Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
- 13125 67
DEVELOPMENT H O PMEIVq Tigard. SERVICES 639 -4171 DATE PERMIT
3/ gR 0 2004 -00059
SITE ADDRESS: 09000 SW DURHAM RD PARCEL: 2S114A0 -00100
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of data telecommunications system in portable classroom.
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:
SCHOOL DISTRICT 23J VERIZON STRUCTURED CABLING
13137 SW PACIFIC HWY 4155 SW CEDAR HILLS BLVD.
TIGARD, OR 97223 BEAVERTON, OR 97075
Phone: Phone: 503 626 - 9155
Reg #: ELE 34- 495CLE
LIC 49350
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/8/04 - $75.00 Elect'I Final
[TAX] 8% State Surchart 3/8/04 $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 wi .. :0 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you t. ollow rules .•.pted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Is. ued by �; !�� Permittee Signature � ��, i /� ,k6e1 Ir�1 / `
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
03/05/2004 09:02 NO.505 D002
Electrical Permit Application F OFFICE USE ONLY
•P., "4 E C w V E f'ceived
4 .City of Tigard DateB . jiterAirm, p.,,,it No.: Ea, -tet,5�
13125 SW Hail Blvd., Tigard, OR 97223 Plan Review
Phone: 503,639.4171 Fax: 503 598.1960 M i a , i ; , t 11. D Other Permit:
;4 4.
Inspection Line' 503.639 4175 fA L `f Date Ready/By: Jun : 0 See page 2 for
Internet: www.ci.tigard -or.us CIT OF TIGAR I Notified/Method. /0 Supplemental lnfgrmation
§iof_. , , #ix: 1 c- a , �.�.. t r� w^ f> t r 9 r l T
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MIS tom- -•' 1 iii-- {t ' l 3H `�l'�S1l�f 3 ` ' iz11,� 1 i ) '� M l r , 11 11 - W ..iij I. �1 :- #all/ t r 1 ,1,,.�, ?- , : ;- te l 1 i t { { #��I {I{#
,�, �._���g ... .[ # l n,a:»L �� -�. <r,,.�r.. r 3 talltltrd>1��7i:tr8��:1.Iir.:S t4.i• ,�.a�...._WW�zW�....:,..I: i = = �r .- r�•r.�- AKA
❑ New construction G Addition/alteration/replacement Please check all that apply.
❑ Demolition ❑Other: ❑Service over 225 amps, couan't ['Hazardous location
.1 : ' s ' { t t i 4 r u t t =urnr n I ;t; = rn, Nt r,{ ( t #'_( € �� ) f ( » u > r El cc over 320 amps - rating DBuildng ovci 10,000 sq. ft.,
-. I 1 i , .. 4 ".∎...ii .t '? .:! ... ai, ,, x hif h -m l ilt- t� ill ,'., Ni �, 6 it- 3 .4- -t a :- of 1- and 2-family dwellings 4 or more new residential
❑ I- and 2- family dwelling G Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units is one structure
❑ Multi family Q Master bulldex Q other ❑Burlding over three stories ['Feeders, 400 amps or more
t. ar =[[u [1 a tl t 1 w Fr� a 51ts S r+ ClOccupant load over 99 persons ❑Manufactured structures or
t, 1 # 1 c #11 111 l 11 p rl ( j{ { : k ;}
' f , t i. :.. #. ,lit . s tr ti t. i t�t' � . . t tt iiIiii>^ ":` • tk �l i 73: � Aillrllitru n roast itl. a t } l it ! "s #[ ;# i ,. , i 1T V .., :: ❑Egtcss / light tt g pla ce RV p ark
Job no.: Job site address: GiOcA 5Q 1 K. '"' �/� ['Health-care facility ['Other:
� } Submit 2 sets of plans with any of the above.
City /State/ZIP: , \ ` O jk tc-122A The above are not applicable to temporary construction service
Suite/bldg- /apt.no.: Project name: nn,, t l 1 111111111t11141i111 11111i!:1 11n;E {,,yO , RtltJ "I ''> . ' 1ViAIi.,:1
Awc nption Qty, Fee. Total r
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: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map/parcel no,: Limited energy, residential 75.00 2
. energy, .
:1 k S r a; F1 s ., rt,t -r. ta, r 1' 917 1,1 P Ir I 1 z t, 2 c, i Limited T non - residential 75.00 1 2
=;t # ': � t ,, i.c aiit �sslEi s rf Illr t1i -� � =�•,_ - --- �- ' =i:�'��I� Each ,matitlfactured
�'N -\ SAC` �J�- • � \ 'tll S • dwelling, service and/or feeder 90 90 2
Services or feeders Installation, alteration, and /or relocation -
W - j21.-- SN , +. \-- C 1%. 5 200 amps or less 80 30 2
�gi +,8 in y I:II uOItl r .i. ? .+ y g 9 4 I g , t s, l.Cr 201 amps t°4°° amps 106.85 2
� ri { t ,..''it ,1, :1' vi, , , l?l wr . , tt l�� l Il ! 3 aFr 't '' ' ,r . ._ � _, • 401 amps to 600 amps 160.60 2
Name: 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; ( ) ( ) 200 amps or less 1 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
}{ s i` (ri �i r 1 i n r Ro 7 a•.• A = r J r c r x t 4 =r or let
rii#: =1 9 !i9, 1# �1 ?�t'`It` `151 j 1 I UEI0'tfi� l Ili .11L1kTE tr'1 k r », tit �� I.�a 6....raPi A Fee
�• , #,14 ,„. r „ ,<N,. s. t.+:+hkLn ru...F��.�s >.z, l >t' 'l1}l - servlce f oz branch feeder circ fee , each wiEh
Business name:
branch. circuit 6 65 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add°l branch circuit 6 65 2
City / State/ZIP: Miscellaneous (service or feeder not included) ,
Phone: ( ) I Fax: : ( )
Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E-mail: in r Signal circuit(s) or limited -
N b � 3#71 ,7` /1 r r r t 5 >u , ..,'fir r u, 1 o s ss 1 t;
t, ,. -1 1 # , ' ,/-. ' =: ...1gI i .1 ,';= 1 _ E ' � 1 f 3 energy panel, alteration, or
.. . - . � , it r to t,tkil... �t�GCkrsir{ {in mum: r . ,� � I
extension. Describe: Page 2 2
Business name: v jklfiz),3 3-J j (+ L‘a,c
Address: P 1 X. tV:fr0 fp - 1 Gko e Each additional inspection over allowable in any of the above
Pcr inspection. 62.50
City/ State/ZIP: 43Ej\v rt: %. pl‹, S-707 i ts Investigation per hour (1 br rain) 62-50
Phone: (5cA) ( 2 $'S� I Fax: (SUS ) (Q 2.1- ?2_8L\ }} p Industrial plant per hour � a�r �. _ nlp` 1 i4INIIf 73.75 E F s 4 3 t tf1 } g
�'/ E .'0111111!r.1� 11 /, #�u11 an11111 1If}{11ti 1
111i
CCB Lie.: '/9§•55D I Electrical Lic.: 4 ? I Suprv. Lic.: f / 95/,---A- 111 Subtotal c l� ° -
Suprv. Electrriclaa� signature, required: (�� � ,� i. ��° �® • Plan review (25% of permit fee) �_
/�,/�y�ry 0�(f�L�J'r"-zt`Q/' State surcharge (8% of permit fee) '
Print name: R R EA/ B O %T t4LEA Date:3 ^ pe{ - 0 (.4 '
'� TOTAL PERMIT FEE 81 ,
Authorized signature: Ibis pewit mppbcahon expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date; • Fee methodology set by In County Buiidnag industry 5orvicc poard
•• Number of inspections per permit allowed.
s 113uilding \Permits\ELGFermitApp.doc 12/03 440.4615T(10/02/COM/Wn33
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DWISION Business Line: (503) 639 -4171
BUP
Received Date 7' 7 AM PM BUP
Location /l)./)CJ '/ /( Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) �7 r- 1/ SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR � � 000,5-7
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation ,(� r 0� A c
Drywall Nailing u �r V
Fi rewal I
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
F - • -rm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ; Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line _ _ I .
ADA
ik (
Date
ate Q� ' ) � -~
Approach /Sidewalk V Inspector Ext
Other:
Final DO NOT REMOVE this inspection re d from the job site.
PASS PART FAIL