Permit CITY OF T IG A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00575
4�1�n DEVELOPMENT SERVICES DATE ISSUED: 2/13/02
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S102AA -02800
SITE ADDRESS: 08770 SW SCOFFINS ST
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT : 026 JURISDICTION: TIG
Project Description: Electrical work for 12,000 sq. ft. 2 -story addition. Limited energy installation includes fire alarm and
security systems.
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: 2 401 - 600 amp: SIGNAL /PANEL: 2
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 10 W /SERVICE OR FEEDER: 90 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: 1 EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: 1 PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TUALATIN VALLEY MENTAL HEALTH CRAWFORD ELECTRIC
8770 SW SCOFFINS RD - PO BOX 2754
TIGARD, OR 97223 ALBANY, OR 97392
Phone: 503 - 617 -3827 Phone: FX 541- 812 -2448
Reg #: LIC 58969
ELE 24 -147C
SUP 2720S
• FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 11/19/01 $1,571.65 2720010000( Wall Cover
Elect'I Service
PLCK CTR 11/19/01 $383.85 2720010000( Elect'I Final
5PCT CTR 11/19/01 $125.73 2720010000(
(additional fees not listed here)
Total $2,660.83
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)
246-6699 or 1 -800- 332 -2344.
Permit Signature: ala 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: 1 / 7 ) o/P DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
1(L �,jt'j1TL' it ‘-'7.-14. •• r
iihit.
11/07/2001 12:43 FAX 5035 PROJEre TIGARD t'OV O 2001 6 o O 4 till 002
- 1 ®6 - � - 0 -
m an Inc. By_ •
RECEIVED CIeetri Permit,A.ppli�cati
1�1� / Permit • j 0 LC20 -40525- �� Date received: f / / Expire date:
is ° project/appl.no.: p
1 achy of Tigard I r l
E y 2 201-4--.. : Address: 13125 S W Hall Blvd. 7223 0 1 Receipt no.: J
City o g gard D issued: By:1)•l4
nc. ne: (503) 6394171 5 L 1
C181t company, ax : ( �u) 598 -1960 Q� 1 Case file no.: Payment rypc: 40 110001 •
Land use approv ``��
7 i•PE OF PLI(Rt1T
0 1 & 2 family dwelling or accessory ❑ Comntercial/mduatrial 0 Multi - family 0 Tenant improvement - A
7Ef-New construction KAddition /alteration/tt:plecement 0 Other: 0 Partial tki
JOB .SITE 1NFO11A1,1flON .
•
Job address: F776 Sul ,SCOFF/A sr Bldg. no.: Suite no.: Tax ma tax to .unt no.: ,t51 -Uo1-
Lot: [Block: . [Subdivision: (-0 -s : ;26 t `TI l .f) f-I (6I)14)/ r. VZ,4c rs '
Project name:TUA(pr,M/ V At tey t 7E4 Description and location of work on premises: iJe't✓ i / (_ SA ry) i
• Estimated date of completion ins on: a-r..0 Z !
- Job no: agate QQ _01 .
l-s
ro .. • Fee Max i
Drseriptioa Q (ea) Total no. imp
Business name: Address: 6 CRS ��n /��wr d lta �16- tamgyper li;
f6 el l7(d . •5A- 1P,,•, — I'tJ & 9-7S'I duelling wig faclodesetadacd garage. L
City: 4/ o
1 State: e 1 ZIP: `J 3,) S dcetncludeek 4 h
Phan j V r �t 3on I F� /i)R /Z 2 W81 E -mail: ' Woo e4. re or less .
�� Each additional 500 eq. ft orpottion thereof
CCB no.: 05S q L Q 'Elec. bus. lie. no: ,./t/ - ( y 7 (1) Limbed energy. residential 2
City/metro lie. no.: !
W O 2-' - Limited energy, nowr sidential 2 ,
TN 1 J/ Each rnnwfactu cal home or modular dwelling II
Sig Date L /01 / Service and/or feeder 2 i
rratute of supervising el. eien (required) i w �mee.orfeeders— Ittstalhtioa,
Sup. elect. acme (primp: l I A. en T 11 „„ u no: 7 S J alteration or related= 201 amps to 400 amps / M
200 maps or lest Ol _111,0 7 N 2
it 2
Name (print): ; t!l}ihTlu L E y �'�Ig 401 amps to 600 amps l if/.LQ 2
Mauling address: I q GOD SW ( h.n elk Rd 601 amps to loon amps I O. D 2
I State: O- MP: q 7'�•9 4 T Over 1000 amps or volts . 2
e�ty: t�pr1
Phone:303 -L 17- 3 nil Fax: E-mail Reconnect only I
Owner installation: The installation is being made on property I own Temporary services or feeder, -
which is not intended for sale, lease. rent, or exchange according to installation, alteration, or relocation:
200 amps or tae 2
ORS 44 7, 455.479, 670, 701. 2.01 amps to 400 amps . r 2
Owner's signature: Date: 401 to 600 an s 2
Brandt circnita - new, alteration,
or extension per panel:
Name: G R . h . I A- RTt-1 E m E I . P A F - k Fee for branch cirreeitt with purchase of
Address: . '() .Si k 3 .20 service or feeder foe, each branch circuit f0 it Sig a 2
City: fORr' 1S�e: 0 iZ1 �:��y -�t0�a B. Fee for branch circuits without pew :hale
- of service or feeder fee. Cast branch circuit 2
. Phon :533 ZA, -2c4.1 Fax: E -mail: - Each additional branch circuit
PLAN 12EVIt %% (1'lca.c chcch all that apply) Misc. (Service or feeder not lnehdedk
)BiSav ce over 225 amps - commercial 0 Health- earefnoility ' Each pump or irrigation citele 2
O Service over 320 amps -rating of 1&2 t] Hazardous location Each signor audios lighting . ,�s17.0( 2
family dwellings jilPoilding over 10.000 square fact four or Signal aecui t(sl or a limited energy panel, /� I
O System over 600 volts nominal more residential units in one structure alteration, oresrcnsion• d' 2
O Building over duce stories • nominal . 400 amps or more •Descaiption:
O Oavpnnt load over 94 persons O Manufactured savetdree or RV park Each additional inspection over the allowable in may of the above
O Eg cesilightingplan O Other. Painspccdon 1 1 I I
Submit sets of plans with any or the above. instigation fcc
The above are not applicable to temporary coastrt•ucilon service. Other
Permit fee $
Net all ladedeeese accept event etude, pleme tali iuhitdicdon for mere irforrnennn. Notice: This permit application Plan review (at 96) $ q • � 1
O vita 0 MasterCard expires ifs permit is not obtained'
Credit nrd number; / / within 180 days after it has been State / e surcharge (8%) $ w r r .
Expire' • - accepted as oomplete. TOTAL $ 6;
_
Neme•ot =Solder ea shown on await Cara 3 - 2.6 3 2. r 7•
c.,,,,,,,, ii... Amount aea.e61s 0..avcox<
CITY OF TIGARD 24 -Hour
BUILDING - Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requeste. 42- r AM PM BUP •
Location 8 7 7 [? Ly{,- Suite MEC
D
Contact Person Ph (.S y l ) g1 a-- --1 -� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 0
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: ='
•
Final
PASS PART FAIL . j
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
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
�f°rnai Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk D ate bEC. [ 9
, 0 Inspector 6rF Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL