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Permit
,r:! �, CITY OF TIGARD -ELECTRICAL PERMIT PERMIT #: ELC2000 -00510 r , DEVELOPMENT SERVICES DATE ISSUED: 9/15/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134BC-00401 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 200 SUBDIVISION: ZONING: C -N BLOCK: LOT : JURISDICTION: TIG Project Description: Installation. of (14) branch circuits w/o feeder 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: 13 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: SISTERS OF PROVIDENCE IN OR OREGON ELECTRIC CONST /GROUP BY STEVE FOSTER 1010 SE 11TH AVE PO BOX 13993 PORTLAND, OR 97214 PORTLAND, OR 97213 Phone: Phone: 234 -9900 Reg #: LIC 203 SUP 1302S ELE 26 -95C FEES Required Inspections Type - By Date Amount Receipt Wall Cover 5PCT CTR 8/30/00 $6.85 2720000000( Ceiling Cover - PRMT CTR 8/30/00 $85.65 2720000000( Wall Cover • PLCK CTR 9/15/00 $21.42 2720000000( Underground Cover Elect'I Final (additional fees not listed here) • • Total $149.30 , 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -1987. PERMITTEE'S SIGNATURE i • ISSUE 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: _ _a �l v DATE: • - LICENSE NO: 9O/..O `f Call 639 -4175 by 7:00pm for an inspection the next business day • CITTIGARD 32538 `� Electrical Permit Applic ( 0-,� (N Plan Check # W HALL BLVD. f . % V' Recd By 13125 n TI , R!3R 97223 �/ Date Recd Phone (503) 639 -4171, x304 op,(4,602)1.0.1.1_ u 1O Inspection (503) 639 X175 . oate Date to to DS P.E. T_g- av rint of Type Fax (503) 598-1960 ��i emit # F aaa� -rte_ IC) Incomplete or illegible will not be accepted `V � ,f`� C.hR� v_ 1. Job Address: , '' ;f r dl �4 r Complete Fee Schedule Below: • Name of Development Scholls Ferry Med. Dr. ___Number_ot.lns Name (or name of business) providence fe-alc rrmttarroweo( 1 2442 SW Scholls Ferry Rd. Ste 2 Servs included: Items Cost Sum Address 4a. Residential -per r unit City /State /Zip T1gard , OR loco sq. ft. orless $ 117.75 4 Each additional 500 sq. ft. or Commercial_ ®,_ _ Residential-0 __ Limited Energy portion thereon 1a= $ 60.00 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2 (Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders Information for COT data base). Installation, alteration, or relocation Electrical Contractor Oregon Electric Group' 200 amps or less Address 1 01 0 SF. 1 1 th AvP 201 amps to 400 amps S 84.25 2 p S 85.50 2 City Portland State OR 4P 9 7 21 4 401 amps to 600 amps $ 12850 2 • Phone No. 2 3 4 - 9 9 0 p 601 amps to 1000 amps $ 192.50 2 Job No. ; )�2 3 4 Over 1000 amps or volts S 383.75 2 Reconnect only S 53.50 2 Elec. Cont. Lice. No. 26-95C Exp.Date No. 2 0 3 ins Temporary Services to or Feeders OR State CCB Reg. Exp.Date I alteration, or relocation COT Business Tax or Metro No. 200 amps or Less S 53.50 2 201 amps to 400 amps $ 80.25 2 Signature of Supr. Eisen ...fffj.cri 401 amps to 600 amps i 107.00 2 2 0 6 4S Over 600 amps to 1000 volts, License No. . - Exp.Date see "b" above. Phone No. 2 3 4 - 9 9 0 0 4d. Branch Circuits New, alteration.or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or feed fee. Print Owner's Name Each branch circuit S 5.35 Address b) The fee for branch circuits 2 City State • Z without purchase of service p or feeder fee. Phone No. First branch circuit 1 $ 37.50 3 7 . 50 Each additional branch circuit 9 $ 5.35 4 8 , 'I 5 The installation is being made on property I own which is not intended for sale, lease or rent. (Service Miscellaneous oltaneow or feeder not included) Each pump or Irrigation circle $ 42.75 Owner's Signature • Each sign or outline lighting $ 42.75 • Signal circult(s) or a limited energy 3. Plan Review section (if require: panel, alteration or extension $ 60,00 . Minor Labels (10) S 107.00 Please check appropriate item and enter fee in section 5B. 4f. Each additional Inspection over • 4 or more residential units in one structure the allowable In any of the above • Service and feeder 225 amps or more Per inspection $ 50.00 System over 600 volts nominal Per hour $ 50.00 In Plant • $ 59.00 Classified area or structure containing special occupancy as described in N.E.C. Chapter 5 5. Fees: " Submit 2 sets of plans with application where any of the above a 5a. Enter total of above fees ��, 1 Not required for temporary construction services, pp�' Surcharge (.05 X total fees) f - $S ��i Subto�ta l� $ NOTICE -5 nb ter 25% of line 5a for / i 3 ( Plan Review if required (Sec- 3) a3 S PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED ubtotal $ IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR ^ // 4 3 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS J Trust Account # AT ANY TIME AFTER WORK IS COMMENCED. _ Total balance Due $ J „ f1 he c 4 ft 00iUA i:'dstskforms`electric.doc - • ; :cITY TIGARD a5 b Electrical Permit Application Planchedc ,iT 13125 SW HALL BLVD. Rec'd By. • Tl 3ARD 97223 Date Recd Phone (503) 639-4171, x304 Add on to existing permit. Date to P.E. �_7 - ©p Inspection (503) 639 -4175 ( C El te to DST Print of Type - permit # G��c -arta o - 60 sio Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called • 1. Job Address: 4. Complete Fee Schedule Below: • Name of Development Scholls Ferry Med. Dr. Alder Number of inspections per permit allowed Name (or name of busineigpvidence Health Service included: Items Cost Sum Address 12442 SW Schoils Ferry Rd. Ste . 200 4a. Residential - per unit City/State/Zip 1000 sq. ft. or less $ 117.75 4 Tigard, OR Each additional 500 sq. ft. or portion thereof $ 26.25 1 Commercial ® Residential ❑ - Limited Energy $ 60.00 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2 (Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders Information for COT data base). installation, alteration, or relocation Electrical Contractor Oregon Electric Group 200 amps or less $ 64.25 2 Address 1 01 0 SP 1 1 Hi Ave 201 amps to 400 amps $ 85.50 2 City Portland State OR Zip 97214 • 401 amps to 600 amps $ 128.50 2 601 amps to 1000 amps $ 192.50 2 Phone No. 2 3 4-9 9 0 0 Over 1000 amps or volts $ 363.75 2 Job No. - 32538 Reconnect only $ 53.50 2 Elec. Cont. Lice. No. 2 6- 9 5 C Exp.Date .4c. Temporary Services or Feeders ' OR State CCB Reg. No. 2 0 3 Exp.Date Installation, alteration, or relocation COT Business Tax or Metro o. Ex to 200 amps or less $ 53.50 2 // II 201 amps to 400 amps $ 80.25 2 Si natur u f. Elm' 0 ti 401 amps to 600 amps $ 107.00 2 Over 600 amps to 1000 volts, License No.2ni 4s - - Exp.Date see "b "above Phone No. 234-9900 4d. Branch Circuits New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase ofservlce or feeder fee. Print Owner's Name Each branch circuit $ 5.35 2 Address b The fee for branch circuits without purchase of service City . . State • Zip or feeder fee. Phone No. First branch circuit $ / 37.50 Each additional branch circuit 4 $ The installation is being made on property I own which is not 4e. Miscellaneous 6, 65 .24. 4 intended for s ale, lease or rent. ' (service or feeder not included) Each pump or irrigation circle $ 42.75 - Owner's Signature Each sign or outline lighting $ 42.75 Signal circuits) or a limited energy 3. Plan Review section (if required): * panel, alteration or extension - $ 60.00 Minor Labels (10) $ 107.00 Please check appropriate item and enter fee in section 5B. 4f. Each additional Inspection over 4 or more residential units in one structure the allowable In any of the above . Service and feeder 225 amps or more Per inspection $ 50.00 Per hour $ 50.00 System over 600 volts nominal - In Plant $ 59.00 Classified area or structure containing special occupancy as described in N.E.C. Chapter 5 5. Fees: • 6a. Enter total of above fees fe ,(, (o D $ 21 _ 40 * Submit 2 sets of plans with application where any of the above apply. 8 % Surcharge (.05 X total fees) a , /3 $ 7 Not required for temporary construction services. Subtotal $ NOTICE 5b. Enter 25% of line 5a for y 6 s Plan Review if required (Sec. 3) cv $ . 23.11 PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due is \dsts \forms\electric.doc /9;64/77o "/.4 �S/ CITY OF TIGARD BUILDING INSPECTION DIVISION 24 Inspection Line: 639 -4175 Business Line: 639 -4171 MST f . BUP Date Requested 9 7 AM PM BLD Location / t' Z S 5 C , % 6 I/ f �y Af Suite e2-0 MEC Contact Person 13 Ph i -�-5 1 PLM Contractor 6 (e & t l -c c '-, c Q - -' r--P Ph 3 62 , SWR BUILDING / Tenant/Owner • ELC .7g& G/ — 6 0 ,57 0 Retaining Wall _ ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing t �"P.� -. -/ • Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In (4/6. / UG /Slab C � ✓�r Low Voltage Fire Alarm • ( A 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 einspection RE: [ ] Unable to inspect - no access ADA Approach/Sidewalk Other Date Inspector .C�� � Ext Other Final PASS PART FAIL DO OT REMOVE this inspection record from the job site. r %tIT OF TIGARD BUILDING INSPECTION DIVISION - • ' 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested /0 '=- — AM " PM BLD Location / VC( Z S i✓ .SC414, Suite C MEC Contact Person rG -q Ph Vat a) 5 r PLM Contractor Ph SWR BUILDING Tenant/Owner ELC 2 i ' Oa i7i) Retaining Wall - _ ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear - Int Sheath /Shear Framing • Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final �� /_ PASS PART FAIL , / s PLUMBING Post & Beam Under Slab Top Out • Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers ` Final PASS PART FAIL • (LECTRI Lj Service Rough In UG /Slab Low Voltage • Fire- ' larm 46 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 Approach /Sidewalk ? /J Other Date — . �� Inspector 1/ st Q �� Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.