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Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00322 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/24/2007 PARCEL: 1 S134BC -00401 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 ZONING: C -N SUBDIVISION: LOT: JURISDICTION: TIG PROJECT: PROVIDENCE Project Description: Data, telecommunications. • A. RESIDENTIAL B. COMMERCIAL • AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: PROVIDENCE HEALTH SYSTEM XTREME COMMUNICATIONS, INC. • 4607 NE GLISAN 24023 NE SHEA LANE PORTLAND, OR 97213 WOOD VILLAGE, OR 97060 Phone: 503 -215 -6282 Contact #: PRI 503- 618 -8816 FAX 503 -618 -9985 • Reg #: ELE 3- 515CEP FEES LIC 147263 • Description Date Amount [ELPRMT] ELR Permit 8/24/2007 $75.00 [TAX] 8% State Surcha 8/24/2007 $6.00 REQUIRED ITEMS AND REPORTS • Total $81.00 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 1.800.332.2344. Issued By: I 4416_, Permittee Signature: /71 etp2h. CO • 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. p 02007 08:40 5036189985 XTREME COMMUNICATION PAGE 02/04 Electrical Pe U11 FOR OFFICE USE ONLY Rece • 1 Electrical �? .°C°361.1 Da . 0 Permit No. al Planning Approval Sims City Oi Tigard AUG Date/By: Permit No.: 13125 SW Mall Blvd. G 2 ill 2001 Plan Review Other Tigard, Oregon 97223 Date/By: _ Permit No.: Phone: 503 - 639 -4171 FQTpO 0 . t D Post- Review Land Use 10 1 ; •: , hit :, Date/By: Case No.: Internet: www.Ci.tigazdt ^ , � , . ' I es I Contact - Jurist-- ® See Page 2 for 24 -hour Inspection Request: 503 -639 -4175 Name/Method: — Supplemental Information. ,..a. .. .. •, . �. „ii, ...t,,�,.:..:.i- ... ...tOrVg#5100;r4 *- .: ..... ,.01A,X .. ....... (P1di e•�1<'- .' ' Ill Ncw construction III Demolition ❑ Service over 225 amps- b Health -care facility commercial 0 Hazardous location ❑ Addition /alteration/re alacement • Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, e.% `• 4� qr�;: x')7; e' y G '..C®,� �l i 1.0.7..".'",... I & 2 family dwellings four or more residential units in ... 1 & 2- Family dwelling • Commercial/Industrial 0 s over 600 volts nominal one structure J— ❑ Budding over three stories 0 Feeders, 400 amps or more Accessory Building ❑ Multi - Family _ ❑ Occupant load over 99 persons ; 0 Manufactured structures or RV park Master Builder ❑ Other: El gress/lightin plan Other: .. - ,,a: :; ll . , . .. ',1,7 ¢ 4 •.0.. um _ sets of plans with of the above. JO I . .'. , t '.'.` Submit s f th as ' ra construction service. •'����= ';�ilhlti The a are not a t licable to tern o Job site address: /9„7..- ..$E yelt /4 / / :'`:'. „:.. :'- aid';: ° '. :. till i. ilff..N.Pl M ;! Suite #: [ Bldg ./Apt. #: Number of inspections per permit allowed Project Name: 4 PR{i, o UracI Description j Qty Fee (c2 Total I New residential - single or multi per Cross street/Directions to job site: dwelling unit. Includes attached garage. Service included: 1000 sq. R or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Limited en- _. residential 75.00 2 Subdivision: _ 1 L o t #: Limited energy, non residential 75.00 2 Tax ma./ • arcel #: Each manufactured home or modular dwelling ... +;: I . :..:5 t , a3tyti' '�,?;.t�n o ldar dd 1';`' r '' .��'i,: service and/or feeder 90.90, 2 1 } nn . .t . , r / I '`_ "lt 't Services or feeders - installation, & I ,SC .Ca/vfe tit h O W alteration or relocation: 200 amps or less _ 80.30 2 . 201 amps to 400 amps 106 85 2 r r� p 401 amps to 600 amps 160.60 2 rt., 2' I. !:;1�,11^.in .�3 :Ili � f� HtT�i�'ul �•��1 :707EG�kl MEr'!. 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: Reconnect only - 66.85 • 2 Address: Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: _ 200 amps or less . 66.8s i 201 amps to 400 amps 100.30 2 , Phone. 77� l Fax: 401to600amps 133.75 2 R.'g ” . rx��! D l ai l!/.1 I�! i ]arl!Ff 1 t 1 '.P j '4. 1 ., ` .id!s:? Bran circuits w, �.: • resits - new, al teration, or Name: e • 4 extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 6.65 2 City /State/Zip: B. Fee for branch circuits without purchase of - • service or feeder foe, first branch circuit 46.85 2 Phone: J Fax: _ Each additional branch circuit - 6.65 4 2 E -mail: Misc.(Service or feeder not included): 2 r ...... Each pump or irrigation circle .. 53.40 11!I r j I r Il r ji ri 1, w ! yi j j q s. 1 , .. . :i 2 _ r i tB� f9 i1.i a• � 1.i: 13z a ,J d " _ i , . each s or ou tli ne li 53.40 Job No: 6 i 02--signal eircuit(s) or a limited energy panel, alteration, or extension Page 2 2 Business Name: XI-re e (for tsean/ cs. .ue. Description: . Address: 2. Zvi NE g " itAes ' Each additional Inspection over the allowable In any of the above: City+ /State /Zip : Lg./cod ViG&Ife r Die- Q 704. O Per inspection per hour (rain. 1 hour) 62.50 . Phone: S� .: / .. '!i Fax: So3. ../t. 1 / Investigation fee: • CCB Lic. #: / W- 24. 3 , Lic. #: *i ' S.' C .. ; ' `t'Tir ;; . ::.. `" 1q t t --�--.. °" " h i 'r''`' ;x , !;; ml 3 � .,..., a p Supervising electrician ,:• -.0 , , /' / � Subtotal $ signature required: /_ L/, (/ Plan Review,(25% of Permit Fee) $ Print Name: 12,./// 1‘0, /, ( Lie. #: ;Mr • State Surcharge (8% of Permit Fee) $ ,�i TOTAL PEST FEE $ A/ . Dv Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after It has been accepted as complete. "Fee methodology Set by Tn - County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms\BlcFermitApp.doc 01/03 CITY OF TIGARD BUILDING DIVISION . PERMIT #: ELR2007 -00322 • A . 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: EJ2412007 Phone: (503) 639 -4171 r 'ki+ �(i Inspection Requests (24 Hrs.): (503) 639 -4175 A:_.. INSPECTION WORKSHEET FOR DATE: 10/9/2007 TIME: 7:00Am PAGE: 36 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PROVIDENCE DESCRIPTION: Data, telecommunications. OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 503 -215 -6282 CONTRACTOR: XTREME COMMUNICATIONS, INC. PHONE #: 503.618 -8816 Inspection Request Scheduled For: Date: 10/9/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Eloctiical final 057200 -01 503-519-3965 N Corrections /Comments /Instructions: N \\\,,., .,, , \ \ ( i ' '' ‘. \ '''''' A \ ,' ' \ 1 I X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: • N Date: I6I 91T) Phone #: (503) 718- 1"1110 CITY OF TIGARD BUILDING DIVISION . PERMIT #: ELR 2007 - 00322 . A 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/224/2007 Phone: (503) 639- 4171gp.� Inspection Requests (24 Hrs.): (503) 639 -4175 P: - INSPECTION WORKSHEET FOR DATE: 10/9/2007 TIME: 7:00AM PAGE: 62 SITE ADDRESS: 12442 SW SC FERRY RD 101 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PROVIDENCE DESCRIPTION: Data, telecommunications. OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 5503.215 -6282 CONTRACTOR: XTREME COMMUNICATIONS, INC. _ Ro N I PHONE #: 503. 61038816 Inspection Request Scheduled For: Date: 10/9/2007 Pour Time: Code # Inspection Description Confirm # 0, Contact # Message 135 Low voltage 057173-01 503- 849 -8658 Y Corrections /Comments /Instructions: ©\ I u,on\ R,( 7 1 N PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: v • 0 (S W Date: ION T) Phone #: (503) 718- im'V • r CITY OF TIGARD BUILDING DIVISION • PERMIT #: ELR2007•00322 ' A 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/24 /2807 Phone: (503) 639 -4171 1 Inspection Requests (24 Hrs.): (503) 639 -4175 I1.. INSPECTION WORKSHEET FOR DATE: 9/26/2007 TIME: 7:01AM PAGE: 88 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PROVIDENCE DESCRIPTION: Data, telecommunications. OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 503- 215 -6282 CONTRACTOR: XTREME COMMUNICATIONS, INC. PHONE #: 503616.8816 Inspection Request Scheduled For: Date: 9/26/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Low voltage 056310 -01 503 849.8658 N Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G' ► (1\1 ()Q L-t Date: 912.6(01 Phone #: (503) 718- 2-111147