Permit 4
' 1
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
fll) DEVELOPMENT SERVICES PERMIT #: ELR2004 -00119
—n 13125 SW H411 Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/5/2004
/ Y.57.5 PARCEL: 2S102CB -00100
SITE ADDRESS: 1288 50 SW GRANT ST
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -12
BLOCK: LOT: 041 JURISDICTION: TIG
Project Description: (2) low voltage systems.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: X
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
TIGARD - TUALATIN SCHOOL DISTRICT #23 SHAW WEST COMPANY
6960 SW SANDBURG RD PO BOX 1427
TIGARD, OR 97223 TUALATIN, OR 97062
Phone: Phone: 682 3723FAX
Reg #: SbRP- 393921s
LIC 63142
ELE 34 -70c
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 5/5/2004 $150.00 Low Voltage Inspection
Elect'I Final
[TAX] 8% State Surchar€ 5/5/2004 $12.00
Total $162.00
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 ,e Permittee Signature I' i . Z %i
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
503 682 3723 P . 02/04
'-' w., 10 : 33
''1 111 16:actrica1 Permit SHAW WEST
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City PS triiard
5 2004 A Received 4,,,
Date/B •
13125 SW Hall Blvd., Tigard, OR 9 722MAY
Plan Revie
Phone: 503.639.4171 Fax: 501598.1960 442111g1W : ''‘ Date/By. Other Permit:
Inspection Line: 503.639.4175
Juris:
N D o at t e t r e ead
Y e l t B h Y o - d :
rup format
2 11 6 n r
Internet: www.ci.tigard.or.us ion
OF T1GA ,- ' . 11.1
:r ' iP "'4*q,''..;1.:.1:!-':"..:''':1-ii,:. :',;+-:-'41,4444:1!
6 New construction 0 Addition/alteration/replacement Please check all that apply:
Demolition 0 Other:
EiService over 225 amps, comm'l pliazardous location
0
;:i40 , . ,, ,, , , ., , , 0Service over 320 amps — rating OBuildrig over 10,000 sq ft .
.04***A04090011'cii4-111A-i.;1':'`::c of 1- and 2-family dwellings 4 or more new residential
0 1- and 2-family dwelling Commercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure
DBuilding over three stories 0 Feeders, 400 amps or more
0 Multi-family 10 Master builder 0 Other:
00ccupant load over 99 persons OManufactured structures or
DEgre„/Iighting plan RV park
Job no.: 0335 Job site address:4 Grant St. OHealth-care facility DOther
_ Submit 2 sets of plans with any of the above.
I
City/State/ZIP: Tigard, OR 97223 /
The above are not applicable to temporary construction service.
Suite/bldg./apt no Pro :::,..J"-q-Alifig,KINVitik',,4,11,1144V4."1.:','.-''''.'
. .. 1 ject name : CF Tigard Elementary
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: North Tigardville Addition I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75 00 2
1 4$Cii1PTIONI0e, -- *0iiic . ' . - :-;,'
Each manufactured or modular
i Additions to original permit / Fire alarm installation & Intercom & paging system dwelling, service and/or feeder 90.90 -.
_
Services or feeders installation, alteration, and/or relocation
200 amps or less ' 80.30 2
0 P "I am M 4CI° am 106 85 1
:-t '.:-,..- -- - , i" ,- '''''''' .-- ''''''''' 401 amps to 600 amps 160.60 2
Name: Tigard-Tualatin School District
601 amps to 1,000 amps 240 60 2
Address: 6960 SW Sandburg Rd. Over 1,000 amps or volts 454.65 2
I
Reconnect only 66.85 2
City/State/ZIP: Tigard, OR 97223
Temporary services or feeders installation, alteration, and/or
Phone: (503)431-4000 I Fax: ( ) relocation
200 amps Or less 66.85
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. I l 113030..7350 2
2
401 amps to 600 amps
Owner signature.
Date; Branch circuits— new, alteration, or extension, per panel
' , '-. ' . ' ' : rt3_ itiPLIcAN'T '• ' ' ' ;'' ' ' - 1' - > '.;:, '•:..,, 1:1TOINAOltittly**: -1-.`:....;1::- A. Fee for branch circuits with
service or feeder fee, each
6.65
Business name:
branch circuit 2 . .
B. Fee for branch circuits
Contact name:
without service or feeder fee,
each branch circuit 46 85 2
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
E-inail:
Signal cireuit(s) or limited-
'
extension Describe: FA install 2 Page 2 50.CO 2
Business name: Shaw West Co.
& intercom
Address PO Box 1427 Each additional inspection over allowable in any of the above
:
Per inspection 62.50
City/State/ZIP: Tualatin, OR 97062
Investigation per hour (1 hr min) .. 62.50
Phone' (503) 682-3939 J Fax: (503) 682-3723 Industrial plant per hour 73 75 1_
__.
- '',:;Y.F:W.').,VIA ''. v ';0,1:14t1414;*06,414,10,WC-,',14,,I.;
CC13 Lie.: 63142 1 Electrical Lie : 34-70C Suprv. Lie. • 221S
Subtotal 150.00
-
Suprv. Electrician signature, required: al ft. Plan review (25% of permit fee)
State surcharge (8% of permit fee) 12.00
Print name: i6( 4 ,, Ais
Date.:_..0.5/0
TOTAL PERMIT FEE 162.00
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name
I Date:
• Pee methodology set by Tri-County Building Industry Service Board
s• Number of inspections per pennit allowed
■mu,1‘11 ty \ Permits1ELC-PermitApp doc 12/01
1 40.46151110/02/C ONI/WEli