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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2007 -00167 COMMUNITY DEVELOPMENT DATE ISSUED: 3/19/2007 'TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S101AC -01300 SITE ADDRESS: 07105 SW HAMPTON ST ZONING: MUE SUBDIVISION: BEVELAND NO. 2 LOT : 018 JURISDICTION: TIG PROJECT: LAISER DENTAL Project Description: 2 br. circuits. Recpts. in 7 dental carts. 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: 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 CHRISTENSON ELECTRIC, INC. PLAN OF THE NORTHWEST #838 111 SW COLUMBIA STREET # 480 ATTN: PROPERTY ACCOUNTING PORTLAND, OR 97201 PORTLAND, OR 97227 Phone: Contact #: PRI 503- 419 -3300 FAX 503 - 419 -3695 FEES Description Date Amount Reg #: ELE 26 -34C [ELPRMT] ELC Permit 3/19/2007 $53.50 LIC 458 [TAX] 8% State Surcharge 3/19/2007 $4.28 Total $57.78 REQUIRED ITEMS AND REPORTS 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: Permittee Signature: Cr 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 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. NPR -1,6 -2007 FRI 06:43 AM CHRISTENSON VELAGIO FAX NO 95034193695 P. 01/02 i el w,« ctrical Permit Application, 1 of -i it i.: i.' t (.):\i, Received aM -7..6.0/6 0/6 City of Tigard _ 9 Plan Review . R4wa .3 1 4 O'? B • Permit C 13125 6w Hall 9ivd., Tigard, OR 9� � ether Perms. � rAkr,�l ; Phone: 503.639,4171 Fax: 503.5981 0 i"1'k i pece/S ' lugs: 13 SEC Pego 2 for Inspection Line: 503.639.4175 r ' r r 1 ,�i4, 'IL, DateReedy/13y. M o p 1 6 NotifiedRvlcthod, Suppkmentul Information Internet: www.ci.tigard,or,us A , please check all that apply; . ❑ New construction itio' "t�>sition7s�p Bement ❑Service over225 amps, cumuli ❑hla2atdous location ❑ Demolition ❑ 0, tber: ❑Scrvicc over 320 amps - rating ❑l3uildng over 10,000 sq. R., TJt";L?I, 1i:': ^::i� :;:i;i<:cz:ii � si i 'i's::.;: iis!: 'r,:' �:i;:: >'.: > if 1- and 2- family dwellings e new residential "' � ❑System over 600 volts nominal unjts in one xtrUClure 1:: 1- and 2- family dwelling �'CommcrciaVindtlstrial 0 Accessory building O S ysie ing over three l tnijce ❑Feeders, 400 amps or more Ma builder ❑ Occ ant load Ove 99 persons ❑ y p P Manufacture structures ps or m re Muhl- Earful ❑ Other: RV Ark E esslli htin plan n Park •.1 ❑ g B T or :. ::. 111 ' �TL. ,.•,:..:, ,.:,...,:..,::,: ....:......... "ig .,.,.. d ress:�i �5 S 1 n � N ❑ ; , ..,: , .... :.:. Job site ad ❑Health - duo facility ' � -- Job no, :t� 3 - O�p z C�t Su bmit 2 eats o f plans with any of the above. Ci ty /Sta[e/ZIP: 3 The above are not applicable to temporary construction service. ;e ;!: •C' e: i tee. 7 4 • Suitclbldg, /apt. no.. ( l rojc, t nAm t . � ]t ��� �— ' Uc�crlpllaa' � Q r � ;I;; �: • Cross street/directions to job site: N(� �: `•61/6 `, J 11',Lt,1 / • 4 lu .y New residential single- or multi - family dwelling unit. _ includes attached garage. r 3 - 731 i l l 1,000 sq. ft. or less 145.15 4 Subdivision; T Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 - Limited energy, residential 75.00 2 Tax map /parcel no. T Limited energy, non - residential 75.00 2 :. or modular lt! Each manufactured factored r rate ..::.:,:. >z,.:. •:, .::...::.: ,..,� :lei $ , -,: : Q. �s : :. . .:.: ....... .:...: .:.;: ::: :.:::::.: :.:,, 90.90 dwelling service and/or feeder � - � .' I Mk ...IS--' �� Services or feeders installation, alteration, and/or relocation amps A — I), (,", i il l,it 200 as or less 80.30 2 201 amps to 400 tunes 106.85 2 :. ;;, . :.. �' ii; .: .:�.:. .::.::::::::: ,. ,... 160.60 2 " .; : ?: 401 am ate 6U0 ramps Name: 601 amps to 1,000 amps 240.60 2 Over 1,000 amps or volts I 454.65 2 Address: Reconnect only { 66,85 _ 2 City /State/ZIP: Temporary services or feeders histailation, alteration, endlar relocation Phone: ( ) Fax: ( 200 amps or loss 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 _i_ intended for sale, lease, rent, or exchange, according to ORS 447, 4.49, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: . • Date: B circuits - new, alteration, or extension, per panel „ : ........:.... :.... . :..,:,:.. A, Fcc for branch circuits with 'R7A Gl.:• :...:':: :' � ;il t::5,. : .:...:. , . .... :... :: .• service or fender fee. each Business name: branch circuit _ B, Fee for branch circuits '/ - C Contact name: without service or feeder fee, 46.85 `h7-0 5 2 __ first branch circuit Address: _ — Eachadd'l branch circuit FE 6,651 62,tp51 2 , City /State/ZIP: Miscellaneous (service ur feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax: : ( ) - , Sign or outline lighting 534 2 E -mail: Signal circuit(s) or limited- .......... ... .... .:..... :. ..., , or :© i s .., energy panel, a teratiotu o Page 2 2 •ec . . extension. Describe: r e e a n W Business name: Christenson Electric, Inc. — Each additional inspection over allowable In any of the above Address: 111 SW Columbia Street, Suite 480 Per inspection 62.50 City /State/ZJP: Portland, OR 97201 Investigation per hour (1 hr min) 6 2,50 -- Industrial plant per hour 73.75 one: 5113 419 -3300 Fax. (503) 419 -3695 4.1 F2t14'I1 '.... 1... :; : , ;"; .? : :".: - CC13 G.ic.: 458 I 1- Date: I /112__ Electrical Lie.: 26 -34C S rv. Lic.: 199 subtotal 53, 50 Suprv, Electrician signature, required: (3? Plan review (25%of permit fee) - M State surcharge (8 :�a of permit fee) Lt r o. , � Print nameP ��„ p 1(+ l ] TOTAL PE1011T FEV. e Authorized signature: ., This permit application expires it a permit is not anionic(' within .150 days gfter it bus been pccepl.td us Cmnplcte Print name Date: � • • fee methodology set by Tri County Hutldmg Industry service Booed l �('� • Number of inspections per permit allowed. enntle�l:.L l'- Perms, \) rind 17/ll_l I JJ IV 'tall o1 I G/12/COM/WFb CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007 -00167 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/19/2007 Phone: (503) 639 -4171 ��� i,� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/20/2007 TIME: 7 :03AM PAGE: 10 SITE ADDRESS: 07105 SW HAMPTON ST CLASS OF WORK: SUBDIVISION: BEVELAND NO. 2 LOT #: 018 TYPE OF USE: PROJECT NAME: KAISER DENTAL DESCRIPTION: 2 hr. circuits. Recpts. in 7 dental carts. OWNER: KAISER FOUNDATION HEALTH, PHONE #: CONTRACTOR: CHRISTENSON ELECTRIC, INC. PHONE #: 503- 419 -3300 Inspection Request Scheduled For: Date: 7/20/2007 Pour Time: Code # Inspection Description irm # Contact # Message 199 Electrical final 052457 -01 503- 936.2141 Y Corrections /Comments /Instructions: 44 • PASS ❑ PARTIAL APPROVAL n CANCEL NO ACCESS n FAIL ❑ CALL FOR INSPECTION I J ADDITIONAL FEES ASSESSED Inspector: ' IV�® Date: ' 26 6 Phone #: (503) 718- 2.44( CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007 -00167 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/1912007 Phone: (503) 639 -4171 " NA Inspection Requests (24 Hrs.): (503) 639 -4175 I.. INSPECTION WORKSHEET FOR DATE: 71/9/2007 TIME: 7:03AM PAGE: 18 SITE ADDRESS: 07105 SW HAMPTON ST CLASS OF WORK: SUBDIVISION: BEVELAND NO. 2 LOT #: 018 TYPE OF USE: PROJECT NAME: KAISER DENTAL. DESCRIPTION: 2 br. circuits. Recpts. in 7 dental carts. OWNER: KAISER FOUNDATION HEALTH, PHONE #: CONTRACTOR: CHRISTEN SON ELECTRIC, INC. MA PHONE #: 503- 419 -3300 - Inspection Request Scheduled For: Date: 7/19/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 052371-01 503 - 936 -2141 Y Corrections /Comments /Instructions: 00 to ow btu Slit To 4‘4014 w 1 140 ikp'AtsVZ \M5 ON Sli g l The electrical installation defects noted on this report shall be corrected and j '' an inspection request made within 20 / calendar days par OAR 918 - 271 -0030` ❑ PASS n PARTIAL APPROVAL r CANCEL n NO ACCESS X FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: 6 M 4� L Date: A L�i ql Phone #: (503) 718- Z'f ab Y CITY OF TIGARD - BUILDING DIVISION tT ,_ , PERMIT #: ELC2007- 00167 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/19/2007 Phone: (503) 639 -4171 /murk 11 Inspection Requests (24 Hrs.): (503) 639 -4175 �1. . INSPECTION WORKSHEET FOR DATE: 6/28 /2007 TIME: 7:01AM PAGE: 23 SITE ADDRESS: 07105 SW HAMPTON ST CLASS OF WORK: SUBDIVISION: BEVELAND NO. 2 LOT #: 018 TYPE OF USE: PROJECT NAME: LAISER DENTAL DESCRIPTION: 2 hr. circuits. Recpts. in 7 dental carts. OWNER: KAISER FOUNDATION HEALTH, PHONE #: CONTRACTOR: CHRISTEI4SON INC. PHONE #: 503- 419 -3300 Inspection Request Scheduled For: Date: 6/28/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final I- 051137 -01 503 - 936.2141 N Corrections/ Comments /Instructions: P N w aR Fcsctimzo N p A`� r~`N� tAn-(c �. vict"S PLA,J v i �W P L —6441.—cv-ts9r.--%&—mti.v - ®Ak 311 -- oo 4 b (' cl i) ke P The electrical installation defects noted on this report shall be corrected and an inspection request made within 20 calendar days per OAR 918 - 271 -0030 I PASS PARTIAL APPROVAL El CANCEL n NO ACCESS )(FAIL ,,CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: bd L Date: (0 ' 141 Phone #: (503) 718 - 7 ^A 41 'C) • •