Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' :
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00083
T IGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/14/2008
PARCEL: 2S 111 AC -02700
SITE ADDRESS: 14650 SW 97TH AVE ZONING: R -4.5
SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 037 JURISDICTION: TIG
PROJECT: TWALITY MIDDLE SCHOOL
Project Description: Install voice /data 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 - TUALATIN SCHOOL DISTRICT 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
Reg #: ELE 36 -94CLE
FEES LIC 145828
Description Date Amount SUP 2312LEA
[ELPRMT] ELR Permit 4/14/2008 $75.00
[TAX] 12% State Surch 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 No ' - ion en Th• - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules • direct questions to 2 UNC at 03.246.6699 or 1.800.332.2344.
lss ed By: 1 Permittee Signature: ?C_ 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.
Electrical Permit Application M cirxoiii is :41.1,, ' ° ; � WO LI.
r.
City of Tigard R"`i"y PI o 3
Date/By P ermit N o . : �� �GtO��
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ' l p • D Other Permit: •
• Inspection Line: 503.639.4175 J I ll Date Ready/By: tar; ' ®See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method / ,c. Supplemental Information
' TYPE OF WORK - PLAN REVIEW .
❑ New construction Vif Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
• . CATEGORY OF CONSTRUCTION of I- 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
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family 0 Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ' ❑Egress/lighting plan RV park
, L/ Sh 5 9 ?
Job no.: Job site address: I / 'T•� ❑ Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City / State/ZIP: /c A-/ The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: , / Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total
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
Po tl GC dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER • ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 7—ii) L -1 m 1 o 5 I L hirile cc 601 amps to 1,000 amps 240.60 2 •
• Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or •
relocation
Phone: ( ) Fax: ( ).
200 amps or Tess 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 A ;, 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per pant't)
❑' APPLICANT • 1 . . V CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: �z4 G, Pi (;)(;)//1/4 Geld ).Geld 1 CA iiat:)S branch circuit
B. Fee for branch circuits
Contact name:
b e Li C-8 ta(, without service or feeder fee, 46.85 2
¢ each branch circuit .
Address: -- O. BDx 50ff Each add'I branch circuit 6.65 2
City / State/ZIP: tfA —S b ti) d I LL C D Q 917070 Miscellaneous (service or feeder not included) .
Phone: (S'p3) 793 - � IN Fax: : (5E3 ) t) J our Pump or irrigation circle 5340 i 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited- • •
. CONTRACTOR . energy panel, alteration, or
extension. Describe: ( Page 2 75 2
Business name'
� A �! �t /A e014 i�ladt)(
Address: /�/ G �� S
Each additional inspection over allowable in any of the above
R r Per inspection 62.50
City / State/ZIP: 01 1,50 11/ 1Jt t cE Q a q 7 p ? p Investigation per hour (1 hr min) 62.50
Phone: (V3 ) �93— 2 2't:V Fax: (503 ) 4,3? -o /(c Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: f L/5S2 Electrical Lic.: 54,3 vac Suprv. Lic.: 23 /2 LEA_ Subtotal 751
Suprv. Electrician signature, required: d Plan review (25 %ofpermit fee)
Print name: / 7 u r �Qd6 G Date: 1- /iv/0g State surcharge (8% of permit fee) • °°
J TOTAL PERMIT FEE e.( .ee
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- PennitApp.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 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:
A: LO Audio and Stereo Systems
0 Boiler Controls
❑ Clock Systems .
Data Telecommunication Installation
❑ Fire Alarm Installation
• ❑ HVAC
❑ Instrumentation
" Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ CMedical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
•
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC- PennitApp.doc 04/03
CITY OF TIGARD .- j
BUILDING DIVISION PERMIT #:
EL R2000
t)t)%;t33
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14/200£1
Phone: (503) 639 -4171 � l tt,,
Inspection Requests (24 Hrs.): (503) 639 -4175 .-.±+r _ f_I
INSPECTION WORKSHEET FOR DATE: i0/17/`�008 TIME: 7_(1 2Alv9 PAGE 10
SITE ADDRESS: 14 AVE CLASS OF WORK:
SUBDIVISION: TIt:;ARDVILL.E HEIGHTS LOT # 037 TYPE OF USE:
PROJECT NAME: 1WALITY MIDDLE SCHOOL
DESCRIPTION: Install voice/data in portable.
OWNER: TIGARD- TUALATIN SCHOOL. DISTRICT, PHONE #: - — . -40tX)
CONTRACTOR: AZIMUTH COMMUNICATIONS INC. PHONE #: 503.639 -0110
Inspection Request Scheduled For: Date: 10/17/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 076861 -02 503- 793 -2906 N
Corrections /Comments/ Instructions:
6
'
' s PAS. ❑ PARTIAL APPROVAL XCANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ( 1\.) L Date: 1 O n Phone #: (503) 718- lLt'tt