Permit W-+
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ELECTRICAL PERMIT -
C � TY OF TIGARD RESTRICTED ENERGY
411 DEVELOPMENT SERVICES PERMIT #: ELR2003 -00137
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/15/03
SITE ADDRESS: 09000 SW DURHAM RD PARCEL: 2S114A0 00100
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of security system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA /TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: SECURITY X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SCHOOL DISTRICT 23J ELECTRIX LLC
13137 SW PACIFIC HWY 115 V STREET
TIGARD, OR 97223 VANCOUVER, WA 98661
Phone: Phone: 360 - 694 - 5094
Reg #: L160-695-10V, :5
ELE 37 -930C
SUP 4398S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 5/15/03 $75.00 Elect'I Final
[TAX] 8% State Tax 5/15/03 $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 throuc
Issued by / - . - Permittee Signature OA/ /77 c�77e7,
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
Na y 14 03 03:23p ELECTRIX 360 6950670 p. 2
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electrical Permit ermlt Applcation . OFFICE USE O1NLY
RECEIVED VED Date received: ..57/9 Permit no : 9/2 2 03 -1) 2003 01 2
.'i +' City of Tigard G C Project/appl. no.: Expire date:
City of Tigard Addr ess: 13125 SW Hall Blvd, Tigard, OR 97223
ry g MAY 14 2003 Date issued: By,, _Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD i)
Land use approval: SUILDINe QICOISECN s �
. TYPE OF PERMIT - --
0 1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi - family 0 Tenant improvement
0 New construction t Addition /alteration/replacement 0 Other: 0 Partial
• ' JOB SITE INFOIIMATION
Job address: C ,St.:.: 42 LLl v>,. }e j, ) . Yt ivCi Bldg. no.: Suite no.: Tax map /tax lot /account no.:
Lot: (Block: `Subdivision: t�J
Project name: _a rd p 1, Q Description and location of work on premises: J . ( : .i • v I- "'14
Estimated date of complctio /inspection:
CONTRACTOR APPLICATION • FEE SCIIEDL'LE
Job no: Ugh Fee Max
Business name:
1, c_.-k.--e-%` Description Qty. (ea) Total no. insp
Newresidcntial - single o rmulti- family per
Address: i( 1 5 t ) .S.1- y .- E t dwellingun it.Includes attached garage.
City- U a. i& c o[.L',e v - I State: wt4 I ZIP: 9 1 to 1 Serviceincluded:
Phone: $g9- 53 -•rptFax: 36,0 69,5-0670 E -mail: `t 5 -f a (PGty0( 1000 sq. ft. or less 4
L �t Each additional 500 sq. 11. or portion thereof
CCB -{ �(p no.: j L 2t. Q lee. bus. he. no: - 331 CI , 0 6 tot Z —
Limited energy, residential 2
City /metro lie, no.: ' 3 /Wef ® Limited energy, non - residential 2
b e.. l= ( 5r) ,L.---- .9 (/t. Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date %r0 (VD / Service and/or feeder 2
Sup. elect name (print): (IA t L , (C_, (. F•'\ License no:14 ! c 5- Services or feeders—installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print):--c } F p Sp 0 1 0lZ 1 (., l-J Se t'1-4.5)4_._. 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 9 CG(% S to 0 u. I G-t a. On le! d 601 amps to 1000 amps 2
City: 7- 6 v " ei, State: , . ZIP: • Over 1000 amps or volts 2
Phone: Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration,or
ORS 447, 455, 479, 670, 701. 200 amps or less 2.
201 amps to 400 amps 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 amps- rating of l&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 over 600 volts nominal more residential units in one structure alteration, or extension* 2
U Building over three stori es 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan 0 Other: Per inspection I I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other l
Not all jurisdictions accept credit cards, please call jurisdiction f m ore mtomiatmn
Permit fee 5 V t�
i �r p Notice: This permit application
U Visa U MasterCard expires if a permit is not obtained Plan review (at %) S
Credit card number: / / within 180 days after it has been State surcharge (8 %) S to r t?a
Expires
accepted as complete. TOTAL S e/ r U7
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440-4615 (6 %00 /COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
�
BUP
Received��� ° ` 3 Z D ate Requested 3 / , / 0 CL AM PM BUP
Location /atil JLC(4"Vt Suite _ MEC
Contact Person W a Ph ( ,57 r 2 <'7a
Contractor Ph ( ) SWR
BUILDING Tenant/Owner dtr ELC
Footing
Foundation ELC
Access:
Ftg Drain E) - 3 7
Crawl Drain —
Slab Inspection Notes: (QM
SIT
��
Post & Beam / 1ic� � (Q-
Sr Anchors
4-0 /�
Ext Sheath/Shear ear
Int Sheath /Shear •
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P ASS 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 pi
Fire Alarm
Final • Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
�� PART FAIL
SI Please call for reinspection RE: 4 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 3 O Inspect ■ - Ext
Other:
Final DO NOT REMOVE this inspection record from the Jo site.
PASS PART FAIL