Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00406
A Al DEVE PMENa r S O ERVICES ) 639 -4171 DATE ISSUED: 08/07/2001
PARCEL: 1 S 126DC -04800
SITE ADDRESS: 09495 SW LOCUST ST A
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P
BLOCK: LOT : 004 JURISDICTION: TIG
Project Description: Installation of (5) branch circuits for TI.
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: 4 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:
MBM MEDICAL WILLAMETTE ELECTRIC INC
9495 SW LOCUST PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: 503 - 245 -2415 Phone: 624 -3631
Reg #: LIC 75059
SUP 1965S
ELE 34 -283C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 08/07/2001 $73.45 2720010000( Wall Cover
Elect'I Final
5PCT CTR 08/07/2001 $5.88 2720010000(
Total $79.33
•
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Speaalty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Ain
Permit Signature: Issued By:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: / q S
Call 639 -4175 by 7:00pm for an inspection the next business day
I
'6 , j .. :7 A ' • Electrical Permit Applica on ..•,.
r .
Date received: A Permit no.: G�`..xy. vo& o
1t:1l1ly City of Tigard 11E- C°\15) Project/appl. no.: Expire date:
Add 13125 SW Hall Blvd, Tigard, OR 97223 (�� /
City of Tigard �� 2® Date issued: By ", Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 pE� E��P� C ase tile no.: P ayment type:
Land use approval: q�askal�W
TYPE OF PERMIT ' 3'
❑ 1 & 2 family dwelling or accessory JO Commercial/industrial ❑ Multi - family Asalenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
. JOB SITE INFORMATION -
Job address: el y 9r Sw L T Bldg. no.: Suite no.: A Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: Nv KCt$o I a V I Description and location of work on premises: Toe. �,,,,_� (kS_ /r+ave mac..,
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDILE
Job no: / 10 Fee Max
, Description Qty. (ea.) Total no. insp
Business name:
to (t} nv e TI e ( c° t 1 r c / w C— New residential - single or multi- family per
Address: 4) , , .. 2 St1 7- dwelling unit Includes attached garage.
City: t /4.2 p I State:at I ZIP: �� Z�1 Serviceincluded:
S
Phone: &zit - 363 1 IFax: 4 2q - ag3rS-I E -mail: 1000 sq. ft. or less • 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 75 c 1 ,/,,,/,, I Elec. bus. lie, no: 3 y - Z& 3 - C Limited energy, residential 2
City/metro lic. no.: / 5 L Limited energy, non- residential 2
'� - ectr , __,-.1 ( Each manufactured home or modular dwelling
Signature of supervising ician (required) Date Service and/or feeder 2
Sup. elect. name (print): 0(,) F, License no: f 9 f -S Services or feeders - installation,
alteration or relocation:
• PROPERTYO�VNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: _601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: • I Fax: I E -mail: Reconnect only 1
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 according to installation, alteration, or relocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: ' 401 to 600 amps 2
ENGI Branch circuits - new, alteration,
or extension per panel: •
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase ' yLyS ICc
of service or feeder fee, first branch circuit: 9 G 2
Phone: Fax: E mall: 6 t
Each additional branch circuit: t 2_0'.=
e " AN ('Please check' a1F`ITiat apply') "- -..e Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial • U Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each signor outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension' _ 2
❑ Building over three stories U Feeders, 400 amps or more *Description:
U Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other: Per inspection I i I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. . Other
Permit fee $ ? r it
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I I within 180 days after it has been State surcharge (8 %) .... $ �r eg--
Expires accepted as complete. TOTAL $ (�
Name of cardholder as shown on credit card
$ •
_
Cardholder signature Amount 440.4615 (600/COM)
•
Electrical Permit Fees: Limited Energy Fees: ..-..
., .
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular n Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning Systt >m`
Installation, alteration, or relocation
200 amps or less $80.30 2 n Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
•
601 amps to 1000 amps $240.60 2 1 1 Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 _ 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation
200 amps or less $66.85 2 Fee for each system $75.00
• 201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 - 260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above. n
Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits
with purchase of service or
feeder fee. .. Clock Systems
Each branch circuit $6.65 2
b) The fee for branch circuits pi Data Telecommunication Installation
without purchase of service
or feeder fee. n Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous '
(Service or feeder not included) n Instrumentation
Each pump or irrigation circle $53.40
Each sign or oatline lighting $53:40 ❑ Intercom and Paging Systems
•
Signal circuit(s) or a limited energy
•
panel, alteration or extension $75.00
Minor Labels (10) $125.00 n Landscape Irrigation Control
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50
Per hour $62.50 Nurse Calls
•
In Plant $73.75 n
Outdoor Landscape Lighting
Fees:
❑ Protective Signaling
Enter total of above fees $ -
El Other
8% State Surcharge $
• Number of Systems
25% Plan Review Fee
See "Plan Review" section on $
front of application.
* No licenses are required. Licenses are required for all other installations
Total Balance Due $ Fees:
Enter total of above fees $
❑ Trust Account #
8% State Surcharge $
Total Balance Due . $
i:\dsts \forms \elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24- Hour Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested C d 3 AM PM BLD
Location q q �, Suite MEC
Contact Person Ph ea PLM
Contractor ( i C fam Ph SWR
BUILDING :q ° ; e Tenant/Owner ELC oerC / O 6 411°
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab Cn_SS Poo, 1 J ih;7/ SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: --
Final
PASS PART FAIL
PLUMBING •, / �i
Post & Beam
Under Slab
Top Out
/
Water Service
Sanitary Sewer j
Rain
Final Drains
Final
PASS PART FAIL
Post & Beam
Rough In
Gas Line
Smoke Dampers �.
Final
-
PASS PART FAIL
Service
"owl -
UG/Slab
Low Voltage
Fire Alarm
-,�5: PART FAIL
SITE '"
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 rae'6-i4'/
Other Dated Afoi Inspector / 42, v 4 G am Ext
Final ' c�J
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•
_CITY OF TIGARD BUILDING INSPECTION DIVISION MST°
24-Hour inspection Line: 639 -4175 Business Line: 639 -4171 p _
' BIJP"
Date Requested q 7 AM PM BLD
Location Li 9 - Q ' Suite MEC
Contact Person !( Ph �- f 3(A � PLM
Contractor �f `fqr mp,/e_ /e c - 9 4 ) - 1 C Ph SWR
Tenant/Owner ELC L 2/ e20
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Drywall r , Ct V on 7
Drywall Nailing /�;/
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _
Roof
Misc:
Final
PASS PART FAIL
6) 2 7
Post & Beam
Under Slab /471—,19
Top Out
Water Service
Sanitary Sewer i
Rain Drains
Final
PASS PART FAIL
ME KOIOW x
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL: ° x `' y
Sere
o ug
Slab
Low Voltage
F' - arm
. PASS PART FAIL
SITE' .:.; <�;
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 n 7-6 Approach /Sidewalk `-7 / Other Date ( ( Inspector Ext
Final
PASS PART FAIL ' DO NOT REMOVE this inspection record from the job site.