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Permit E ; ,CITY OF TIGAR® ELECTRICAL PERMIT PERMIT #: ELC2004 -00577 *F l DEVELOPMENT SERVICES DATE ISSUED: 9/14/2004 4.61:114.4 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 25101 AC -01300 SITE ADDRESS: 07105 SW HAMPTON ST SUBDIVISION: BEVELAND NO. 2 ZONING. MUE BLOCK: LOT : 018 JURISDICTION: TIG Project Description: Compressor change out. 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 HMI SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 1 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: KAISER FOUNDATION HEALTH CHERRY CITY ELECTRIC PLAN OF THE NORTHWEST #838 8100 NE ST JOHNS ROAD D -104 ATTN: PROPERTY ACCOUNTING VANCOUVER, WA 98665 PORTLAND, OR 97227 Phone: Phone: 360 - 571 - 4411 Reg #: ELE 37 -620C LIC 91668 FEES SUP 3486S Description Date Amount Required Inspections [ELPRMT] ELC Permit 9/14/2004 $53.50 [TAX] 8% State Surcharge 9/14/2004 $4 Low Voltage Inspection Elect'l Final Total $57.78 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 or 1-800- 332 -2344. Issued By: k Permit Signature: SA 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 7:00pm for an inspection the next business day ,; x'. J; ;� �' , • 1 , _:s Y k 5 , y S'i`t' C ,, ,, C3 3y El 'trmit Appli 0� x ,fi )FF�CE .. �� f City of Tigard ��v DateByd. �y _a,,,,7. a/ �,�i /�- ~ Permit No. .L 1,04/ (7Q) 17 • 13125 SW Hall Blvd., Tigard, OR 97223 q 15 10 � Plan Review Phone: 503.639.4171 Fax: 503.598.196 [¶ . J �� 11 Date/By: Other Permit: Inspection Line: 503.639.4175 �GG" f`�' ! ' Date Re ady /By: Iuris: 0 See Page 2 for rA �`I O ` \ `, S r.. Nottt d/ t ethod, Internet: www.ci.tigard.or.us 1 Supplemental Information : .,n,....a__ .., _, , -. .x f -,., . . W.. ,.- .. ,., -cam,.. r le • % may. ❑ New construction ❑ As • • i Please check all that apply: ❑Service over 225 amps, comm'l ❑ Hazardous location ❑ Demolition ❑ Other: ❑ Service over 320 amps rating ❑ Buildng over 10,000 sq. ft., ..,7, •::*? ,t - 3 ' o wresidential >r� r .,� -- . -_.- * t�r�•� = �r -and 2-family dwellings 4 or more new wii. At..i_ 3, RY'4OF:aC01\STRUCTION 5 ..,. ° ,. i t ,, o. l ) o ,.;_:%�a;ic �:r•� :,.GAT -EGO � . .4..- ��:_ .� � -.. __ � ,._._. _�,_ ..,.� „� .•�,_.,.r�`� :. : -_. ❑ 1 - and 2 family dwelling ,E /industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure ❑ Building over three stories ❑ Feeders, 400 amps -or more . ❑ Multi - family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons Manufactured structures or fs:. o RV park l ” :• - •> r - E gress /1i htin plan "`�t�t: �._.. . JOB�SI'• 1h�IlVF. OR9IZ: ATIOIV..- a '�p�IiO.CATIOl�,��t� �': >�' ❑ g � P ❑ Health -care facility ❑Other: Job no 311,114,- p 1 Job �site address: 105 , 5W �/I Submit 2 sets of plans with any of the above. • City /State /ZIP L W The above are not applicable to temporary construction service. � t4i l `~ , F E ;E =: AC ,,,, „. ' Suite/bldg. /apt. no.: Project name: i dfp 'V �/ De o ( . , 1 ' Description u.:,...._�. , t .. p [ion t _ - . - _•” _ ._ � t I Fee. � Total Cross street/directions to job site: . New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 I 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I 1 Limited energy, residential I . 75.00 J I 2 Tax map /parcel no.: • . Limited energy, non - residential I 75.00 1 I 2 -: ' ,., n2DESCRI'PTIOltt OF W072K= �., ' " ' x— - :�> ` " "` r '""�' -�;�`� Each manufactured or modular `�r.,��.,� .,; ;..f�>�s;:=��';f�:�::_���.,:,.. , ,., �, �3:. t�: z.. �..« ��,. � ..= �z= t�',�� >.�_ .u'��F> - sue:. - „ . Y ' C ^ dwelling, service and /or feeder 90.90 2 (l'�f1,/1 "/�" / V V v ' Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 ,,_ .�_'.: - • .. „- .... >,.._;,><< ;: <' -' * "" _.,..,.:'- - rte : ,*...• t amps to 400 amps I s•:t;vr sue: ° ;' 201 10 � rod „:: , .c. 3=a c°i _ TEN =ANT: ,- ,, srR ,:- -;, tr PROPFsRT1 _O«iVER. 1; _- 4 . __. -_. _.....a,.K rw� �,x- w4,....v a' ' 1_- _x,� - , ...r kT� - 401 amps to 600 amps 160.60 2 � Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 1 454.65 I 2 Reconnect only 66.85 . I 2 . City /State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less I 66.85 I 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps I •133.75 I 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel .,;;., ,._,.__.. ,_,. - .•s : - :: —t.-- z elf : ,:. ,;, - r .;,t - r =�; ,” 1 . A. Fee for branch circuits with ;:�;•�:'r - - g ��. s; �.,... =�, •`•.r <�.- .,,�,< A ..,; � ,CO'�' :P =RSO1�„>� =_,: a�. x 12; °APPII;AIVT. <= ' •_..._,.,;r:::a...n , ._.4- ,,•F .....:._ ;:t.r° -- .. - w - - - - service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, i 46.85 lam / � 2 each branch circuit "Lf� �. Address: Each add'l branch circuit 1 6.65 �O �- 2 City /State /ZIP: Miscellaneous (service or feeder not included) 1 Pump or irrigation circle I I 53.40 . I 2 Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited- = ,.- ,;rnr.. = t :a >. - sf en ergy pan el, alteration, or t a - „s :<`;'; =` ` r.� .. V"-"'�.,., g . a = z t wait energy P : �'r �-:�= �:c-c::^�',.�*'�s�'`. -r� �. =e:-•ra:'`���:� ...< .. - .- ,.n... �'._.w`,��"�,:rk:w r' :.,��, , - ..,,.u�•:F -:�'� . 2 `" "�"" °� � extension. Describe: Page 2 Business name: eY ft f - o l � /� // Each additional inspection over allowable in any of the above I Address: g160 t �� Y I� l I Per inspection 62.50 I I City /State/ZIP: Vain l ( ' l V V V 4 4s v (P5 Investigation per hour (1 hr nun) • 62.50 I v / � / / Industrial plant per hour I I 73.75 I � ant Phone: ) L �U S7( � (14 V a n t �(( Fax: ?=. _ 3,- . EMTI2TC T;; =PE121�7�IT REES ` ., CCB Lie.: f / n�QQ Electii dal Lic.: r Suprv. Lic � S ubtotal 5- Suprv. Electrician signature, re uired: Plan review (25% of permit fee) f }f-= State surcharge (8% of permit fee) 7 s CA Print name: �j t (�`i ; - t r•w Date: r ' e f l TOTAL PERMIT FEE �7 Authorized signature: This permit application expires if a permit is not obtained within 1S . 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. i:\ Building \Permits\ELC- PernitApp dot 12/03 440 4615T( /02 /COMIWEB CITY OF TIGARD 24 -Hour BUILDING Inspection Wne,�(,503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 9 3 AM PM BUP Location C ...e-diL_A6 Suite MEC Contact Person .fe/1 Ph (tea) gl`� PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC � ' d Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT /1.11 Post & Beam AWNS Shear Anchors Ext Sheath/Shear MEW Int Sheath /Shear Framing Insulation Drywall Nailing Fire wall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: 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 F - farm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL 0 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line A DA �° Approach/Sidewalk Date 2 3 Inspector ✓ 1 � / i ' �� % Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL •