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Permit • 'cI''rY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2003 -00247 DEVELOPMENT SERVICES DATE ISSUED: 7/9/03 LTS-21. mamma �•I Il 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135AA-01400 SITE ADDRESS: 10215 SW HALL BLVD SUBDIVISION: METZGER ACRE TRACTS ZONING: C -N BLOCK: LOT : 037 JURISDICTION: TIG Project Description: New 2 - story dermatology clinic 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/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 2 W /SERVICE OR FEEDER: 40 PER INSPECTION: 201 - 400 amp: 1 1st W/O SRVC OR FDR: 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: INTEGUMEND LLC BY SCOTT COLLINS MD BOONES FERRY ELECTRIC INC & MARIA ROSS MD PO BOX 628 9495 SW LOCUST STREET WILSONVILLE, OR 97070 PORTLAND, OR 97223 Phone: Phone: 682 - 4936 Reg #: SUP 3170S • LIC 88482 FEES ELE 3 -223C Description Date Amount Required Inspections [ELPRMT] ELC Permit 6/5/03 $533.45 [ELPLCK] ELC Pln Rev 6/5/03 $133.36 Elect! Service [TAX] 8% State Tax 6/5/03 $42.68 Rough -in Elect! Final Total $709.49 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 OA' • . : e 1010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1 -800 -3." -2344. Issu d By: ' ;, 011 , 1 Permit 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: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: 4 0/g 5 Call 639 -4175 by 7:00pm for an inspection the next business day . l electrical Permit Application , ph Cat1011 w orrlcc USE 01.1' ; • ' Date received: 5 S-03 Permitno. : EL G2,A3'0' ' . T AW . City of Tigard Project/appl. no.: Expire date: Cin• of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Phone: (503) 639-4171 Date issued: By: Receipt no.: \ �1( Fax: (503) 598 -1960 Case file no.: Payment \° \U�`I J Ym Ham= Land use approval: L C 3-- tX2 7 Sal 11'PE'OF PERIMHT , 1& 2 family dwelling or a+ c sory -; Commercial/industrial I e m e n a New construction OMulti- family ❑Tenant improvement 1 0 Addition/alteration /replacement 0 Other. ❑ Partial - w `` JOB SITE INFORMATION Job address / 0215- 5 N, a ` V I 4 ` U , Bldg. no.: Suite no.: Tax map /tax lot/accotrnt.no.: Lot: l Block: j Subdivision: Project name: Du `nq Description and location of work on premises: Estimated date ofcompletion// ` , i ection: i L� ! , 00 c7G'{ _ 'CONTRACTOR: APPLICATION 04. Tine. s— A Job no: 1-4 7 (- Fee Max FEE SCHEllfLE' Business n a m e : B o o n e s Ferry Electric on Qty. (ea.) Total no. insp Address: P. Box 628 2 $ New resideotud- siogfeormrdd-familyper City: Wilsonville I State:OR I ZIP: 97070 S la ded: sat�bedgrnage. Phone: 682 -4936 I Fax: 682 -79 e-mail: 1000 sq. fl.orless CCB no.: 88482 4 �) Sec b us. ti c. no: 3-223C Each ad diti ona l 50 0 sq. R or podia' thereof City/metro • . no.: 0002851 Limited energy, residential 2 Limited energy, non - residential L 2 Each manufactured home or modular dwelling I N Signature of supervising electrician (required) D. e Service and/or feeder Sup. elect. name (print): r� 2 c / A Herron License no: _ Services or feeders - installation, alterationorrelocation: ....PROPERT OWNER • 200 amps or less 2 Ix .) /3 ,f 1 �=0 2 Name (print): 201 amps to 400 amps r, Mailing address: 401 amps to 600 amps 16Xo j�� 2 2 City: 601 amps to 1000 amps 2 I State: J ZIP: Over 1000 amps or. volts Phone: Fax: I E -mail: 2 Reconnect only I Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange accordinglo installation, alteration, orrelocatione ORS 447, 455, 479, 670, 701. 200 amps or less 2 Owner's signature: 201 amps to 400 amps 2 Date: 401 to 600 amps .- ENGINEER "`, 2 Branch circuits •new, alteration, Name: or extension per panel- Address: A. Fee for branch circuits wide purchase of 1' %.1 service or feeder fee, each branch circuit `�. J L �., � ,_, City: I State: I ZIP: B. Fee for branch circuits without purchase \Ay Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2 ?` PLAN,RE�'IE�i' (Please check all_tI(at a I� Each additional branch circuit: pp •) Y misc. (Sernceor feeder not included): .Service over 225 amps - commercial {1ealth care facility U Service over 320 amps-rating of l &2 0 Each pump or irrigation circle 2 i°g Hazardous location Each sign or outline lighting alteration, o or family dwellings ❑ Building over 10,000 square feet four or Si 2 U System over 60structure s nominal more residential units in one structure ci r(e) mited energy pane(, U Building over three stories , extee extension' ❑ Feeders, 400 amps or more J Occupant load over 99 peisons O Manufactured structures or RV pad •Description: U t.eres'lighting plan U Other: Per I additional inspection over the allowable in any o f the above: Per inspection I I I I Submit __ sets of plans with any of the above. the above are not applicable to tem to Investigation fee P° ry construction service. Other ' ' No; All itn i,dicuons accept credit cards, please call jurisdiction for more information. Permit fee $ J visa J MasterCard Notice: This permit application expires if a permit is not obtained Plan review (at 2 ' %) $ ('reds card number: __L_/ - within 180 days after it has been State surcharge (8 %) $ Expires 9 Fame of cardholder as shown on credit card accepted as complete. TOTAL $'�] Q �- ..— Cardholder signature $ 1 Amount 440 -4615 (6/00/ OM) BOONES FERRY ELECTRIC O t lq 1 n G` WILSONVILLE, OR 97070 S i g IA c \ j • • `,. • • tE�lectrical Permit Application FOR OFFICE USE ONLY Received ,� Q Date/By: •-i/ I U C--.. � . d / Electrical Permit No.: 1 1 . - 0 1 6 4 3 -- 110,2. 7 City of Tigard ii 0°4E* Planning Approval Sign Date/By: Permit No.: 13125 SW Hall Blvd. l Plan Review Other Tigard, Oregon 97223 Afl V 71103 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: Q503- 598 -t960 Post - Review Land Use /au 't� DaDate/By: Case No.: Internet: www.ci.tigard.or.us D h+ry�i °� I t,l i Y���OF T{GAR � !I C on t act Juris.: El See Page 2 for 24 -hour Inspection Request: 5 -639,'1�j/t5?{G " Name/Method: Supplemental Information. a"A �s°�`q.. �1:�� ��v . -r`w,a �� .rX . r �.��� '_� ;01100:0M. ... _._.�'•.,�?a.aa� -z�r�. ��, t".�- � . a��,�t�..kx �'� 1.. :.,.. -;....�VAIM ' ='-tiktiOF MMU ,. li g �'IEW Pleasetarila all that:app_lY) ,�> a . _ , w . ►�/ New construction • ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location Addrtlon/alteratlon/repl acement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, ',, , SMOIEGO;E2X;OO i$ i STRUCT.I®N ,, t` 1 & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling ►.l Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories 0 Feeders, 400 amps or more ❑ Accessory Building • Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: 4 ,� ; .>;, ,, { a ,,t;TOB SITE,INTOI3;IVI AcTI®�ndLOGATI01€ - -; C _. °- °, .f �; <,-M , : Submit sets of plans with any of the above. .1 i i � i � � � D The above are not applicable to temporary construction service. Job site address /0;1/g /j *IX) - Pp a c P. ., * SC nALt> y.x Suite #: Bldg. /Apt. #: Number of inspections per permit allowed . Project Name: i ) yV ) LL Description Qty Fee (ea.) Total 1 Service residential - single or multi - family per Cross street/Directions to Ob site: .v...1 # A vQ ` ' t • C .,, * V� dwelling included: Includes attached garage. � V � �W �y�.IF- ervce icluded: ©) F-( A, i- c�.r-+, 4) E5-11i4 - Av'. , 1000 sq. ft. or less 145.15 4 + w 1 �+ Each additional 500 sq. ft. or portion thereof 33A0 1 Subdivision: . Lot #: Limited energy, residential 75.00 2 1 � .� . Limited energy, non residential 75.00 2 Tax map /parcel #: 'T' ,. L 1 1 Each manufactured home or modular dwelling +� r - - �= service and/or feeder 90.90 2 : � DESCRaIPION 14 e-, w 1 1 ` 1 A � .- Services alteration or r feeders - installation, V v `�{ Y Vt relocation: G' 1G � �� � � �/ 200 amps or less 80.30 2 l+l 1 201 amps to 400 amps 106.85 2 , 401 amps to 600 amps 160.60 2 PROPER Y ,ONVNER r in • NANT fi . , : + , i±. 601 amps to 1000 amps 240.60 2 '� /� � ` t °" ' '' Over 1000 amps or volts 454.65 2 acne. t �UY v v t� t ` V M WC' Reconnect only 66.85 2 , Address: 1�{-1r -� J\J L c t ,y ' Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: - Z7 � { �, 97 22.E 200 amps or less 66.85 1 p r � �-� 201 amps to 400 amps 100.30 2 A ne: �Gj 2 . 2 • s� 1 401 to 600 amps 133.75 2 :m9 APPLICANT n a C01� IrTA.G ' It P it$:° Branch circuits - new, alteration, or Name: tAV 6 D C. , extension per panel: r ��� A. Fee for branch circuits with purchase of Address: 322 j� w 5114- v ! l service or feeder fee, each branch circuit 6.65 2 City /State /Zip: f Pt cyrz 1 ZD� B. Fee for branch circuits without purchase of ( service or feeder fee, first branch circuit 46.85 2 Phone: 95 Q• (5 5 Fax: 2 ) • -224- 23,11 Each additional branch circuit 6.65 2 E-mail: (01 ibe ( c yl et GCU{/ A Misc.(Service or feeder not included): M " GON RAG OA ,, ,,, ,; . a Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: l - Signal circuit(s) or a limited energy panel, Business Name: ( alteration, or extension Page 2 2 _ — Description: Address: , Cit /State /Zi Each additional inspection over the allowable in any of the above: y � Per inspection per hour (min. 1 hour) 62.50 Phone: Fax: • investigation fee: CCB Lic. #: { Lie. #: Other: RV Tra, Electnca`I termlt 0.01 MI M Supervising electrician Subtotal $ signature required: Plan Review (25% of Permit Fee) $ Print Name: 1:141/: State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ / Il�% Authorized /' Notice: This permit application expires if a permit is not obtained within Sign. 1 re: / �� /, ' ' •O 180 days after it has been accepted as complete. O/�_ *Fee methodology set by Tri -County Building Industry Service Board. / di A A P V r ( "ease p Ana - i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard ` - Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: n Audio and Stereo Systems n Burglar Alarm 0 Garage Door Opener 0 Heating, Ventilation and Air Conditioning System Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system ... $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: Audio and Stereo Systems Ei Boiler Controls • n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation HVAC n Instrumentation El Intercom and Paging Systems • El Landscape Irrigation Control Medical El Nurse Calls n Outdoor Landscape Lighting n Protective Signaling . n Other • Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received .3 7 Date Reque ted �Z30/0 AM PM BUP Location > Z ' -- / �` /` Suite MEC Contact Person Ph ( ) PLM Contractor 41 LL)L . _Ph (- �) �� 2 � 7 � � SWR BUILDING Tenant/Owner .C1�� c . ` 00 ..2V7 Footing Foundation ELC Access: Ftg Drain ELR • Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling I / Roof J4 C/ Other: /// " " "S Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fir- Alarm PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE El Please call for reinspection RE: E1 Unable to inspect — no access Fire Supply Line ADA Date / Inspector /4=1 Ext Other: Final DO NOT REMOVE this inspection record from a job site PASS PART FAIL