Permit 1 7 4i.
C ITY OF TI GARS 1 ELECTRICAL PERMIT
PERMIT #: ELC2003 -00601
- Ak DEVELOPMENT SERVICES DATE ISSUED: 9/29/03
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1SI346C -00401
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 100
ZONING: C -N .
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical TI. Job No: 19561
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: SIGNALJPANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 14 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
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: 503 - 234 -9900
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount
Required Inspections •
[ELPRMT] ELC Permit 9/29/03 $173.40
[ELPLCK] ELC Pin Rev 9/29/03 $43.35 , Elect'l Service
[TAX] 8% State Tax 9/29/03 $13.87 Rough -in
Elect'l Final
Total $230.62
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 Q2 I1-0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -800 -3 - 344.
• Iss d By: ' 1 � 1 ■ i t , J k, ,1 Permit 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: ✓ - ` e ,_ e i e lam/' • DATE:
LICENSE NO: y�4
Call 639 -4175 by 7:00pm for an inspection the next business day
•
/' d /�I
Electrical P466 b+tion
OFFICE USE ONLY
A City of Tigard sL� L�03 D Dattereceived:9 A 0 Permit no.: EL 580,3 -'LY�l6/
13125 SW Hall Blvd ject/appl. no.: xpi : •ate:
..e -%f
, )k s Phone: (503) 639 -4171, FAX: (503) 598 - 1960 Date issued: ' Byli, .P i Receipt no.:
Internet address: www.cl.tlj14rt1.4MCGARD Case file no.: Payment type:
24 -Hour Inspection Ig# 'ppMjaA9a e o
U 182 family dwelling or accessory L=1 Commercial/iindustn I A�Q r O q - 2 . j L I M ult i- fam ❑ Tenant improvement
❑ New construction El addition /alteration /replacement ❑ Other: . ❑ Partial
JOB SITE INFORMATION
Job Address: 12442 SW Sholls Ferry Rd Bldg. No.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision
Project Name: Sholls PMG Ti _Description and location of work on premises: remodel of reception area, nurse station, and
Estimated Date of completion/inspection: (2) exam rooms
Will ou call for ins.ection within 24 hours? Yes ❑ No O Project Contact Todd Coffman (503) 331 - 7004 Phone
CONTRACTOR APPLICATION FEE SCHEDULE
'axno.
Job No.: 19561 Description Qty Fee (ea.) Total wisp
New residential - single or
multi - family per dwelling unit.
Business name: Oregon Electric Group Includes attached garage.
Service Included:
Address: 1010 SE 11th Ave. 1000 sq. R or Less $ 145.15 $ - a
City: PortlandiState: OR Zip: 97214 Ea Addl 500 SF or Portion $ 33.40 $ - 1
Phone: (503) 234 -9900 Fax: (503) 234 -1001 1E-mail: Limited Energy, 1 ✓R 2 Family $ 75.00 $ - 2
CCB no.: 203 Elec. bus. lic. no.: 26 -95C Limited Energy, Multi- Family $ 75.00 $ - 2
City/metr.lic. o.: 19
Each manufactured home or
modular dwelling. Service
s,.... L1.,,; >� ,,,104/ 1 9 te: 9/25/2003
and/or feeder. $ 90.90 $ - 2
• I Service or Feeders -
Su.. lect. Name 1 ; , int :M,ark Kenne // icense no: 4460S Installation, Alteration or
Relocation:
PROPERTY OWNER 200 am .s or less 1 $ 80.30 $ 80.30 2
Name (print): 201amps - 400amps 8 106.85 $ - 2
Mailing Address: 4olamps- 600amps $ 160.60 $ - 2
City State: IZig: 601amps - 1000amps $ 240.60 $ - 2
Phone: Fax: 1E-mail Over 1000A or Volts $ 454.65 $ - 2
Owner Installation: The installation is being made on property I own which is Reconnect Only $ 66.85 $ - 1 or
not intended for sale, lease, rent, or exchange according to ORS 447, 455,
Temporary - Installation,
Services
9 g Feeders - Insfallation,
479, 670, 701. Alteration or Relocation:
Owner's signature: Date: . 200 am .s or less $ 66.85 $ - 2
ENGINEER 201amps - 400amps $ 100.30 $ - 2
Name: Over 401amps - 600amps $ 133.75 $ - 2
Branch Circuits - New,
Address: Alteration or Extension Per
Panel: A. Fee for branch
City: State: Zip: circuits with purchase of service
or feeder fee, each branch
Phone: Fax: E -mail: circuit 14 $ 6.65 $ 93.10 2
B. Fee for branch circuits W /Out
Purchase of Service or Feeder.
PLAN REVIEW 1 st Branch Ckt $ 46.85 $ - 2
❑ Service over 225 amps - coma' iealth -care facility Each additional branch circuit $ 6.65 $ -
I i
❑ Service over 320 amps - rating of ❑ Hazardous location Miscellaneous - (service or
feeder not Included)
182 family dwellings ❑ Building over 10,000 square feet four or Each pump or irrigation circle $ 53.40 $ - 2
❑ System over 600 volts nominal more residential units in one structure Each Sign or Outline Lighting $ 53.40 $ - 2
❑ Building over three stories ❑ Feeders, 400 amps or more Signal Circuit(s) or Limited Energy
Panel Alteration or Extension'
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park $ 75.00 $ - 2
❑ Egress /lighting plan ❑ Other:
'Description:,
Submit 2 sets of plans with any of the above.
The above are not applicable to temporary construction service. Each Additional Inspection over
the Allowable in any of the
Notice: This permit application Above Per Insp
$ 62.50 $ -
expires if a permit is not
obtained within 180 days after (t Investigation fee:
has been accepted as complete. (Other
Permit Fee $173.40
Plan review 25% $43.35 L.
State Surcharge 8% $13.87 7
Total $230.62
CITY OF TIGARD 24 -Hour .
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
- ► BUP
Received 2 -q 3 ", 23 bate Request -d 1%r I AM PM BUP
Location 2 ,iri.M dip / 0 0 MEC
Contact Person : _ 1 A J .!-_. Ph ( erC 9 — 3 6 3 PLM
Contractor 672/2/, �Ph ( ) n SWR
BUILDING Tenant/Owner lU�.t - �Z • dlin /
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors ,fin (�) (� Y�I� �� 3
Ext Sheath/Shear VY, i►`7 ) �1v 1, J r
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL 1 �
PLUMBING I
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
m
VI1M -- � PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Li Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line _
ADA
Approach/Sidewalk D a t ��� G Inspector /t � Ext
Other:
Final DO NOT REMOVE this inspection record f rom the j s ite.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received '- d _ Date Requested , f (/z ' 0 . AM PM BUP
Location 1 _ i A Suite in 6 MEC
Contact Person ..1.: AA- . I ...1.. Ph ( 5 !) )7' l — ?)6. S S
Contractor s �•- L 1.. -. ° Ph ( ) SWR
BUILDING Tenant/Owner P/Uf2thi ' 41120 3 -00(00 I
Footing Xi 4.-e/2/1/1,1 ELC
Foundation Access: /
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam Grl - 7reit 9F- (.()di,C41-0A-
Shear Anchors
Ext Sheath/Shear - ,. • �- l j r . 30 pm
r11/� . (�[MXrL�,
int Sheath/Shear I I �
Framing ,j
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm \ \NA) U O �1 `�J 1a . CD r/ (4, q5 ED 6 11 S� �1+
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
- TRI ,
. - -
Lo Voltage
• e � PART FAIL Alarm
Fi I
III fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
,
SITE ❑ Please call for reinspe tion RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 6 Inspector y�� Ext
Other: G6
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD • 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received IO 3 1(0 P Date Requested / Z — ( 3 AM PM BUP
Location / Z ern LS/L. r N biA",/ Suite f 072 MEC
Contact Person lg... , I . ' -i ( 5 Off) g / - ?) (0 S SPLM
Contractor d 4 Ph ( )) SWR
BUILDING Tenant/Owner i_11170 WAd • ELC 3 -00(00 I
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation Of
Drywall Nailing (j
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL.
PLUMBING )‹.
fw, a 0 kin
Post & Beam
Under Slab • - at AIL . _ i � si
Rough -In �� "lb
Water Service F !/�^7 /
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In G�
UG/Slab �
Low Voltage / APT
Fire Alai. :a,
final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- ART FAIL
❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line f �j
ADA D ate L [ � I ns actor ' . a E. Ext
Approach/Sidewalk ! p
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART - FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
•
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received / Date Requested / � � AM PM BUP
Location �—��3Gte /On MEC
Contact Person Ph ( ) ( I 9 ' 3�aS� PLM
Contractor L Rs) C S Ph ( ) 9 - a (9 ? SWR
BUILDING Tenant/Owner ELC
do 6 of
Footing
Foundation ELC
Ftg Drain Access: ELR 3 — o‘..)36).-...
Crawl Drain
Slab Inspection N �� SIT
Post & Beam •
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation `
Drywall Nailing �� J
Firewall �4' f
Fire Sprinkler V
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: I
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Volta• e
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
/PASS) PART FAIL
❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date hIJ.. � � 0 3 Inspector -/
�-(• _
Other: U
Final DO NOT REMOVE this inspection recor ; fro ob site.
PASS PART FAIL