Permit CITY OF TIGARD ELECTRICAL PERMIT
•
PERMIT #: ELC2005 -00876
ii� DEVELOPMENT SERVICES DATE ISSUED: 11/14/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 10X6 -02300
SITE ADDRESS: 13240 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT : 008 JURISDICTION: TIG
Project Description: (1) branch circuit for receptacle for treadmill. Job No. 88626
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: 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: X
Owner: Contractor:
PACIFIC PROPERTIES OREGON ELECTRIC GROUP
BY MARTIN JOHNSON 1010 SE 11TH AVE
13240 SW PACIFIC HWY PORTLAND, OR 97214
TIGARD, OR 97223
Phone: 503 - 598 -2009 Phone: 503 - 234 -9900
FEES Reg #: LIC 203
tion Date Amount SUP 26
Description ELE 26 - 95C
[ELPRMT] ELC Permit 11/8/2005 $46.85
[TAX] 8% State Surcharge 11/8/2005 $3.75 REQUIRED ITEMS AND REPORTS
[ELPLCK] ELC Pln Rev 11/8/2005 $11.72
Total $62.32
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 1-80-332-3344.
Issued By: 4 ai/,A.,. A 5 44 ,1 1 74 Permittee 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:
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.
• . NOV -09 -2005 11:42AM FROM -OR ELECTRIC SERVICE 5035352763 T -503 P.001 /004 F -104
Jvlei:Il'iCSl t CI 1Ra16 2 tppaas.asivaa
'
, City of Tigard a. �,. /w . 14, P emut Nu — ,.� • �() . 13125 SW Hall ,Tigard, OR 97223 Q C � i , r Pla e f t:0� / 4
Caber Penna.
Phone: 503.639.417.417 1 Fax 503.598.1960 11 �� t " r ��` i ?` Taul3v eBe llUU
Inspection Line: 503.639.4175 , F.e�- 'I �., Pax Ren4-By ,, a see Page 2 for
Internet www.ci.tigerd.or.us w, Notified/Method l(Q Supplemoatallnfortuntlon
TYPE OF WORT: PLAN REVIEW
v
*1 - 1 1011
RD Pieces check all that apply:
❑ New construction ® Addition/alai& it.
gulLD ❑Service over 225 amps, comm't ['Hazardous location
El Demolition 0 Oth er _- ❑ Serviec over 320 amps - rating ❑ Buildng over 10,000 sq. ft,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more now tesideotial
❑ 1 - a nd 2 - famil dwelling Comtnerciallmdustrial ❑ Accessory building ❑Sy�m over 600 volts nominal units in one stud=
Y g ® ❑Building over three storing QFeedrrm, 400 amps or more
❑ Multi ❑ Master builder ❑ Other: ❑Occupant load over 99 persons ❑M:taufacnned strictures or
JOB SITE INFORMATION AND LOCATION ❑Egrcns/lighting plan RV park
Job no.: 88626 1 Job site address: 13240 SW PACIFIC HWY SUITE C �l-Ic lth -care facility ❑Oth
Submit 2 sets of plans with any of the above.
City/State/MP: TIGARD, OR 97223 The above aro not applicable to temporary construction service.
Suite/bld ./a t. no.: C Project name: PACIFIC MEDICAL GROUP -- • SCHEDULE
p J uoralp /au I Qty. [ Fm I Total I"
Cross strecl/directions to job site New residential single or multi - family dwelling unit.
- includes attached garage -
1,000 sq. ft, or less 145.15 4
Subdivision: l Lot no.: Ea. add'! 500 sq. ft or portion 33.40 1
Limited energy, residential 75.00 ` 2
Tax map/pureel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
INSTALL (1) 20 AMP 120 VOLT RECEPTACLE FOR TREADMILL Services ns, service and/or feeder 90.90 2
Services or feeders installation, alteration. and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps I60.60 2 —
Name: PACIFIC MEDICAL GROUP 601 amps to 1,000 amps 240.60 2
Address: 13240 SW PACIFIC HWY Over 1,000 amps or volts _ 454.65 _ 2
Reconnect only 66.85 I 2
City /State/ZIP: TIGARD, OR 97223 Temporary services or feeders Installation, alteration, and/or
Phone. (503)598 - 2009 1 Fax: ( ) — - relocation
200 amps at less 66.85 1
Owner installation: This installation i� being made on property that I own which is not 201 amps to 400 amps 10030 2
intended for sale, ltaue. rent, or exchangc_ according to ORS 447. 449. 670, and 701 401 amps to 600 amps 133.75 2
Owner sigature; ! Date: , Branch dreults -new. alteration, or extension, per panel
0 APPLICANT I ❑ CONTACT PERSON A. Fee fbr branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
' B. Fee for branch circuits
Contact name: without service or feeder fee, 1 4101
each branch circuit 46.85 2
Address- Each add'1 brunch circuit 6.65 2
City/Slate/ZIP: Miseelbmeous (serer or feeder not included)
Phone: ( ) I Fax; : ( ) Pump arirril anion circle 53.40 2
Sign or outline c lighting 53.40 2
E -muiL' (- Signal circuits) or limited.
CONTRACTOR energy panel, alteration, or
l
extension. Describe: Page 2 2
Business name: Oregon Electric Group
Address : 1010 SE 11th Ave Each additional inspection over allowable In any of the above
_ - Per inspection 62.50
City/State/ZIP: Portland, OR 97214 Investigation per hour (t hr min) _ 6250
Phone: (503) 234 Pax: (503) 535 -2763 Industrial plant per hour 73.75 - • ELECTRICAL PERMIT FE S*
CCB Lic.: 203 I Electrical Lic :, 26 I. Cuprv: ' : 44605 Subtotal 4 t $ 5
S P lea review ( 25% of permit foe) 1 I _ l 'a
ttprv. Electrician signutttle, required: " 1
Print Mine: IA 0%164. in � � Dat . 11/09/05 State smucharge WA of pconh fee) , ) `j '�'
TOTAL PERMIT FEE �1C� • _ °'
Authorized signature: I'hrs permit application expire: ire permit Is rot oblatned MLUdd 180
days alter It has been accepted ne complete
Print name: M 0 (S, K . , d) • di g Date: 11/09/05 • Fee methodology set by'rri.coway Building away Service Board
•• Number of inspections per permit allowed.
CITY OF TIGARD . A
BUILDING DIVISION PERMIT #: ELG2005 -00876
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2005
Phone: (503) 639 -4171 �WI�
Inspection Requests (24 .): (503) 639 -4175 _ F__..
INSPECTION WORKSHEET FO' DATE: 1211/2005 TIME: 7:08AM PAGE: 33
SITE ADDRESS: 13240 SW PAU IC HWY CLASS OF WORK:
SUBDIVISION: FREVVINGS OR ARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: PACIFIC MEDICAL GROUP
DESCRIPTION: (1) branch circuit for ; ceptacle for treadmill. Job No. 88626
OWNER: PACIFIC PROPERTIES, PHONE #: 503-598-2009
CONTRACTOR: OREGON ELECTRIC GR UP PHONE #: 503- 234 -9900
Inspection Request Scheduled For: Date: 12/1/2005 Pour Time:
Code # nspe . • - 'Description • • nfirm # Contact # Message
199 Electrical final 02:755 -01 503-849 -2594 - Y
Corrections /Comments /Instruc ions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / Phone #: (503) 718 - 1- •
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: ELC200S -00876
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/14/2005
Phone: (503) 639 -4171 / ARAB
Inspection Requests (24 Hrs.): (503) 639 -4175 1J-
INSPECTION WORKSHEET FOR DATE: 11/30/2005 TIME: 7 :09AM PAGE: 20
SITE ADDRESS: 13240 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: PACIFIC MEDICAL GROUP
DESCRIPTION: (1) branch circuit for receptacle for treadmill. Job No. 8862G
OWNER: PACIFIC PROPERTIES, PHONE #: 503-598-2009
CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503 2349900
Inspection Request Scheduled For: Date: 11/30/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 022675-01 503-849.2594 N
Corrections /Comments /Instructions:
1 ..00 • —
linfin
EIM
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL AN° ACCESS
A FAIL XC LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Ai/41e_ Phone #: (503) 718- 2 •