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Permit CITY OF T ELECTRICAL PERMIT , � � ,�i��� DEVELOPMENT SERVI PERMIISSUEDLC�8 -0375 -4171 PARCEL: 8S1O2CB -08300 SITE ADDRESS...:13200 SW PACIFIC HWY SUBDIVISION •FREWINGS ORCHARD TRACTS ZONING:C —G BLOCK • LOT •008 JURISDICTION: TIG Project Description: Mullikin Medical Center - -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS 1000 SF OR LESS • 0 0 — 200 amp • 1 PUMP /IRRIGATION • 0 EACH ADD'L 5O0SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0 LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL 0 MANE. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0 - - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- - 0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0 201 — 400 amp : 0 1st W/0 SRVC OR FDR.: 0 PER HOUR • 0 401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0 601 — 1000 amp • 0 PLAN REVIEW SECTION 1000+ amp /volt • 0 > =4 RES UNITS • > 600 VOLT NOMINAL..: Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.: Owner: FEES MULLIKAN MEDICAL CENTER type amount by date recpt 13200 SW PACIFIC HWY PRMT $ 50.00 JSD 07/08/98 98- 307179 TIGARD OR 97223 SPCT $ 2.50 JSD 07/08/98 98- 307179 Phone #: Contractor: SHAW WEST COMPANY $ 52.50 TOTAL PO BOX 1427 REQUIRED INSPECTIONS TUALATIN OR 97062 Elect'1 Service Phone #: 682-3939 Elect'1 Final Reg #.. : 63142 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 'e rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -8010 through OAR 952- 001 -1':. You may obtain a copy of these rules or direct questions to by calling (503)246 -1987. Permittee 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: ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + ++ Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + ++ • Community Development ELECTRICAL PERMIT APPLICATION � 13125 SW Hall Blvd. C / V (/ Tigard, OR 97223 Permit # Al ilb "lli v i il`j Dat Issued - 0 i3W2 Phone (503) 639 -4171 ~-"' FAX (503) 684 -7297 CITY OF TIGARD TDD No. (503) 684 -2772 Inspection (503) 639 -4175 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Mullikin Medical Center Number of Inspections per permit allowed Address 13200 SW Pacific Hwy. Service included: Items Cost(ea) Sum City /State /Zip Tigard, OR 97223 4a. Residential - per unit 1000 sq. ft. or less $110.00 4 Name (or name of business) Each additional 500 sq. ft. or portion thereof $25.00 Commercial Residential ❑ Limited Energy $25.00 Each Manuf'd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: 4b. Services or Feeders Installation, alteration, or relocation Electrical Contractor Shaw West Co. 200 amps or less $60.00 2 Address P.O. Box 1427 201 amps to 400 amps $80.00 2 City Tualatin State OR Zip 97062 401 amps to 600 amps $120.00 2 601 amps to 1000 amps $180.00 2 Phone No. (503) 682 -3939 Over 1000 amps or volts $340.00 2 Job NO. 2803 Reconnect only $50.00 2 contractor's license NO. 34-70C 4c. Temporary Services or Feeders Contractor's Board Reg. No. 63 42 Installation, alteration, or relocation Signature of Supr. Elec' 200 amps or less _1- 50.00 2 License No. 1S P e No. 201 amps to 400 am $50.00 2 401 amps to 600 amps $ Over 600 amps to 1000 volts $100.00 2b. For owner installations: see „b„ above. 4d. Branch Circuits Print Owner's Name New, alteration or extension per pane Address a) The fee for branch circuits with purchase of service or feeder fee. 2 City State Zip Each branch circuit $5.00 Phone No. b) The fee for branch circuits without The installation is being made on property I own which is purchase of service or feeder fee. 2 not intended for sale, lease or rent. First branch circuit $ $5 . 00 Each additional branch circuit $5.00 Owner's Signature 4e. Miscellaneous (Service or feeder not included) 2 3. Plan Review section (if required): Each pump or irrigation circle $40.00 2 Each sign or outline lighting $40.00 - Signal circuit(s) or a limited energy 2 Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00 - 4 or more residential units in one structure Minor Labels (10) $100.00 Service and feeder 225 amps or more System over 600 volts nominal 4f. Each additional inspection over Classified area or structure containing special occupancy the allowable in any of the above as described in N.E.C. Chapter 5 Per inspection $35.00 - Per hour $55.00 In Plant $55.00 - Submit 2 sets of plans with application where any of the above apply. Not required for temporary construction services. 5. Fees: 5a. Enter total of above fees $ 50.00 NOTICE 5% Surcharge (.05 X total fees) $ 2.50 PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ 59 _ 5n COMMENCED. wor5.....w Alec- ❑ Trust Account # $ prm.app Balance Due $ 52.50 64P97 D570 Page No. 1 CASE HISTORY FOR CASE NO.: ELC98 -0375 MULLIKAN MEDICAL CENTER 13200 SW PACIFIC HWY 03/04/99 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code .Sent Done Done Date By 1 ELCC001 Application received 07/08/98 / / 07/08/98 PASS DLH 07/08/98 JSD ELCC003 Permit created 07/08/98 / / 07/08/98 PASS DLH 07/08/98 JSD ' ELCC500 (F)Issue permit / / / / 07/08/98 PASS JSD 07/08/98. JSD ELCC730 Elect'l Service 07/08/98 / / / / 07/08/98 JSD ELCC799 Elect'l Final 07/08/98 / / / / 12/28/98 inspection request (research) NOTE JMT 12/28/98 JT sent to Chuck ELCC799 Elect'l Final / / / / 01/28/99 Conduits not supported in elevator FAIL BRP 01/28/99 B *P room.Bonding to control cabinet is through reducing washers. Inspection is terminated; to determine scope of elevator mechanic to install electrical feeder to equipment. ELCC799 Elect'l Final / / / / 01/27/99 This permit was for temporary power PASS BRP 01/28/99 B *P , only. Previous entry is in error, for this permit. ELCC800 Case Finaled / / / / 02/01/99 02/01/99 JT • • • • • CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST ; l BUP Date Requested I 12A9 9 1 AM PM BLD 4 Location Ao • Am Suite MEC Contact Person ( ,t,i ,� ' h '31 — 05 ? PLM Contractor Ph SWR • BUILDING Tenant/Owner ELC )3 75 Retaining Wall EIR ? 8 d 3 Footing Access: Foundation FPS r �� - nC�( 7 Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation / Drywall Nailing n e, - -Zoo 2.6'0 o k (oC ie_01 Firewall / Q Y Fire Sprinkler !� �'cf d — (' ` Fire Alarm Susp'd Ceiling t !y Roof Q 3 Go Misc: Final PASS PART FAIL PLUMBING Post & Beam /� Under Slab /1- C 9c 04 cc_ Top Out Water Service /14 �� l Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL j' ^ FC) Post & Beam Rough In ) / Gas Line , Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm IWO — PART FAIL 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 �l Approach /Sidewalk 7 Other Date Inspector t Final PASS PART FAIL • DO NOT REMOVE this inspection record from the job site.