Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00123
W DEVELOPMENT SERVICES DATE ISSUED: 3/18/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 114A0 -0 0100
SITE ADDRESS: 09000 SW DURHAM RD
ZONING: R - 4.5
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: (1) 200 amp or less service, (2) branch circuits and limited energy for (2) systems: fire alarm &
paging.
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: 2
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: 2 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 PORTLAND ELECTRICAL CONST INC
13137 SW PACIFIC HWY PO BOX 586
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: Phone: 655 - 2281
Reg #: LIC 51764
SUP 3461S
FEES ELE 3 -246C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/18/04 $243.60
[TAX] 8% State Surcharge 3/18/04 $19.49 Low Voltage Inspection
Elect'I Service
Total $263.09 Rough - in
Elect'I Final
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 O• -ii 8810 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-6699 or
1-800— 2 -2344 /
L0 /
IsJued By: f 1'1 , - � -- / /� �I1_ Permit Signatur , a . /�
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: `// f
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application , r EOFLOF'FICE USE ONLY °, ; ', r .
i Received Ar 4Y , /�� Permit No : / i ppl� 3
Cl25 SW I agard EC E a p y E Plan Review
DatDate/By' Date/By' /f
i 3125 SW Hall Blvd ,Tigard, OR 9722 A 9V/ Other•Perrmt ��~d���
Phone 503.639.4171 Fax. 503.598 1 0 I I Date /By:
�^ -.1 I- Date Ready/By: lung ® See Page 2 for
Inspection Line: 503.639.4175 Le 2O '_ ` = -..
Internet: www.ci.tigard.or.us V1 10^�' r MAR 16 Notified/Method. Supplemental Information
g . `T ,tea . -`,' ,, :, rt :e .' . " ": tsf- , No,,, .�`�',.�.,,., <,i :.. ,, ,*.a,,',:,,, •, . � -: -;. •
� t;ay`� �. � �j. , i y � d = _., ,,!4-‘,..., ,.r�s r�q��r � q [g .Hw�x: -wL.. � xo =`i4 .., y�"�.a ? °. ..
' P�� .�a„a.`' "fi.•�, z. «.— ,. .� <Y "�`"r �' -, en � R 3L ".�'s = �.. � u, ,..< m , � . -, >, �.�" � , . . " "�
", - T��'� � Please check all that apply:
❑ New construction Ad i ��rr (I�c�nt pp Y
❑Service over 225 amps, comm'1 ['Hazardous location
❑ Demolition ❑ Other: ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft ,
.< sue,• ° ` =:,,,,,, _",' " '_, ,: ,wry. ` -T- ` O "' '"� ,` 4- A , : of 1 - and 2-family dwellings 4 or more new residential
I°, .� 4 ,��,,.. „ , - CATEGORY :10W Q_O ' NST ''.''RE TION ; - %'F ',i , .:: ems , : Y g
N ;, < : , t, .,;, :&: „ x, ,w, "**a=,**,",-," ',".:, "" ',, '4"': .., *' . � -
❑ I- and 2 -family dwelling Commercial /industrial' Accessory bu ❑ System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi- family ❑ Master builder ❑ Other: ['Occupant l oad over 99 persons ['Manufactured structures or
� � �"��;,� ..�«, ,;�;,;., .,.;�£
_�.���.::,� .;�,,•��� . :, ; ",.., , . � , RV park
r ,. . �Y" :"" a ` gr g g P lan
;�; � pJOB Sl'['E INFORMATIUIY= AIVD�,C � , �
"` =' E ess /li htin
` �. �`
❑Health -care facility ['Other:
Job no.: Job site address: ?ODD Sid o Aare Submit 2 sets of plans with any of the above.
City /State /ZIP: 77sa 9 The above are not applicable to temporary construction service
a � ��ry °4,.y � :�_��xE r SCII1�DClI ;��_�� "- '.,;,�u
Suite/bldg. /apt. no -1. Project name: t �� "!�l ',Project nrgcriptton I Oty. I Fee. I Total I
Cross street/directions to job site: ear 4 91 " .6 in a 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
'
•y , i „ c�,, ';;� 1;',
". ;, ,,; ��nn"TI O FWORI :% : * -t• F' ' - " Each manufactured or modular
.�' • ''N:' �. >f::��y�', �, ,, :L" _ * r��\::RJSr<. ��<.., .., ... a'ro„ • ..., - �rfk "w:,.r „ z,,,;', Z =?�'�. .4 '�3, ir:` � - -
2
i,5 Dr7 re ,'i' - a s ) dwelling, service and /or feeder • 90.90
j u )at , c l z ” Services or feeders installation, alteration, and/or relocation
e ij mop ht /4 a t+ p ce 71-/e),7 200 amps or less / 80.30 (J ,01. t) 2
; :: _, ;: c. ' °.",F ; -,I � '"',4.-i 'TE `A 'I '-' '; c , . • •; ,: 201 amps to 400 amps 106.85 2
=_:;-,: _ OPE ." RT O, "W_ , 4. 1 ' k . ,. , "<. 2
':c- Y`-'5,.' =` ., .,. w .. . >av®s. '`= is ''', ' * -"' ' ,,. : , '' . _'"' " '' - ... ,, 401 amps to 600 amps 160.60
Name: ,� i F) / v. /cll.— 601 amps to 1,000 amps 240.60 2
-
' ` , � Over 1,000 amps or volts 454.65 2
Address: -
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
: " ` s. - T . �" -PERSON%`` n `•. s '� `" A. Fee for branch circuits wttit l
'' max; - ' , -2 : A I, ' '';' ' W ' ' ' 'G ...� ,
°: -' ?A service or feeder fee, each
Business name: branch circuit 2 6.65 /3,30 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
E -mail: M ,, : •m.. - , <- energy panel, alteration, or
Via,' —7 - 1 :' ' „'` "'sill; -.7" _ ' " "' '.`" ". "'
, . , `r ...Ien GOi V Ti2ACTOR; . Page 2
,
w _. .,,; „� ; extensio Describ 2.. / " � '-
2
Business name: Portland Electrical Construction, Inc. Fire ' larm
Each additional inspectioti'over allowable in any of the above
Address: 1019 7 Street Per inspection 62 50
City /State /ZIP: Oregon City, OR 97045 Investigation per hour (1 hr mm) 62 50
Industrial plant per hour 73.75
Phone: (503) 655 -2281 F ax: (503) 655 - 5033
Industrial ' tA w.,,' �� �' `' ;
( ) `r;; # `:: ELEC7'RICA�L PERMITFEES =, ,,:K;
CCB Lie.: 51764 I Electrical Lie.: 3 -246c _ I S rv. Lie.: 3461S Subtotal I z y3 , GO
Plan review (25% of permit fee)
Suprv. Electrician signature, required: - /
'' ¢ State surcharge (8% of permit fee) 19, I/9
�
Print name: ,? Date: � , TOTAL PERMIT FEE 2 rio , D?
Authorized signature: /
This permit application expires if a permit is not obtained within 180
�s/ L f days after it has been accepted as complete
�. �'ts !t i Date: -' ` " / * Fee methodology set by Tri- County Building Industry Service Board
Print name: .4 - .. ,,,. ® # �' 4 t s 0 ** Number of inspections per permit allowed •
440- 4615T(10/02/COM/WEB
1 \Butldmg \Pcrmtts \ELC- PermttApp doc 12/03