Permit I
CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00223
` � ' l i �� DEVELOPMENT SERVI DATE ISSUED: 05/01/2001
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25111 AC -02700
SITE ADDRESS: 14650 SW 97TH AVE
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -4.5
BLOCK: LOT : 037 JURISDICTION: TIG
Project Description: Installation of (8) branch circuits to computer lab.
• 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: 7 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:
UNION HIGH SCHOOL DISTRICT CAPITOL ELECTRIC CO INC
NO. 3 JT 12810 NE AIRPORT WAY
UNIT 1
PORTLAND, OR 97230
Phone: Phone: 255 - 9488
Reg #: LIC 048748
SUP 3132S
ELE 26 -496C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
5PCT CTR 05/01/2001 $7.47 2720010000( Elect'I Final
5PCT CTR 05/01/2001 $93.40 2720010000(
Total $100.87
•
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:
i / Al
, - f 0 ,/ Issued By: ��-/ �.
a Rlr/: /Oa1 '1�I r
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: (7)-7 c7,9 DATE:
LICENSE NO: Z/..3...-
Call 639 -4175 by 7:00pm for an inspection the next business day
1
Electrical Permit Application
X
Date received: OFFICE USE ONLY .
RE VED �� ?- _ _�i/ �Di •
i r CItV of Tiand Project/al. no.: Expire date:
AA . � �I J b Date issued: By: Receipt no.:
CITY OF TIGARD Address: 13125 SW HALL BLVD, TIGARD, OR 9724PR 3 0 2001 Case file no.: Payment type:
Phone: (503) 639 -4171 Fax (503) 598 -1960
Land use approval: COMMUNITY DEVELOPMENT
TYPE OF PERMIT
❑ 1 & 2 family dewlling or accessory s® Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction AA114 c s 7.51_ 1 e ....4. t • etlacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 14650 SWVrazThl AVE City: TIGARD Bldg. No.: Suite no.: Tax map /tax lot/account no.:
Lot: IBlock: N/A (Subdivision:
Project name: COMPUTER 'Description and location of work on premises: COMPUTER LAB
Estimated date of completion inspection: -
CONTRACTOR.APPLICATION FEE SCHEDULE
Job no: 21 -658 Fee Max.
Business Name: Capitol Electric Co., Inc. Description Qty. (ea.) Total no. insp
Address: 12810 NE Airport Way New residential - single or multi - family per
City: Portland State: OR ZIP: 97230 dwelling unit. Includes attached garage.
Phone: 503 - 255 -9488 (Fax: 255 -9488 IE -mail: darrell @cepdx.com Service included:
CCB no.: 48748 'Elec. bus. lic.no: 26 -496C 1000 sq, ft, or less $ 145.15 4
City/metro lic.no.: N/A Each additional 500 sq. ft. or portion thereof $ 33.40
— ref ,/ 4/26/01 Limited energy residential $ 75.00 2
Signature of supervising electrician (required) Date Limited energy, non - residential $ 45.00 2
Sup. elect. name (print): ' Darrell MCNeeI - - License.no.: 3132 - Each manufactured home or.modular dwelling
PROPERTY OWNER Service and/or feeder $ 90.90 2
Name (print): Services or feeders - installation,
Mailing address: • alteration or relocation:
City: I State: IZIP: 200 amps or less $ 80.30 2
Phone: Fax: IE -mail: 201 amps to 400 amps $ 106.85 2
Owner installation: The installation is being made on property I own 401 amps to 600 amps $ 160.60 2
which is not intended for sale, lease, rent, or exchange according to 601 amps to 1000 amps $ 240.60 2
ORS 447, 455, 479, 670, 701. Over 1000 amps or volts $ 454.65 2
' Owner's signature: Date: Reconnect only $ 66.85 1
ENGINEER Temporary services or feeders -
Name: . . . installation, alterations, or relocation:
Address: 200 amps or less $ 66.85 2
City: State: ZIP: 201 amps to 400 amps $ 100.30 2
Phone: . . Fax: E - mail: . .. _ 401 amps to 600 amps • $ 133.75 2
PLAN REVIEW (Please check all that apply) Branch circuits - new, alteration,
❑ Service over 225 amps - commercial ❑ Health -care facility or extension per panel:
❑ Service over 320 amps- rating of I &2 ❑ Hazardous location A. Fee for branch circuits with purchase of
family dwellings ❑ Building over 10,000 square ft. four or service or feeder fee, each branch circuit $ 6.65 2
❑ System over 600 volts nominal more residential units in one structure B. Fee for branch circuits without purchase
❑ Building over three stories ❑ Feeders, 400 amps or more of service or feeder fee, first branch circuit: 1 $ 46.85 46.85 2
❑ Occupant load over 99 persons ❑ Manufactures structures or RV Park Each additional branch circuit: 7 $ 6.65 46.55
❑ Egress /lighting plan ❑ Other: Misc. (Service or feeder not included):
Submit sets of plans with any of the above. Each pump or irrigation circle $ 53.40 2
The above are not applicable to temporary construction service. Each sign or outline lighting $ 53.40 2
Signal circuit(s) or a limited energy panel,
alteration, or extension* $ 75.00 2
*Description:
Each additional inspectionover th allowable in any of the above:
Per inspection I I $ 62.50 I I
Investigation fee •
Other
❑ Visa ❑ MasterCard Permit fee $ 93.40
Credit card number: / / Notice: this permit application Plan review ( ) $
Expires expires if a permit is not obtained State Surcharge 8% ) $ 7.47
Name of cardholder as shown on credit card withing 180 days after it has been
$ TOTAL $ 100.87
Cardholder signature
Amount accepted as complete.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24- Hour'i tspection Line: 639 -4175 Business Line: 639 -4171
®n BUP
t O 1 Date Requested (J l AM PM BLD
Location / 7-(0 G(0 q % Suite MEC
Contact Person / Ph PLM
Contractor Coi f) / ID / E /pe./ rl C . J� Ph 57 / � 20 SWR
[ ELC , (" CxO� ,R3
BUILDING Tenant/Owner 0 [�l 11,0 / �i �c-1 00 / t/ S Y` ,
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab !t %r , L( l", SIT
Post & Beam j
Ext Sheath /Shear Lee-- /O
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling.
Roof
. Misc: ..
Final
PASS PART FAIL -1 I q P d 179ve__c/
:PLUMBING ,
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer •
Rain Drains
Final
PASS PART FAIL
MECHANICAL °:
Post & Beam
Rough In
Gas Line -
Smoke Dampers
Final •
P A FAIL
(ELECTRIC
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
S PART FAIL
•
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall,.13125 SW Hall Blvd
Catch Basin
Fire Supply Line — ] Please call for reinspection RE: _ [ ] Unable to inspect - no access
ADA i
Approach /Sidewalk r - r,
Other Date (y , j / Inspector N„ „. i, , _ , Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .