Permit CITY OF TIGARD OM 0 ELECTRICAL PERMIT
rte° PERMIT #: ELC2007 -00152
COMMUNITY DEVELOPMENT DATE ISSUED: 3/13/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S102CB 02300
SITE ADDRESS: 13240 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT : 008 JURISDICTION: TIG
PROJECT: WEST SIDE SURGERY
Project Description: Wire 30 amp UPS circuit. Job No. 07.150
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: 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:
PACIFIC PROPERTIES DEKORTE ELECTRIC INC.
BY MARTIN JOHNSON 4115 SE CLINTON ST #1
13200 SW PACIFIC HWY PORTLAND, OR 97202
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 288 -2211
FAX 503 - 288 -2231
FEES
Description Date Amount Reg #: ELE 34-541C
[ELPRMT] ELC Permit 3/13/2007 $46.85 LIC 159954
[TAX] 8% State Surcharge 3/13/2007 $3.75 SUP 4075S
Total $50.60 REQUIRED ITEMS AND REPORTS
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 fs ••- than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those r. es are set fo • in • 952 - 001 -0010 through OAR 952 -001 -010(1 You may obtain copie - these rules or direct questions to OUNC at
503.2 6.6699 or 1.800.32
Issue• By: - � ; J 1 4 . j Permittee Signat re: ` / W"
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:
• NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
�� i�.��1.lr� i
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.
FRO : DEKORTE ELECTRIC INC FAX NO. :532882231 Mar. 12 2007 10 : 05PM P2
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Electrical Permit Application . 1:01: OFFICV I - Si:. (>N1.1
I
City of Tigard AEG A Received 1
' Ag 4' 7 1155‘ Permit No.: ELd ,g46-7-,04 /5 3..
13125 SW Ralf Blvd, Tigard, OR 97223 -
Plan itevilw
Plume: 503.639.4171 Fax: 503.598.1960 M AR 1 3 2007 4, ,si 4 , 4 )!L., tmem I ellusr Permit:
Inspection 1.14c: 503.639.4175 .a.-4 li• , 'i` • Dos gouty/ 211
lark Ill See Page 2 fur
Internet wwweltiganioros CITY OF - 1R4FIJI Notified/hi t Supplemental [raiment=
-
,Rip,ORT,,,z94'Wq173 q'T-fat: '': 3 ,,,,,,i'lvill 7, iiRri • lifqr,T,',
:11':. a ti..•+•*( l',I ., .6 .:Iii40,. Ni , 4i .1 ' N tl klatili !bLdii 40 i,4,56'
0 New construction WI Addition/alteration/repiacernent ; Please check all that apply:
0 Demolition • Other: , I IDS'erviix over 225 amps, cannel Oilaaardous location
0, L
OService over 320 amps -.rating Ofluildng over 10,000 sq. it..
.. ..0;earfii/73,1UsTii,t„' • :3 i • •:' OA • •
. l'al tAl,v-4 1:4-itt c.t P -, 4, • ,,m,h,,,,,„sak,„-0,a01,,,,„A„,v 4 , . 4, 7 nriet,id, . t bl • l • ' of 1- and 2-fainily dwellings 4 or more new residential
El I- and 2-family dwelling r, commaciaifindustrial El Accessory .I'ptilding ['System over 600 volts nominal units in one sauemre
A Building over three stories I:Weeders, 400 amps or more
ID Multi-family • Master builder El Oth LI er: I
°Occupant Load OM' u penialui 0Manufactuved structures or
7. v4yr,', iv,ogivr Irpfrit,-,,ite -. t.'ilfrr,'Noviiirififflir
„ , ,., ,..3.,,..L ,. ,,,K, ...,,.04, • ,,,,,,,•,,,,•,,,,, ..,,,„ i..A,..,.,..i&ii,;„:;.,- ,„...,),,,,,.., N.,..'in-Ans‘ w . . ,,,,V, ;gt,d A 14i...i, ih, , al,. ClEgressilighting plan RV park
Job no.01, i SD Job site address: 1 32...ic, I. AnnER nil Itealih-eare facility POthec
.... - .. IX . II MUM ..1 sets ot' plans with any of the above.
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City/State/ZIP: " ) a/A,y-ei Dr 6 : Tbc above arc not applicable to temporary construction service.
Suitelbltig./apl. no {-"Pr mett mane . -
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....4441416 gd.1 ,..! .2
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Cross street/directions to job situ: . 4 New residential single- or multi-family dwelling unit.
I . . I-- . Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision:
1 • Lot no.: . ka. addl 500 sq. IL or motion 3340 1
-•--- - Limited enera. residential 75.00 2
Tax map/parcel no
I : I , • - 1.iinited energy. non-residential 75.00 2
. t. ' ' '1 ., - ,.., . 0,03A
PtiLIVEMOVE ' ' ' 4 'I e'lrlrAltfLrir''''' -: • .51'; r ach '''')WFA :"1 • li • '.ili'a ' aq .
. nIsi 2 Ai: 0 0 ., . 1 , r . ,. i : A A Jr«. Ok tl-NgaN' '4'..r, ,.. eitille. : F. mafacturtmed or modular
Isk) Let, 30 I) p. . cut ! , , , . dwelling, service and/or feeder 90.90 , 2
- -
Services or feeders inatallation, alteration, and/or relocation
• 1 1 I 200 amps or less
.-- 8030
2
7, " liMPAY9MtliMilaWral,',,lit'MfAMV,en, Xrigia 201 amps to 400 amps 106.85 2
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,ii ll'i. ■!.. '' ;.101tr.A°';..0 10 . 'i6' )::4;444140 i°1 V.IIttk.40.i401' • 40 i amps to 600 amp , 160.60 2
Name: ' . I 601 amps to 1,000 amps 240.60 2
- - ,
Address: 1 Over 1.0(10 MIAS or volts 454.65 2
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' Reconnect only 66.85
. -. --..- - 2
CityStateIZIP: : . . Temporary services or feeders humiliation, alteration, atulittr
ielocarina . . ...,_
. I Fax: ( ) • I
, . 200 amps or less 66,85 1
._..-
Owner installation: This installation is being made on property•that I own which: is n it I - 201 an to 400 amps 100.30 Z
intended for sale, lease, rent, or mtchatige, according to ORS 447, 449„ 670, and 701. 1 ' ----7-
• 401 amps to 60 amps 133,75 2
1 j • 4.' -_-.......--
Owner signature: • . . Date ' : _L, ..„,,,,.. Ionia& circuits- new, alteration, or Clittledeli, per panel
-,„......-
0 "t,• 111„,r. J.1 &fel .• , rp , ,erri #.6 • - A. 1.'"ce" fo7hum eh circuits with
veakel0k4oLlaw.),1,,wrAgiAt T
i.IJI,033m, .61 , , A . ritc','I ,A•,4,g,w .Y.,-6, J,•.,i, v'e,,,.'
1 setviec or feeder fee, each 6.65 2
L3usine mime: I • I . 1 branch circuit
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----+ -- f - • • I 13.1w fnr branch circuits ---- _
Contact name: 1 1 L j ! without service or feeder fee. 46.85 46 375 2
-
• I ----- ' '''''' . first branch circuit.
Address: 1 Each addl Manch circuit 6.65 I 2
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City/State/ZIP: ; Misedlanams (service or feeder not included)
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• I ump or irrigation circle 53.40 2
P.honc: ( ) I Fax: : ( I ) . -- --•-
.ign or outline lighting 53.40 2
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E-mail: I Signal circuit(s) or limited-
',WIRECart* 11'' ' 'A; 177 aurrearamminolgogynt ve ' - .inergy Panda okorid.itina or
I • ' extension. Describe.; Page 2 2
Business name: DellCorte Electric, Inc ,
- .. ..
I ia of the above
. a
Eaeb additional insipection over allowable mu , v
Address: 411S SE Clintan Si.. #1 ---- - - -, .--
' 62.50
- -- --,- ,...- . -._ 1 , • Per inspection -.----- -. _
City/State/ZIP: Portland, OR 97202 , .
, • : I ; ! investigation per ho ( r lir mi.) 62.50
_-- ............. -,--
. --4
ustrial lant Of 73.75
Phone: (503) 288-2121 LFroc. (503) 2118-2 0 1 .. ME • . P P MIMI=
----- ' VNF •Vil Kifi:
CC13 Lie.: 159954 _cc:Erica! Lie,: 3 • 4 I.0 _ • S pm 'e.: Fill'! Subtotal , . ZS
&mew. Electrician signature, required: 41 Mr i gild 4 ," ;illw r---77 iell 7 ----- - Plan ' Jew (25% of permit fee) ---
Print name: V e4 4 .
• .1
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stde 0% or permit tee) ;,.3 . - 7 . ,
- TCYfAl, 'PERMIT .1Frita'E 5-0.--(a-C?
... • A
• Authorized signature: • . 111M patadtapplim on expires if a perm it is mot ambled within ISO
• . ._ • days aqiet it has been accepted as 110111140!
Print name: I I.e.
• _.J • Fee mothodoluy sot by Ili-County Hathling Trulustiy Service Beard
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FROM :DEKORTE ELECTRIC INC . ..FAX NO. :5032882231 Mar. 30 2007 02:02AM P1
Building Division
RECEIVED E Att Request for Permit Action or Refund
and • MAR 3 0 2001 _
TO: CITY OF TIC ARD . B Dr
Permit System Administrator
•
13125 SW Hal I Blvd., Tigard,. OR. 97223
Phone: 503.718.2430 Fax: 503.598.1960
FROM: l Owner [] Applicant (1 Contractor El City Staff •
(Check one)
Name: DeKorte Electric, Inc.
VOID (usiness or Individual)
y2/0 7 .
Mailing Address: 4115 SE Clinton St, #1 •
City /State /Zip: Portland, OR 97202 _ •
• • Phone No. .503-28&-2211
•
•
• PLEASE TAKE ACTION FOR T.HEITEM(S)CHECKED (✓):
0 CANCEL PERMIT APPLICATION. •
0 REFUND PERMIT FEES. •
0 REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: ELC2007 -00152
•
Site Address or Parcel #: _13240 SW Pacific Hwy
Project Name: • West Side. Surgical Center
Subdivision Name: Lot #:
EXPLANATION: We are able to use an MLP.
•
Signature: Date: 03 /30/07
• Ken DeKorte •
Print Name: •
ltctund Policy •
1. The Building Official may mulhorine the refhnd of
a) •any feu which was erromeously.paid or collected. •
h) 'cot more t BO percent of the permit fee. for issued permits prior to any inspecticm requests, •
c) not more than R0 percent of plan review fee when an application is canceled before any. plan review effort has been expended.
2. Refu will Ere returned to the original Payer in the same mcrfind in which payment was received. .
. /e9
Ft)R (1► 1 1( 1'�I O\1.1
Rte to SysAdmin: [ r� ! / ,.mpj Rte to Bldg Admin: Date ,7O = r4r
Refund Processed: Date i Invoice Processed: [)ate By
Permit Canceled: Date B �� Pal - ctrl T Added :Date - / �
*0? �� Plat.. /0� IUn ""A A e....,,..,: �F
C� V e , , Pe
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