Permit A ` 1 CITY O I TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00583
DEVELOPMENT SERVICES DATE ISSUED: 9/15/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S114AA -00100
SITE ADDRESS: 08680 SW DURHAM RD SCHL. SWIM CTR.
SUBDIVISION: ZONING: R
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (1) 200 amp service and (12) branch circuits.
Job No. 22 -130
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: 1 W /SERVICE OR FEEDER: 12 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
SCHOOL DISTRICT 23J 3D ELECTRICAL SERVICES INC
6900 SW SANDBURG RD PO BOX 173
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: 503 - 431 -4000 Phone: 503 - 657 -9173
Reg #: ELE 3 -460C
LIC 135234
FEES SUP 4478S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/15/2004 $160.10
[TAX] 8% State Surcharge 9/15/2004 $12.81 Elect'l Service
Rough -in
Total $172.91 Elect'l Final
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 . •- se o + OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain copies of these rules or direct questions to OUNC at (503)
246 .4 or 1 -800 -3 ' 344
Issue By: ,�i - ! �� `! Permit Signature: _I s _.Al
OWNER INSTALLATION ONLY ' I
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: - a7 4 ( DATE:
LICENSE NO: 37'7 35
Call 639 -4175 by 7:00pm for an inspection the next business day
,
1
A _ Electrical PermitApplication
. . Date received: Aff Permit no.: 't (. „ci--,
_
.
ii/Crt) ■ ,I, . . •
i i I - City of Tigard '-'..
- . - Project/appl. no „ Ex I ire date:
City of Tigard Address: 13125 SW Hall.Blvd, OR 97223 ‘:. ' Datelssued:: . ' . Receipt no.: _
: 114. . =. .
Phone: (503) 639-4171 1
Fax: (503) 598-1960 ' ''• --• '-' ''. - ---::.- s':-' Case file no.: • ' '' ' Payment tYpe: • .' - '. -:.,,: 4. 1: i ., , ,
Land use approval:- -,. ':. -,-', -:' --, ' ' --
, _.__ ___.
r ' t; - '71.--,-,v, ,,.. • , !.. , . , - - ' . 1 i
- - TYPE OF PERMIT
. .. .
0 1 & 2 family dwelling or accessory. L: filiCogunercial/industrial . 0 Multi fam 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement - -. -0 Other: • • - . 0 Partial ' '' '''- I li t''.-1 1
, .
JOB SITE INFORMATION
Job address: . ,.3 N ,z,j.._., Bldg. no.: Suite no.: Tax map/tax lot/account nd.: . - i
Lot: 34g,677 I Block: Subdivision: _ -. .. . - . .
.
Project name: - - - -I-Description and location of work on premises: --r, . 4 ez hi; D 14 ..c ,t , G wi ' Z
Estimated date of completion/inspection: « - 2,0 - pi 1•3' • ..• P c..,. , ( C..“ - 1 - 5.' '-'r '.' 1 ' , ' . 0
CONTRACTOR APPLICATION FEE SCIIEDULE
Job no: 2_Z, ( 30
Business name:3i) Et...:6(x 11.1 (.._? Description - Qty. (Ca.) Total. no. insp
_ New residential -single or multi-family per
Address: Po 120y. [72) . , .• dwelling nit. Includes attached garage. - •
City: 2E-01...j U-ry I S tare: OR. I ZIP:( EA-5 Serviceinduded:
Phone:(,DS --q ( Fax: CT-fib-11411y-mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 1 :2E- I Elec. bus. lic. no: 3-itim L,
Limited energy, residential 2
City/metro tic, no.: 694 5? Limited energy, non-residential 2
.'--•) UNc---0--Cre,i)J ' • --9 -I C- i?'Af Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date , • Service and/or feeder
Sup. elect. name (print): 13 ; I 1 D kl License no:E rA ?C) ' 5 Services or feeders - installation,
alteration or relocation: : , . .:' -
PROPERTY OWNER 200 amps or less
Name (print): • 201 amps to 400 amps • - • 2
401 amps to 600 amps . 2
Mailing address:
601 amps to 1000 amps 2
City: I State: - • ',- - I ZIP: ' Over 1000 amps or volts ',- • 2 .".
Phone: I Fax: I E-mail: Reconnect only - - I
Owner installation: The installation - is being made on property I own Temporary services or feeders - .
sta * - . • .i
which is not intended for sale, lease, rent, or exchange according to inllation;alteration, or relocation: .
.1 200 amps or less . 2 •
012S 447, 455, 479, 670, 701. - -
,
201 amps to 400 amps '• t ,._ 2 .
Owner's signature: - :Date: 401 to 600 amps 2
ENGINEER . Branch circuits - new, alteration, .
- - -
. . .
or extension per panel:
Name: .. . . . -
A. Fee for branch circuits with purchase of
Address: .
service or feeder fee, each branch circuit /,'•••• 2
City: I State: - I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: ,.2
Phone: . Fax: ' ' E-mail:
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
• -
0 Service over 225 amps-commercial 0 Health-care facility Each pump or irrigation circle 2 '
0 Service over 320 arfips-rating of 1&2 • 0 Hazardous location Each sign or outline lighting .‘., - . 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System river 600 volts nominal ' --- /mom residential units in one structure . alteration, or extension*
-- "CI over three stories - 0 Feeders, 400 amps or more " *Description•
0 Occupant load over 99 persons 0 Manufactured structures or RV park . Each additional inspection over the allowable in any of the above: .
0 Egre.ss/lighting plan 0 Other. Per inspection I .1 . I - r- I
- - --- • --- -------gubmit sets of plans with any of the above. ,., : Investigation fee — - - ' • .-- - - '
The above are not applicable to temporary construction service. ; Other
. •
. ... ._. . _ . .. .
. . . . . ... . ,
Perm f
Not all jurisdictions accept credit cards,,please call jurisdiction for moreAnforrnation. _ Notice: This permit application it ee .., ._ . . _. ___ _ $
„.,......... . ____ .
El Visa 0 MasterCard - • • expires if a permit is not obtained Plan review (at _ %) $
• Credit card number: / / within 180 days after it has been State surcharge (8%) .... $
Expires TOTAL $
accepted as complete.
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/)0/COM)
' . . .. ___. ___ _ • - .
•Electrical Permit Fees: . • . Limited Energy Fees: .
,.. _.,_.,„
, . .,.. . ..
. ,
TYPE OF WORK INVOLVED
Complete Fee Schedule Below:. -- - ' - '' - RESIDENTIAL ONLY Restricted Energy Fee 475.00
• - . . Number of Inspections per permit allowed • ' (FOR ALL . .. - . .-..
• „. , - . . ..
• Service included: ... -- '4 ' Items ' Cost. Total
Check Type of Work Involved:
Residential -,per.unif .
-1000 sq. ft or less , . - $145.15 4 El Audio and Stereo. Systems . -
Each additional 500 sq,ft.or
•
portion thereof .. ,.:.-* ,,- %- ---- --- * * $3310 -';'-*--''. -7: '• - •'•'' - ' li' • - - '' - ' ' 1 1 1-1.- ' : TA urglir.A16rm - 7 : r • , - -. .;
. Limited Energy" - * - • $75.00 • ,:., .,..••• , ___ _ • .. :„ : 2` ' , "'''^':■...ts Ili , ' - .
Each Manufd Home or.Modular ., , - ,, •
Dwelling Service or Feeder. . $90,90 , 2 - • Fi Garage Door Opener • - " • •
'Services or Feeders ' • ,.. :---- - - •: ,.. - - z - -. .7 I - ': - ''• • ',Heating, Ventilation and Air Conditioning System* • -
Installation, relocation„.• . , •,-.. _ , .... -. , ;,, .D_ , .. - , ; ..,-, ,, 4 ., • ,, 11:1 , : ., ,, .,,: • _,.,,' _ , .: 1, , :.,..,, . , , :. . . . < .
J. , ,
, • ,;, •••
' • ' - '. ' ' •.',•!•A
200 amps or less. -4,-,„ . - . :. ,- . , - , .- 1 . $80.30 C-L) '
- 201 amps td400 amps " - - $106.85 2- um ri Vacu Systems
-- - _ .,.
401 amps to 600 amps - . _$160.60 2 , ";,;
- , , 0 -
_ 601_amps to -woo amps $240.60 • 2 , Other •
Over 1000 amps or volts $454.65 2 • -
.
,
Reconnect only' ' : • ,- - . - . . r,:$66.85, - • _ . --, -. •
-,. .. '
. ..., , ,,
`.- '' - *. - ' TYPE OF:VVORK INVOLVED - COMMERCIAL ONLY
Temporary Services or Feeders
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less -- $66.85 _ . 2 . (SEE OAR 918-260-260)
201 amps to 400 amps $100.30 2 • --
401 amps to 600 amps $133.75 ' 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, . - • ,
see "b" above. pi Audio and Stereo Systems
.
Branch Circuits
New, alteration or extension per panel • I BoilerControls
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit •
1 ;- ,$6.65 - .t P
-,-°- 2 0 Data Telecommunication Installation -
b) The fee for branch circuits - , , -- - without purchase of service - i .; - = n --,.,,__ -. ._ • .
, _ • Fire Alarminstalletio h ..
• or feeder fee. --
- First branch circuit - - - - -- - - • -
Each additional branch circuit $6.65 . - El HVAC . -
' Miscellaneous - -- --- - -
ri ,, Instrumentation
(Service or feeder not included) -
Each pump irrigation circle - - $53.40 --. - - , . _ .. _ •• •
.
Each sign or outline lighting - $53.40 - 0. •
Intercom and Paging Systems .
Signal circuit(s) or a limited energy - .... • . .- . • - -,
- - ---panel, alteration or-extension $75.00 '. • I' '1 Landscape Irrigation Control'
' Minor Labels (10) _ ' - ' $125.00 .
, .. : - •
Each additional inspection over . - - • ri Medical •
,
the allowable in any of the above • ' i.' :::,:::: '4 • - ,`!: •* . .i • '-''. 1 -,-.-:,'
Per inspection . . $62.50 " . .. --- Nurse Calls - ,- ' -=,* - - ` - -- — "-
. ,
Per hour • - .' ,- - - - , .. •
. _
In Plant - -= " -- - -7' $73.75 ' •-..... Li - Outdoor Landscape Lighting
_ .
- - .-:*- .
- Fees:. _+_. - • _.. ,- - n -Protective'Si - - -
•
=
- , .
Enter total of above fees Other ^
; ' - _ .
,, ., „ -,,,„ _
• - - -_ • - -' .- IL:./3 t '
8% State Surcharge
.. --- - • -- - ... Number of Systems
25% Pian Review Fee i - - •
• See "Plan Review" section s , .. . ..• . „ - * .No licenses are required. »Licenses are required for all other.installations
on ' . --1
__ __ • • • • ` ----- - - .- . -. .- . -_
7--• . Fees:
• -Total Balance Due . -. $ i rti--7 - ,--„,,- ! _. , - . - :-,_
...... . . . - - — .....
EnteE-total of above fees. . ,,,. .. _ _ $
.. ._
-D--Trust-Account-#-- ---- -- ----.- - . :. - . - '
—8VIPState Su'rcharge '-.'-.... ' - ..-: --2$ - -
• . Total Balance Due $
.
i:\clsts\forms\elc-fees.doc 10/09/00
1
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION , 4 Business Line: '(503) 639 -4171 MST
BUP
G ,
Received �j Date Requested / AM PM BUP
15 o
Location D 0 j) - Suite MEC
Contact Person Ph ( 7/ ) 5276 $s( a PLM
Contractor Ph ( ) SWR L
BUILDING Tenant/Owner ,� ELC .v , 7 0 J 66
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT •
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear .�
Framing
Drywall Nailing
L ,�
Dryll N a�
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
C .'//
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
rz . Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
` 7 PART FAIL
0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA � /
Approach/Sidewalk Date ( ® Inspecto
Pp Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL