 5 Service included: Items Cost(ea) Sum
City /State /Zip � IA R.p 4a. Residential - per unit
q 1000 sq. ft. or less $110.00 4
Name (or name of business) Ir eD • I ( � «kQ33 &,i ldi is Each additional 500 sq. ft. or
portion thereof $25.00
Commercial X Residential El Limited Energy $25.00 1
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
---- 4b. Services or Feeders
Installation, alteration, or relocation
Electrical So/n'� 'x tr for &' IecJ (2/ C- 4 4. i rpie Al sieAt 5 200 amps or less $60.00 2
Addra�s Y(� � t 1 2.143 v /� p 201 amps to 400 amps $ 50 . 00 2
City -'R -
Cit 11 L 4N State oQ Zip -f 7212 401 amps to 600 amps $120.00 2
r 601 amps to 1000 amps $180.00 2
Phone No. -,x711 ,5e7 Over 1000 amps or volts $340.00 2
Job NO. Reconnect only $50.00 2
contractor's license NO. l'1 Li 4c. Temporary Services or Feeders
Contractor's Board Reg. No ,... V 49. r ! Installation, alteration, or relocation
L
Signature of Supr. Elec'n Argw 17/ 2 00 or less
amps p 2
. -� C 201 amps to 400 amps $50.00 2
License No. 2 (� .S Phone NO.LT >Z / C +.�� 401 amps to 600 amps $75.00 2
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5.00
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. Ea a ddch ca brt I $$5.00
Each additional branch circuit TEE $5.00
1
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ II 2 C .�
NOTICE 5% Surcharge (.05 X total fees) $ ( 26
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. wordlcomdeNeleu ❑ Trust Account #
$
prm.app
Balance Due $ Z5
i
Page No. 1 CASE HISTORY FOR CASE NO.: ELC97-0079
TIGARD MEDICAL & REHAB
14145 SW 105TH AVE
06/04/97
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
- - -- - -- -- ------ - --
ELCC001 Application received 02/12/97 / / 02/12/97 02/12/97 TAT
ELCC003 Permit created 02/12/97 / / 02/12/97 02/12/97 TAT
ELCC500 (F)Issue permit / / / / 02/12/97 PASS TAT 02/12/97 TAT
ELCC700 Ceiling Cover 02/12/97 / / / / 02/12/97 TAT
ELCC720 Wall Cover 02/12/97 / / / / 02/12/97 TAT
ELCC725 Underground Cover 02/12/97 / / / / 02/12/97 TAT
ELCC730 Elect'l Service 02/12/97 / / / / 02/12/97 TAT
ELCC799 Elect'l Final 02/12/97 / / / / 02/12/97 TAT
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
p�
BUP
Date Requested (0/ 7/0 AM PM BLD
Location 'qv-6 ( C) g "604.- Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
9 -7 _i ��y
BUILDING. Tenant/Owner SU fl � �; 114 ��
� AC ELC _I wl.�7q
Retaining Wall ELR Q,-0 g 0
Footing Access:
Foundation � r (� _. FPS
Ftg Drain �� SGN
Crawl Drain Inspection Notes: no , , I
Slab lit `� SIT
Post & Beam j o
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler /r;t1,4z-
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PA P FAIL
LECTRICA
Service
Rough In
UG /Slab
Low Voltage
Fir- . larm
- -'11k .� PART FAIL
E
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. 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
Other Date - AIN Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
.-r
CITY OF TI:GARD BUILDING INSPECTION DIVISION MST
24tiour- 4nspection Line: 639 -4175 ' Business Line: 639 -4171
BUP
Date Requested ,, AM PM BLD
Location d 41 \ 4 .�'r"�i - 2 , Suite MEC •
Contact Person Ph - PLM
Contractor Ph SWR
BUILDING Tenant/Owner a _ •�, Li .4 -•ELC QB 7 0 11 06' 7?
Retaining Wall i x A %VA" P ,e„ s LR 'F
,_ E- ICJ c /
Footing . 7 .". ; ` ` r ' .` D ��i:{!v 4
.0 ; 4;,i', �: ,. W- ' -
:W ± ..r l�' �- �--t� zKy �� �e •� � l � � . � Z.•
Foundation , �+ Yy �. j,v '''' a ;•
Ftg Drain _ ,� t.� t.� Q t, ..r.. -ra"' --:,:. 'A • .:":�,�;1`.XL !' t • + 6• * ;.=-1 FPS
_
.cs >s.. -• mac' S G N
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear f ��
F amingth /Shear 'Pi/ 9 o00 15 i 1 �6.✓1 C 3: ,f e �.L. � �--
9
D n Nailing fp „ � � . \ Q
Dwall t }�
Firewall 0
Fire Sprinkler
Fire Alarm •
Susp'd Ceiling •
Roof •
Misc:
Final
PASS PART FAIL
' PLUMBING.
Post & Beam
_.Under Slab
Top Out
Water Service
Sanitary Sewer //^^ {�, r
Rain Drains 1" °1 Cl °' { Jo C- 2 �
�1D° ( �0�0)
Final
PASS PART' FAIL ' `% n ■ i .1_.,, r e l-A 9-4( 01tA, fl
MECHANICAL ' 1 : '' - \
Post & Beam
Rough In f f � t I - . I -
Gas Line � -
Smoke Dampers ° .
Final
PASS PART FAIL
("ELECTRICAL)" , • --- Service°" A A!
Rough In . @ r�' _ 1
UG /Slab - -
Low Voltage / ,.l
Fire Alarm •
e •Final•°) a-'
PASS PART FAIL °+ y
SITE r ;
Backfill /Grading
Sanitary Sewer '
Storm Drain [ ] Reinspection fee of $ required before next inspection. 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
Other Date Inspector Ext
Final r
PASS • PART FAIL DO NOT REMOVE this inspection record from the job site.
• I / ; r
441201,64k:
ACTIVE CASE: Grp Smry Edit Prcl Name Actn Cond Log -note Fee Doc Tag Misc Xit
List related cases in project group # 1388
— BUILDING PERMIT
:BUP97 -0059: PROJECT:TIGARD MEDICAL REHAB: TATUS:R : UPD:06/14/97: :JT :
PERMITTEE:TIGARD MEDICAL & REHAB /' PRIM..:SIT96 - 0046:
SITE ADDRESS:14145 SW 105TH AVE / JUR...:TIG:
— DESCRIPTION OF PROJECT (1)
Installing emergency generator and alarm system
HOLD C/O ON BUP96 -0389 UNTIL THIS HAS PERMIT IS ISSUED & INSPECTED
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION -
CLASS OF WORK.:FPS: FIRST 2510:sf N: : S: : E: : W: :
TYPE OF USE...:COM: SECOND...: 0:sf PROTECT OPENINGS?
TYPE OF CONST.:5 -1HR: ...: 0:sf N: : S: : E: : W: :
OCCUPANCY GRP.:I1.2: TOTAL 2510:sf ROOF CONST: : FIRE RET ?: :
OCCUPANCY LOAD: 29: BASEMENT.: 0: AREA SEP. RATED: :
STOR.: 0: HT..: 0:ft GARAGE...: 0: OCCU SEP. RATED: :
BSMT ?: : MEZZ ?: : REQD SETBACKS REQUIRED
FLOOR LOAD 0:psf LEFT: 0:ft RGHT: 0:ft FIR SPKL: : SMOK DET..: :
DWELLING UNITS: 0: FRNT: 0:ft REAR: 0:ft FIR ALRM:Y: HNDICP ACC: :
BEDRMS: 0: BATHS: 0: IMP SURFACE: Osqft PRO CORR: : PARKING: 0:
VALU $: 3313: NOTES:
6,/,‘T? t
,ca eeZ4/2,4TI,--
0 037k
ACTIVE CASE: Grp Smry Edit Prcl Name Actn Cond Log -note Fee Doc Tag Misc Xit
List actions for this case , -. ,` /,?
— BUILDING PERMIT -
:BUP96 PROJECT:SUNRISE HEALTHCARE : STATU::F : UPD:06/14/97: :JT :
PERMITTEE:SUNRISE HEALTHCARE PRIM..:VAR95 -0015:
SITE ADDRESS:14145 SW 105TH AVE 0JUR...:TIG:
— DESCRIPTION OF PROJECT (1)
Addition of physical therapy rooms and offices to existing structure
HOLD C/O FOR ISSUE /INSPECTION OF BUP97 -0059 (GENERATOR)
REISSUE: • FLOOR AREAS EXTERIOR WALL CONSTRUCTION -
CLASS OF WORK.:ADD: FIRST 2370:sf N:1HR: S:1HR: E:1HR: W:1HR:
TYPE OF USE...:COM: SECOND...: 0:sf PROTECT OPENINGS?
TYPE OF CONST.:5 -1HR: ...: 0:sf N: : S: : E: : W: :
OCCUPANCY GRP.:I1.1: TOTAL 2370:sf ROOF CONST: : FIRE RET ?: :
OCCUPANCY LOAD: 29: BASEMENT.: 0: AREA SEP. RATED: :
STOR.: 1: HT..: 0:ft GARAGE...: 0: OCCU SEP. RATED: :
BSMT ?: : MEZZ ?: : REQD SETBACKS REQUIRED
FLOOR LOAD 0:psf LEFT: 0:ft RGHT: 0:ft FIR SPKL:Y: SMOK DET..: :
DWELLING UNITS: 0: FRNT: 0:ft REAR: 0:ft FIR ALRM: : HNDICP ACC:Y:
BEDRMS: 0: BATHS: 0: IMP SURFACE: Osqft PRO CORR: : PARKING: 0:
VALU $: 245000: NOTES: add area= 2370,new total 27000 add occload 29
0 c.L \t\ 11) V 12-1
\(
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I
ATTRIBUTES: View Add Change Delete Esc
View notes about this parcel
— PARCEL
:2S110AA 00300 CREATION DATE: / / .
— PROPERTY OWNER LEGAL LOT? •
:BEVERLY ENT TIGARD CARE CTR LAND VALUE..$: 449740:
:BY GEORGE MCELROY & ASSOC INC BLDG VALUE..$: 1234420:
PARCEL ATTRIBUTES
» Building Dept Action 12/30/98, research on 14145 105th. No L -- NOTES (max 254 char)
12/30/98, research on 14145 105th. No final inspections on
Bup97 -0378, Elc97 -0079. Bup97 -0059 is "R ". Electrical contractor
UPDATED: 12/30/98 JT
» Building Dept Action 12/30/98, research on 14145 105th. No
— » Building Dept Action 12/30/98 Issuing any further permits
—NOTES (max 254 char)
12/30/98 Issuing any further permits as of this date is not
recommended. Requested Supervisor respond to either Debbie /Jeanne
— — UPDATED: 12/30/98 JT
- » = Special flag
I
Press F10 when done...
From: Hap Watkins
To: Jeanne Temple
Date: Wed, Dec 30, 1998 2:36 PM
Subject: Re: Parcel 2S110AA 00300, 14145 SW 105th Ave, Tigard Medical
Four outstanding permits, three with no inspections called. Yes, that sounds like one to hold all further
permitting until current permits complete. The owner /tennant or management company has to be called
and notified. Good call thx hap
hap@ci.tigard.or.us
»> Jeanne Temple 12/30 1:07 PM »>
Please view my notes in Parcel Attribute and respond to either Debbie or I. Debbie is holding incoming
electrical application until further notice. _ /
Thanks! �" 43-OM 8
a J
Jeanne Temple /' i
City of Tigard G �� I /�
Building Division 4.S , 0
503 - 639 -4171 ext. 310 J
Jeanne@CI.TIGARD.OR.US
CC: Debbie Adamski IT:
•