Permit ''n ^ - CITY F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' 1 COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00082
T,i cAi D; DATE ISSUED: 4/14/2008
R 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S114AA - 00100
SITE ADDRESS: 09000 SW DURHAM RD ZONING: R-4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TIGARD HIGH SCHOOL
Project Description: Install voice /data system in portable.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD- TUALAI1N SCHOOL DISTRICT 23J AZIMUTH COMMUNICATIONS INC
6960 SW SANDBURG ST P.O. BOX 508
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: 503 - 431 -4000 Contact #: PRI 503-639-0110
FAX 503- 639 -0115
FEES Reg #: ELE 36 -94CLE
LIC 145828
Description Date Amount SUP 2312LEA
[ELPRMT] ELR Permit 4/14/2008 $75.00
[TAX] 12% State Surchai 4/14/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 t ese rules or direct questions to OUNC at
503.24C
99 or 1. .332.2 I
Issue : „0 Permittee Signature: cc v rr--a' W V
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 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.
Elec 'icat Permit Application 4 „,,,P! w1 i oli " or l ii ki .' ' • `- ;' t
City of Tigard Received Permit No.: f�
13125 SW Hall Blvd., Tigard, OR 97223 /��g
D �8 � ('
Plan Review � 2
Phone: 503.639.4171 Fax: 503.598.1960 " *!(9 `' Date/By. Other Permit:
Inspection Line: 503.639.4175 tu1 '.il Date Ready/By: Juris 65 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / Supplemental Information
- TYPE OF WORK PLAN REVIEW '
❑ New construction 10 Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comet ❑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 14 Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ 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.: Job site address: ! p Do s ki Dr��4�t �� ❑Health -care facility ❑Other.
. Submit 2 sets of plans with any of the above.
City /State/ZIP: 7764.M The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE * ;SCHEDULE
Description 1 Qty. I Fee. I Total I ''
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION 'OF WORK . Each manufactured or modular
1� dwelling, service and/or feeder 90.90 2
UD / CF:/ Drl Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPERTY OWNER ' J ❑ TENANT
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 • 2
Name: 776,44) / A 56/ L PPL aLE S' 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 1 2
City / State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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 k jt 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
' ❑. APPLICANT 1 (r CONTACT .PERSON A. Fee for branch circuits with .
service or feeder fee, each 6.65 2
Business name: 44A ti pi u��t I ?off ( branch circuit
�/ B. Fee for branch circuits
. Contact name: e L/ 4 ' L without service or feeder fee, 46.85 2
i�O cog O each add'I br c circuit i
Address:
RG Ea ch add'I branch circuit 6.65 2
City /State/ZIP: to LSON -1- Lc E CO q-70-76 Miscellaneous (service or feeder not included)
Q/� Pump or irrigation circle 53.40 2
Phone: ( .503 ) 75 - 2 '57 Fax: : ( �03) y' _ S
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: ' Page 2 2
Business name:
r4'Ui4iu ed" (i,✓tc.4�UpS
Address: ,P n e b y se . g Each additional inspection over allowable in any of the above
C Per inspection 62.50
City /State/ZIP: WI l-S /A./A.0_6— ( '76 76 Investigation per hour (I hr min) 62.50
Phone: L503) 6, 3 q _ 0 it U Fax: (50 . ) („q- () ti c— Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES *" •
CCB Lic.: / ',$ 72 g - Electrical Lic.: y 6 L�' Suprv. Lic.:).3 /2(eA Subtotal :G0
Suprv. Electrician signature, required: 1
Plan r eview (25%of permit fee) • . C G � m ate: I ( ( � / State surcharge (8% of permit fee) j
Print name:
gt u ` TOTAL PERMIT FEE 84.4%
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 Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /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*
❑ Vacuum Systems*
❑ Other:
— COMMERCIAL' , WORK ONLY
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
' _Check Type of Work Involved:
- . ❑ Audio and Stereo Systems
❑ Boiler Controls
'_❑ Clock Systems
y ri Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
' ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: /
*No licenses are required. Licenses are required
for all other installations
\ Building \Permits\ELC- PennitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2006-00082
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 41140008
Phone: (503) 639-4171 Ae.
Inspection Requests (24 Hrs.): (503) 639-4175 ,,,, -.....
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
10117/2008 7:02AM 11
SITE ADDRESS: DURHAM RD CLASS OF WORK:
01:3000 SW
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIC HIGH SCHOOL
DESCRIPTION:
Install eoiCnCtidata Extern in portable.
OWNER: • TI PHONE #:
GARD SCHOOL DISTRICT 23J, 503
CONTRACTOR: PHONE #:
AZIMUTH COMMUNICATIONS INC ,s- -E v E . 0J-` 639-0110
Inspection Request Scheduled For: Date: Pour Time:
10/17/2008
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 076061-01 503- 793-2906 y
Corrections/Comments/Instructions:
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PASS
G444°5 ('' APPROVAL 111i 31(3t
sciz
0 PARtIAL
-------katf-E ri NO ACCESS
El FAIL I 1 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: 5. L Date: 101 i I ( 0 Phone #: (503) 718- 144-6
, . •