Permit •
A CITY OF TIGARD ELECTRICAL -
ENER RESTRICTED ENERGY
A F �J I I DEVELOPMENT SERVICES PERMIT #: ELR2004 -00267
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/23/2004
SITE ADDRESS: 14650 SW 97TH AVE PARCEL: 2S111AC -02700
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -4.5
BLOCK: LOT: 037 JURISDICTION: TIG
Project Description: Replacing low voltage electrical for irrigation valves.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: X
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: 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 TRUGREEN LANDSCAPE
6960 SW SANDBURG ST 16075 SW UPPER BOONES FRY RD
TIGARD, OR 97223 TIGARD, OR 97224
Phone: Phone: 503 - 597 - 2350
Reg #: ELE 7233
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 8/23/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 8/23/2004 $6.00
Total $81.00
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 these rules or direct questions to OUNC at (503) 246 -6699.
Issued by Permittee Signature A :_, I . AP"
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 7:00 P.M. for an inspection needed the next business day
, . ,•:,-; • , i- .
Electrical Permit Application . . .
- F'17,11i OFFICE USE ONLY • • - - ,,-: . ••-- .
City of Tigard
E.CPO 540 Received
Permit No.: 60-- aoy 00 - 6 1
13125 SW Hall Blvd., Tigard, OR 97223 l ik ...._ Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ■ ■.C; TA, ■Vii
2, 'I Date/B : . Other Permit:
Inspection Line: 503.639.4175 . 41
\\/ 1. - Date Ready/13y: ffill El See Page 2 for
rn
Inteet: www.ci.tigard.or.us Notified/Method: Supplemental Information
tmoliiennw,ole,,, Nnyeefa., f4 6-0 , 41 , ,, - rwitgootP, Yit N:ViRtfm;.e=4 ::.:f : -... . - -
00-1,,,,,,liza,,Ly6-ft., -.;%0.c-,,,,, - A.:iii„, , ,‘, ,: 13 , , „,..,,,,i,vmm :06A.,•.4.•,m,:At ,..,.0. .0 „..,,,,..„,„,• .,,,,,..,•,„ ..„,,...„.,..,,„:&_,..„.„,,,,.,,,!•:-... . .. . ••
0 New construction a Additiong09Weplacement Please check all that apply:
['Service over 225 amps, comm'l EHazardous location
0 Demolition 0 Other:
SE ervice over 320 amps - rating DBuildng over 10,000 sq. ft.,
l aW' ' '''' W
of 1- and 2-family dwellings 4 or more new residential
i' "iTac-Lte ...-:.'.., .,,, ..4.1-wita ,• iC
El 1- and 2-family dwelling gCommercial/industrial 0 Accessory building CISystem over 600 volts nominal units in one structure
EBuildin over three stones ['Feeders, 400 amps or more
0 Multi 0 Master builder 0 Other:
Occupant load over 99 persons OManufactured structures or
k4:4111LJTEIIIftk13... Wh-.lfc1,2r0b.1;45:9l'irlltr!'':VrrSr'rq Cl El E plan RV. park
OHealth-care facility ['Other:
Job no.: 52_0 Job site address: 1 Li 6so scAi cr7 -0 - 4 Lie .
Submit 2 sets of plans with any of the above.
City/State/ZIP: - T - t b i 0, 97z2_/../ The above are not applicable to temporary construction service.
, kM174114 i.'":',
Suite/bldg./apt. no.: Project name: 1 -
/1 7 ' TemPLETNI SCHL D Qty. Fee.
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'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
7,, ut
I ,*,74,.87;;T-T;rnt.,,,,,.. W ,,-- -
t bAl i B Wall 1tk::.1A=Q Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Ept...<46 Low vo L 6 l_E7 /cAte._ LA-WO-ES Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
Fo g_ i 124_ I Goit7/6/V t/..1 t_ VE3
Wtt; irWViiinik )ti:,Q FerJ ,, , A 4S , :„ 7 .-,', , '4,14, 41 ,..4V
amps 106.85 2
600 amps 160.60 2
Name .77& 141 b /477,i/ 5 65re 1_ b f'Sr4 I Cr Z33 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 less 66.85 1
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
'1" '''' 414-0 A 0.4itiffAill:.;t::16liii MElllaftiMol.lirMitaral,:,:ttilet A. r Fee for branch circuits with
: '''r•v MiltAt •'.' ,,, Ai'w ,, . , - , L ': -':r' ''' - -' l '' "''"' ' ':'''''' service or feede fee, each
6.65 2
Business name: 7 G kLEA/ Z_A4A(DcAgE branch circuit
B. Fee for branch circuits
Contact name: )44 / k E ilApre, vi K without service or feeder fee,
46.85 2
each branch circuit
Address: / 6 () 75 5 - 1-4._) IA 0 PE-e Bow/6s FE/C.e y ■ e .13 Each addl branch circuit 6.65 2
City/State/ZIP: - 7 - 1G4Ae .._ ,, Q.. 9 z - e _ Li Miscellaneous (service or feeder not included)
L? I L) Pump or irrigation circle 53.40 2
N Phone: (503) 5 - 2..."'SCD Fax: : ( •S 5 - 7 - 3 57
.."-- Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
MI:nMe1 14.VWIRDITWOCOLTWASk.;:f-agteMat M energy panel' alteration ' or
extension. Describe: Page 2 2
Business name: -- Tie, pi - \ e twne4c7 - 002.s
Each additional inspection over allowable in any of the above
Address: / 7/7 0 4,, , z- reiesoN 4,,, .
Per inspection 62.50
City/State/ZIP: 1/Voop a , LA4edtf / 9707/ Investigation per hour (1 lir min) 62.50
Industrial plant per hour 73.75
Phone: ( Slo 9 13-2, _ Fax: (503) ?yr-a_ - ( D-9 b
'l
CCB Lic.: y3,490 Electrical Lic.: Suprv. Lie.: Subtotal 7 .ca
Suprv. Electrician signature, required: ,.., 4
/) .e '
Plan review (25% of permit fee)
Print name: Date:
State surcharge (8% of permit fee)
gyAllt/ A---- #6 A 57 ' 3/e 5 A '/
TOTAL PERMIT FEE . 9 i . 00
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-PerrrutApp.doc 12/03 440-4615T(10/02/COM/WE8
Electrical Permit Application - City of Tigard ,
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�.�.^- "�grnk sew w - u� � �4;���d••:✓ '.c: L �, + �+
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:
b��
53. ? t a . �.�»..� \, �..." % ?;,4'O ��M:tY �W':y" �'�g�i+6a - :'.`2�. ;....
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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
•
❑ Instrumentation
❑ Intercom and Paging Systems
Landscape Irrigation Control*
E. 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
i:\Building\Permits\ELC- PermitApp.doc 04/03
CITY OF TIGARD 24 -Hour -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested , /2 `(7 AM PM BUP
Location l 7 �`'\ Suite MEC
o /
Contact Person -�� ,a� � Ph ( ) 0 (- 0 337 PLM
Contractor Ph ( ) SWR
� r
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR o ' O 2 ` CU..
Crawl Drain Ste` 'f S
Slab Inspection Notes:
Post & Beam Do - (
Shear Anchors �� ' (� �� * _
Ext Sheath /Shear V
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
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
P SS PART FAIL
L E TRICA
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
— 7 - WP
�" PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE - ' ; ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA �
Approach/Sidewalk
Date 7 / /° 6 7 Inspector i G1�'
G ' J Ext
Other:
Final DO NOT REMOVE this inspection recor from t job site.
PASS PART FAIL