Permit I t Y OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 - 00481
�i � DEVELOPMENT SERVICES DATE ISSUED: 8/17/2004
'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S126BC-01506
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 570
ZONING: C -G
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Add (1) panel and (34) branch circuits in dental office. Limited energy for audio /stereo wiring and
nitrous alarm. Job No. 102
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: 0
LIMITED ENERGY: 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: 1 W /SERVICE OR FEEDER: 34 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: X
Owner: Contractor:
PORTLAND OFFICE ASSOCIATES - TIMBERLINE ELECTRICAL CONTRACTORS
BY TC PORTLAND, INC PO BOX 298
8930 SW GEMINI DR LAKE OSWEGO, OR 97034
BEAVERTON, OR 97008
Phone: Phone: 503 - 969 - 8488
Reg #: LIC 160037
ELE 26- 121 I C
FEES SUP 4957S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/17/2004 $456.40
[ELPLCK] ELC Pln Rev 8/17/2004 $114.10 Ceiling Cover
[TAX] 8% State Surcharge 8/17/2004 $36.52 Wall Cover
Underground Cover
Total $607.02 Low Voltage Inspection
Elect'l Final
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 . 2d a 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: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
` Electrical Permit E FOR OFFICE USE ONLY
City of Tigard ,a Received o / T/ Permit No.: �+ � /t // -60 A
13125 SW Hall Blvd, Tigard, OR 972 0 { { Date/By: 0 G
Phone: 503.639.4171 Fax: 503.50 Plan Review Q /�
I Date /By:
O` O 1• Other Permit
Inspection Line: 503.639.4175 ,Gpf N ^'� 1i ' D Date/By: v ReadyBy d / g'� (�
� H See Page 2 for
VV
Internet: www.ci.tigard.or.us OFD ` OC) Y N�otille i /O. Supplemental Information
V 1 iF WORK
—17r4 1 % PLAN REVIEW
❑ New construction LIE Addition/alteration /replacement Please check all that apply.
El Demolition El Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ® Commercial/industrial ❑ Accessory building ❑S over 600 volts nominal units in one structure
El Multi - family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: /O 2 Job site address 02o tSJV - Wes s
®Health -care facility ❑Other:
9 `s N iyr Submit 2 sets of plans with any of the above.
City /State /ZIP: T a ` _D O , 'e,) , 6 f c el The above are not applicable to temporary construction service.
/ ' Ot � + FEE° SCHEDULE
Suite/bldg. /apt. no.. Project name: AR.
Seo 14 g Q `/' Description I Qty. I Fee. I Total f •
Cross street/directions to job site: Ha /� New residential single- or multi - family dwelling unit
d Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33 40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Ad. 9 ' r. r dwelling, service and/or feeder 90 90 2
(� 1944 fl , / ✓QN.C9c.lri/leY" bred/IL:4 C /c✓(iwA Services or feeders installation, alteration, and/or relocation
A . Ae H 7K ( Dh4 $ie 200 amps or less / 80.30 SO. ) 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
IN 401 amps to 600 amps 160.60 2
Name: p 2TLA}01 O I �t �l dvve,i t n-6 601 amps to 1,000 amps 240.60 2
9
Address: S Az N ( -/ . \ — bk. T 1 L� Over 1,000 amps or volts 454.65 2
v I dlJ Reconnect only 66.85 2
City / State/ZIP: 6,.. C-) G 76Od Temporary services or feeders installation, alteration, and/o
v l b relocation
Phone: ( ) Fax. ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 3 �[ 6.65 IV 2
B. Fee for branch circuits 1
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: • ( ) Sign or outline lighting 53 40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or Gv
,f extension. Desqribe: Page 2 /�• 2
Business name: r/ ;Yl £(eJ- n t CSI, do' /y hie. A14%0 /`t !�i a-6 lL/}� I
Address: P 0 . Each additional inspection over allowable in any of the abov
3"/ Per inspection 62.50
City /State/ZIP: L li % ( efw e j 6 / 0,2 . ( /y 74 Investigation per hour (1 hr min) 62.50
) Industrial plant per hour 73.75
s63 % p 4 9 — 8Y8 Fa (� ) 3 ) . y 2 7 ELECTRICAL PERMIT FEES°
$ Surv. Phone: ( CCB Lic.: � e 003 7 Electrical LicSuprv. L ic Subtotal 1/54. it Electrician signature, required• ' `/ Plan review (25% of permit fee) / / y / Z �
Print name: � ,. L- D ate: State surcharge (8% of permit fee) �, 5A. " / % �"`'e / U -2 — of TOTAL PERMIT FEE 4 r7 . D..
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tti- County Building Industry Service Board
** Number of inspections per permit allowed.
i1Bwldmg\Permis\ELC- PemtApp doc 12/03 440 -46I5T(I 0/02/COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
Burglar Alarm
Garage Door Opener*
Heating, Ventilation and Air Conditioning
System *
n Vacuum Systems*
Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
X Audio and Stereo Systems
Boiler Controls
Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control *
Medical
Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling
Other L ` r ,&4
Total number of commercial systems: 2.
*No licenses are required. Licenses are required
for all other installations
11Building \PermrtslELC- PernutApp doc 09103
JU Ub - LUU4 rKl Ua oU rill rrtn iru, l • U1/ U1 tee, 1ll]
City of Tigard
Attention: Brian Blalock
Building Department
13125 SW Hall Blvd.
Tigard, OR 97223
Tel: 503/639 -4171
Fax: 503/684 -7297
Doctors/Dentists Questionnaire June 08, 2004
As part of the building permit review for your proposed tenant space, the following
information is requested.
Please answer the following questions and return to us a signed copy. Please also
provide a copy to the building owner or their agent:
- 1. Yes Will there be use of procedures that render a patient incapable
of unassisted self - preservation? (This would include any use of
general anesthesia, as well as any procedures that would result
in a patient becoming incapable of recognizing a fire
emergency, or of immediately leaving the building without
assistance.)
2. If your answer to Question 1 was "yes", what is the maximum
number of patients who could possibly be incapacitated at any
one time? (This would include all patients meeting the
description above, whether they are being prepped, undergoing
a procedure, or in your recovery area).
3. If you answer to question #1 was "yes" would you normally
transfer patients in an emergency in a gurney or a wheelchair
(please underline)?
Signatur . Building Name /Address:
Name: r)r4 hn ,- aA._ _ , L 11 d i ■ 9. S- 4(
Date: /co /o A Su, tc- 67n
7' 1A-(A, Olt 17617_3
This information is intended solely for the purpose of determining construction standards
for the building and for your space in it. There is no correlation with the procedure lists
used by the State Health Division in its licensing process, nor with any lists that may be
used by any insurance carrier, etc.
Thank you for filling out this questionnaire and returning it to the architect or space
planner responsible for obtaining your building permit.
-
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639171 MST
BUP
Received Date Requested /l / I AM \ PM BUP
Location 0-0 LL /3 ,S Q - Suite 76 MEC
Contact Person Ph ( ) 3) 3 63 3( PLM
Contractor n , PPh ( ) SWR p
BUILDING Tenant/Owner M' L ELC �d (/ 66 ve
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 f)
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
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage L t • a 9 — c ZS2
Fire Alarm
PAS PART FAIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 111 Please call f• r reinspection RE: Unable to inspect — no access
•
Fire Supply Line
Approach/Sidewalk Date 1 • Inspector 1.6 Ext
Other:
Final DO NOT • EMOVE this inspection record. om the job site.
PASS PART FAIL
•