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Permit CITY OF T ELECTRICAL PERMIT ,, d .�,.,�� DEVELOPMENT SERVICES PERMIT #: ELC97 -0343 - • "� A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 06/17/97 PARCEL: 2S112DA -01300 SITE ADDRESS...:O664O SW REDWOOD LN m in SUBDIVISION •MLP96 -0002 ZONING:I -P BLOCK • LOT • JURISDICTION: Project Descript ion: Providence Health M.O.B. Job 018030 - -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS 1000 SF OR LESS • 0 0 - 200 amp • 0 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 • 1 MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0 '..P----SERVICE/FEEDER---- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- - 0� - 200 amp • 2 W /SERVICE OR FEEDER: 46 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.:X Owner: FEES SISTERS OF PROVIDENCE type amount by date recpt PROVIDENCE HEALTH SYSTEMS PRMT $ 390.00 DRA 05/27/97 97- 295114 9205 SW BARNES RD PLCK $ 97.50 DRA 05/27/97 97- 295114 PORTLAND OR 97225 SPCT $ 19.50 DRA 05/27/97 97- 295114 Phone #: Contractor: OREGON ELECT CONSTRCTN /GRP INC $ 507.00 TOTAL 1010 SE 11TH REG!UIRED INSPECTIONS PORTLAND OR 97214 Ceiling Cover Elect'l Final Phone #: 234 -9900 Wall Cover Reg #..: 036359 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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952401 -0010 through OAR 952 -001 -1987. You may obtain a copy of these rules or direct questions to OUNC)v ailing )246 -1987. Permittee Signatu'e: Lj- 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: . )0, L.cz�,a...,. DATE: LICENSE NO: 11 �, ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + ++ rd e , 0 d.i*Ir 6-! (_ 6 & - _dam - / 5.-- Communi eve o ant ELECTRICAL PERMIT APPLICATION .. A 13125 SW Ha Blvd. C , ����(�� Tigard, OR 97223 Permit #` 7 ,��,�lll�l., I , Date Issued "� �l Phone (503) 639 -4171 FAX (503) 684 -7297 �a g) CITY OF TIGARD TDD No. (503) 684 -2772 (,2 �'`� Inspection (503) 639 -4175 ( q n i c & -.9 / 6646 GS�S,� .- • %_ h,(,..�._ Le 1. Job Address: e/ 4. Complete Fee Schedule Below: OREGON BUSINESS PARK Name of Development PROVIDENCE HEALTH M.O.B. Number of Inspections per permit allowed Address 6640 SW Redwood Lane Service included: Items Cost(ea) Sum City /State /Zip Tigard, OR 97224 4a. Residential - per unit 1000 sq. ft. or less $110.00 4 Name (or name of business) 1st Fl. Clinic /Ptld Clinic Eachadditional500sq.ft.or portion thereof $25.00 Commercial © Residential ❑ Limited Energy $25.00 1 Each Manurd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: 4b. Services or Feeders Electrical Contractor OREGON ELECTRIC GROUP Installation, alteration or relocation 2 $60.00 1 20.00 2 200 amps or less Address 1010 SE 11TH 201 amps to 400 amps $80.00 2 401 amps to 600 amps $120.00 2 City Port land State OR Zip 97214 601 amps to 1000 amps $180.00 2 Phone No. (503) 214 -9900 Over 1000 amps or volts $340.00 2 Job NO. 18030 Reconnect only $50.00 2 contractor's license NO. 26 -95C 4c. Temporary Services or Feeders Contractor's Board Reg. No. 203 Installation, alteration, or relocation Signature of Supr. Elec'n OW/ 200 amps or less 2 /' $50.00 License No. 1481S •. :! 9900 201 amps to 400 amps 401 amps to 600 amps $75.00 2 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 46 $5.00 230.00 Phone No. b) The fee for branch circuits withou The installation is being made on property I own which is purchase of service or feeder fee. 2 2 not intended for sale, lease or rent. First branch circuit $35.00 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 1 $40.00 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 X 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 $ 390.00 NOTICE 5% Surcharge (.05 X total fees) $ 1 9. 50 PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 409.50 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) $ 97.50 A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ 5(l7 _OO COMMENCED. wmdkomdmeo. ❑ Trust Account # $ prm.app 507.00 Balance Due $ MEMORANDUM CITY OF TIGARD, OREGON TO: Finance FROM: Jim Duckett DATE: June 9, 1997 SUBJECT: Receipt #97- 295114 The mentioned receipt indicated $507.00 was credited to ELPLCK23- 0000 - 433040. The correct entries should have been: ELPLCK $97.50 23- 0000 - 433040 ELPRMT $390.00 23- 0000 - 431510 TAX $19.50 10- 0000 - 230010 Thank you Page No. 1 CASE HISTORY FOR CASE NO.: ELC97 -0343 SISTERS OF PROVIDENCE 06640 SW REDWOOD LN 05/13/98 Action Description Reg/ Scbd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By - - -- --- -- --- - -- --- ELCC001 Application received 06/06/97 / / 05/27/97 PASS DRA 06/06/97 JD ELCC003 Permit created 06/06/97 / / 06/06/97 PASS JSD 06/06/97 JD ELCC110 Plans checked /approved by P.E. 06/12/97 / / 06/11/97 • PASS MJR 06/12/97 MIR ELCC115 Approved plans routed to DSTs / / / / 06/11/97 PASS MJR 06/12/97 MJR ELCC117 DST Post- Review complete / / / / 06/16/97 PASS JSD 06/16/97 PHN ELCC400 (F)Ready to issue / / / / 06/16/97 PASS JSD 06/16/97 PHN ELCC500 (F)Issue permit / / / / 06/17/97 PASS DRA 06/17/97 DRA ELCC700 Ceiling Cover 06/06/97 / / 08/04/97 no low volt permits PASS MJR 08/04/97 MJR ELCC700 Ceiling Cover / / / / 08/12/97 eastside offices and corridors PASS MJR 08/12/97 MJR ELCC720 Wall Cover 06/06/97 / / 06/23/97 COVER FOR TENANT IMP. WALLS FIRST FLOOR PASS BRP 06/23/97 J *H ONLY APPROVED ELCC720 Wall Cover / / / / 07/02/97 Hall & bath area approved for wall PASS MJR 07/06/97 J *H cover. Code -weld to rebar approved. ELCC799 Elect'l Final 06/06/97 / / 01/26/98 PASS BRP 01/26/98 J *H ELCC800 Case Finaled / / / / 01/26/98 PASS BRP 01/26/98 J *H ELCC920 Miscellaneous action / / / / 06/27/97 Correction of hazardous open enclosure HAZ MJR 07/06/97 J *H and live current within 48 hours per ORS 479 (Petsmart) • Page No. 1 CASE HISTORY FOR CASE NO.: ELC97 -0343 • SISTERS OF PROVIDENCE 06640 SW REDWOOD LN Unit: 100 06/12/98 • Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By -- -- --- -- -- - - -- - -- ELCC001 Application received 06/06/97 / / 05/27/97 PASS DRA 06/06/97 JD ELCC003 Permit created 06/06/97 / / 06/06/97 PASS JSD 06/06/97 JD ELCC110 Plans checked /approved by P.E. 06/12/97 / / 06/11/97 PASS MJR 06/12/97 MJR ELCC115 Approved plans routed to DSTs / / / / 06/11/97 PASS MJR 06/12/97 MJR ELCC117 DST Post- Review complete / / / / 06/16/97 PASS JSD 06/16/97 PHN ELCC400 (F)Ready to issue / / / / 06/16/97 PASS JSD 06/16/97 PHN ELCC500 (F)Issue permit / / / / 06/17/97 PASS DRA 06/17/97 DRA ELCC700 Ceiling Cover 06/06/97 / / 08/04/97 no low volt permits PASS MJR 08/04/97 MJR 8LCC700 Ceiling Cover / / / / 08/12/97 eastside offices and corridors PASS MJR 08/12/97 MJR ELCC720 Wall Cover 06/06/97 / / 06/23/97 COVER FOR TENANT IMP. WALLS FIRST FLOOR PASS BRP 06/23/97 J *H ONLY APPROVED ELCC720 Wall Cover / / / / 07/02/97 Hall & bath area approved for wall PASS MJR 07/06/97 J *H cover. Code -weld to rebar approved. • ELCC799 Elect.1 Final 06/06/97 / / 01/26/98 PASS BRP 01/26/98 J *H ELCC800 Case•Finaled / / / / 01/26/98 5/13/98 plan sent to microfilm PASS BRP 05/13/98 JT ELCC920 Miscellaneous action / / / / 06/27/97 Correction of hazardous open enclosure HAZ MJR 07/06/97 J *H and live current within 48 hours per ORS 479 (Petsmart) • • • • •