Permit "CITY '
®F TIGA ELECTRICAL ENERGY
RESTRICTED ENERGY
H' 1 DEVELOPMENT H BMEiVq Tigard, ) 639 -4171 DATE SSUIED: ELR2004-00337
- 13125 SITE ADDRESS: 12855 SW GRANT AVE PARCEL: 2S102CB 00200
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -12
BLOCK: LOT: 041 JURISDICTION: TIG
Project Description: Sound system in Gymnasium & Commons.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD - TUALATIN SCHOOL DISTRICT #23 BROWNELL SOUND + HI -Fl
6960 SW SANDBURG RD 12115 SE 82ND AVE
TIGARD, OR 97223 PORTLAND, OR 97266
Phone: Phone: 503 652 - 2160
Reg #: LIC 73876
ELE 26- 789CLE
SUP 412LEB
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/27/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 10/27/2004 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by Permittee Signature
OWNER INSTALLATION ONLY ` r
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
ElectricerPermit Application ,... . FoROITIO: USE ONLY
- City of Tigard
SW Hall d.Tigard, OR 9
ECEIVEDA ;17 v(1 AXV-- Permit No
13125 Blv, ra Plan DReaLteu .1.2tv.inw
40
Phone: 503.639.4171 Fax: 503.598.1460 14 ".1%11ig)0 Date/13v, Other Permit'
Inspection Line: 503 639.4175 -;,.',1.10.. ear Date Ready/By, IBI Er See Page 2 for
rn
Inteet, www.ci tigard or.us OCT 2 6 2004 * Notified./Method: Supplemental Information
III' ,li # , -,"!tu .L„...,.,.i :,• .. , „II; .. ;;,..,•,,•.., ..,,!.., , ,.,. :,.. , ,,,•3 , ' '.', .,:. „LAN ,, , PIE:SY -, I.rm:..
[EJ New construction 123340iiitiNFM•81arrnr•nt Please cheek all that apply,
El Service over 225 amps, comm'l 0 Hazardous location
1=1 Demolition 0 Other:
p$crvice over 520 amps - rating OBuildng over 10,000 sq 0..,
. e •
ill '':.. .:gic - 4. V"..'14 ••••:. ...'... - of I- and 2-family dwellings 4 or more now residential
El I- and 2 dwelling [X] Commercial/industrial 1:j Accessory building ['System over 600 volts nominal lltlitS in one structure
['Building over three stories OFccetcrs, 400 amps or more
111 Multi D Master builder 0 Other; ElOceupant load over 99 persons DVItuaufactured structures or
, :,'',',•''.:'. , ' .' ' - - '.'. rli' ' ,jitiP8.4e41■4614,i1Ailiii144 - ,",'. : 'J'''' ,"'''"'^•::' Egress/lighting plan RV park
Elliealth-eare facility 1:10ther
Tob no.: Job site address; 12855 SW Grant Avenue
Submit 2 sets of plans with any of the above,
City/State/ZIP: Tigard, OR 97223 The above are not applicable to temporary construction Service.
'1,FEE 'SCHEDULE ;..;'; ,' ;,;
Suite/bldg./apt. no.: Project name; CF Tigard Elementry
Description I Qty. I Fee. I . Total
Cross street/directions toiob site: Off Walnut New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or leSS 145.15 4
Subdivision: Lot no.: Ea. addi 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
15**40T rpx., ,:- -. ,,.. ,,.!•.,..:';',, '''': ..,;•'-' ;'.' Each manufactured or modular
dwelling, service and/or feeder 9090 2
Sound System in Gymnasium & Commons
_..„ Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2 201 arnpuito400nnips . 106.85 2
1 '.1111"-ORCtitEWEVA)WNER.Ir• '-"..' i .,." —:ii , i''''''?'•'." -- -10-4ENANT', '.' •.- d '.'''', ,.., '
160.60 2
Nam ( )3Z C-/t0 ," c)\--6;,7._7 601 amps to 1,000 amps 240,60 2
Address: Kq C. .3\c- Over 1,000 amps or volts 454.65 2
...) RCCOMMOt only 66 85 2
City/State/ZIP:—".1 K• 4-0dt.— , - Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax; ( ) - I
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; 1Branch circuits — new, alteratiOn, or extension, per panel —
'..: :,::::',, .'...l.::::: :.. ..» :,1 . A. Fee for branch circuits with
service or feeder fee, each
6,65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
— 46 /35 2
each branch circuit
Address;
— Each add' I 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
E-mail; Signal circuit(S) Or limited-
. •,- ',. Y,:,:!,:?:.. ," sr :..,;;;toNtit:A. - (11: - .4(n , ,::,;;; !..-:, ..: .,;,,,,, • c; , r .;'. -,.,_ ' energy panel, alteration, or
extension Describe: .1 Page 2 2
Business name: Brownell Sound, Inc
Address; 12115 S 82" Avenue 1 additional inspection over allowable in any of the above
E
, Per inspection 62,50
City/State/ZIP: Portland, OR 97266 Investigation per hour (I hr nun) 62.50
Phone: (503) 652.2160 Fax: (S03) 652.2764 Industrial plant per hour 73.75
ELEC:TRICAL . 1tB1110 , .. - -FEES,:' ..';. ':',!,;:.
COI Lic.: 73876 Electrical Lie : 26-783CE. Suprv. Lie.: 2385LEB i , n ,..... a i
Subtotal ..
•
Suprv. Electrician signature, required:
Plan review (25% of permit fee)
GO
1 . J , State surcharge (8% of permit fee) 4 ...,
Print name: :1 E ry u i r ) ( 1 , I ( pr gi a___ Date: 10/26/2004
_ TOTAL PERMIT FEE 0
Authorized signature y"---- This permit application expires if n permit is not obtritne *thin lilt)
days after it has been accepted as complete
Print name: Date: * Fee methodology 5et by Tri-County Building Industry Service Board
" Number of inspections per permit allowed
:\ituddingwermlistELC-PermaApp doe 12/03 440-4615T(10102/COM/WZB
•
Zl3 39VcI ciNnos 1 V9LZZS9COS 817:0T t00/9/BI
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ELR2004 -00337
Phone: (503) 639 -4171 *if, ilanylp�ll�ii�,, 10/27/2004
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: PAGE:
511112005 TIME: 7:12AM
SITE ADDRESS: 12855 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: LOT #: NORTH TIGARDVILLE ADDITION 041 TYPE OF USE:
PROJECT NAME: C F TIGARD ELEMENTARY
DESCRIPTION:
Sound system in Gymnasium & Commons.
OWNER: TIGARD- TUALATIN SCHOOL DISTRICT #23, PHONE #:
CONTRACTOR: BROWNELL SOUND + HI -Fl PHONE #: 503-652-2160
Inspection Request Scheduled For: Date: 5/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 006535.01 503- 260.8283 Y
Corrections/Comments/Instructions:
. ------------- ter_
P ASS El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n AIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: XL( /0-- Date: "( / Phone #: (503) 718-