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Permit CITY OF TIGARD COMMUNITY DEVELOPMENT ELECTRICAL PERMIT ilq '� PERMIT #: ELC2007 -00466 D ATE ISSUED: 7/9/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S135DD-03301 SITE ADDRESS: 11945 SW PACIFIC HWY 113 ZONING: C - G SUBDIVISION: TIGARD PLAZA LOT : 002 JURISDICTION: TIG PROJECT: ALLIED HEALTH Project Description: (2) branch circuits for a /c. 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: TIGARD PROPERTIES INC ADVANCED WIRING SERVICES INC 2106 SE OCHOCO ST PO BOX 644 MILWAUKIE, OR 97222 CLACKAMAS, OR 97015 Phone: Contact #: PRI 503 - 310 - 3655 FAX 503 - 698 -6372 FEES Description Date Amount Reg #: ELE C7 [ELPRMT] ELC Permit 7/9/2007 $53.50 LIC 162591 [TAX] 8% State Surcharge 7/9/2007 $4.28 SUP 46755 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 mor an 180 days. - ENT e ' • Oregon law requires you to follow rules adopted by the Oregon Utility Notification enter. Those rules are set forth in R 952 - 001 -0010 throug ',AR 9 001 -0100. You may obtain copies of these rules or direct questions to OUN — 03.246 • • •9 or .800.332.2344. Issued By: , ` ∎ // ∎� ✓ Permiftee Signature: ' '1/P r 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: C it RACTO - : "ALLATION ONLY SIGNATURE OF SUPR. ELEC'N: _�- .,„,r i ri DATE: 7/ LICENSE NO: ` ' 5---5 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. Electrical Permit Application FOR OFFICE USE ONLY ived �;l y of Tigard Dat ( �J 4 t7 Permit No.: `�gltt --co 6.., • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: TI G A It D Inspection Line: 503.639.4175 Date Ready/By: Jun ® See Page 2 for Internet: www.tigard or.gov Notified/Method: t C Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction WI, Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1 - and 2- family dwelling W Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Q� 2? Job site address: ` 995 ,/J Me /h6 /kW 100HP or more. occupancy. zoo or more residential units. 0 Recreational vehicle parks. City/State /ZIP: 1744 0. 1 7233 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: 4-1i 3 Project name: k #6-4-1,7-d ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) /� , / /� Limited energy, multi - family 75.00 2 4/ . oh ` T Rr. residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /ZIP: Temporary services or feeders installat ion, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 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 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or ex tension, per panel g A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 1 46.85 /` 2 first branch circuit Address: Each add'I branch circuit 1 6.65 ti F5 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: ' , t n, A Signal circuit(s) or limited - t�flVAtJ Vim► l 1 =1 �G- sup I I • energy panel, alteration, or Address: 17_ 0 . Rt37C Mit extension. Describe: Page 2 2 City/State /ZIP: CA_AeXAJAiK . �i ?01 S Each additional inspection over allowable in any of the above 1 C�p3) Fax: 4 Per inspection 62.50 Phone: ( ( ( ) 82 — �o� c i / Investigation per hour (I hr min) 62.50 CCB Lic.: (( I Electrical Lic/ C. Sum. Lic.: 6 Industrial plant per hour _ 73.75 qq / Ii4 756 ELECTRICAL PERMIT FEES Suprv. Electrician sign ,required: � Subtotal: 6, .6 Print name: ` . A 77 i , ' Date: 7/47/0..7 Plan review (25% of permit fee): State surcharge (8% of permit fee): 1 _ As Authorized signature: /+ - TOTAL PERMIT FEE: `7 7 . 7 $' / This permit application expires if a permit is not obtained within 180 Print name: Date: 7 / 7 / days after it has been accepted as complete. • Number of inspections allowed per permit. I :\ Building \Permits\ELC- PermitApp.doc 05/23 /06 440- 4615T(11/05 /COM/WEB Electrical Permit Application - City, of Tigard .Page 2 - Supplemental Information 'LIMITED ENERGY PERMIT FEES: PRESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ - Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other t Total number of commercial systems: *No licenses are required. Licenses are required =for' all "other installations 1:\Building\Permits\ELC- PermitApp.doc 03/23/06 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007 -00466 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/9/2007 Phone: (503) 639 -4171 l' Inspection Requests (24 Hrs.): (503) 639 -4175 � °`''�� INSPECTION WORKSHEET FOR DATE: 7/16/2007 TIME: 7:04AM PAGE: 20 SITE ADDRESS: 11945 SW PACIFIC HWY 113 CLASS OF WORK: r SUBDIVISION: TIGARD PLAZA LOT #: 002 TYPE OF USE: PROJECT NAME: ALLIED HEALTH DESCRIPTION: (2) branch circuits for a/c. OWNER: TIGARD PROPERTIES INC, PHONE #: CONTRACTOR: ADVANCED WIRING SERVICES INC PHONE #: 503 310 - 3655 Inspection Request Scheduled For: Date: 7/16/2007 . Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 052048 -01 503 -833 -2980 Y Corrections/Comments/Instructions: At e 4 9-o Ocv A & /Occu Pc,..... — A- w 0 o & - l T ► ( 4 _ t - 1 f ea_ A o f k t c - e — -4 .f r2 q a ; Ike aL hi fiha u ii— I- — e-( e ch / p4.np f C io, et ,` wt vi 3©" . " � G' a i1i-- 44,141 r te - Flo°I^ .149 -a2.- g o C 1- co pQ1Ie 0 (}i 4 otO det 7s 4-0 r0` ly C' il/ ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED kk,. Inspector: 42�� Date: / —16 0g Phone #: (503) 718- •