Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
tikkAlii DEVELOPMENT H PMENa Tigard. � 639 -4171 DATE PERMIT
7/21/2004 P00220
PARCEL: 2S102CB -00100
SITE ADDRESS: 12i5 S GRANT ST
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -12
BLOCK: LOT: 041 JURISDICTION: TIG
Project Description: Limited energy for HVAC controls for boiler room not inspected under ELR2004- 00012.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD - TUALATIN SCHOOL DISTRICT #23 NORTHWEST CONTROL COMPANY
6960 SW SANDBURG RD 10320 SE HWY 212
TIGARD, OR 97223 CLACKAMAS, OR 97015
Phone: Phone: 503 656 - 9205
Reg #: LIC 54300
ELE 151LHR
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/21/2004 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 7/21/2004 $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 wi o =1 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you . ollow rules a• ..ted by the Oregon Utility Notification Center. Those rules are set forth i • A R 952 - 001 -0010
through OAR 952 -001 -8 00. You o• -in ' opies of these rules or direct questi. • - o OUNC at (503 •46 -6699.
I .sued by . 1 Permittee Signature"' /1j
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
. . ..,
Electrical Permit Application • - - - --- - - : • FOR OFFICE USE ONLY ' • '''',''',, ---'" -; • ' - -
.
—A,C9...III
Cify of Tigard RDeact: iriv3ed -7A111117A.
Permit No * /
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone 503.639.4171 Fax. 503.598 1960 h . .. .1. Date/By: Other Permit.
Inspection Line 503 639 4175 -SW • el 11,' Date Ready/By „ 0 See Page 2 for
Internet: www cistigard or.us Notified/Method WI Supplemental Information
; ''' I ' iP ' i' ' (SfNV ' l6rth 4t
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t „SPV . , arAraZ 4 i.141 g„ •.- „' A, „..c., .0„1 ,', , - ,,, ,9' ,', ,,,„„ ,,,,, , „ , - _ ,, ,- , • „
0 New construction E3 -Addition/alteration/replacement Please check all that apply
D
['Service over 225 amps, comm'l 0Hazardous location
Demolition 0 Other:
EService over 320 amps - rating El Buildng over 10,000 sq ft ,
'IrfaVf?VitISI*14 tekkaliiitbilOkSilitlatiAIV-W -;' ' ' ''Aki*'- ' 4 1 ::MX of 1- and 2-family dwellings 4 or more new residential
D
1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building OSystem over 600 volts nominal units in one structure
E Building over three stones El Feeders, 400 amps or more
CI Multi-family D Master builder 0 Other:
... ,, , ElOccupant load over 99 persons OManufactured structures or
1 1 '"' Viai'''''V''"P''''''-' '"I'l
4,9 i
..„, , ,f2 '„,„,, -: pE plan RV park
0Health facility 00ther.
Job no.: Job site address: 12 a av 5,,.) T
submit 2 sets of plans with any of the above
City/State/ZIP: --- n r d e m u z) Oa_ q7 22.3 The above are not applicable to temporary construction service
WICM:
Suite/bldg./apt. no.: Project name C (----- --rtl‘p .c
Description Qty. Fee Total **
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: Lot no.: Ea ale' 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
I, - " , ?Iill&iiifitOrWvtik44 .
4a,ti,A ,,, ,t,t,, ,,,,,,A ..4.4,* Each manufactured or modular
dwelling, service and/or feeder 90.90 2
APD LA- V61...1)3 .. b.Dc. - THe . 0 .4 ,v„„fh.1 -
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
201 amps to 400 amps
143 , tia7. , ,.,F4 ,.ITENANI, i;.:.,oxtvo, 106 85 2
.,....----,..;:.,,, - 4,4,,.., , ;....,,a ,,,,,=='.. - ,,,, -,---,,,, •, , t , -=.i• ,Z , ..4.- „k; ' , ,,- 5, , , , 4= -, ,,A4,,,,L , ,.,4 ,,,'?,,,,,,,,,...' 4 0 1 amps to 600 amps 160 60 2
Name: 1 -- (4 ,,,, :o 7 , 1 ,,,„ sr) 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: ( ) 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
A Fee for branch circuits wzth
service or feeder fee, each
Business name: 0 0 7.2, 4. c
; (4_ 1 . _- 5 7 - n. k ( C ,... ,, ci branch circuit 6 65 2
B Fee for branch circuits
Contact name: IN\ ( v - 36 ,,, ri s without service or feeder fee,
46 85 2
each branch circuit
Address: to 3 2 5 i f--(,... 7/ 2 t2 Each add'I branch circuit 6.65 2
City/State/ZIP: . 1 . ):) - C.../C - p M cvs 6 L. 9 o / C Miscellaneous (service or feeder not included)
Pump or irrigation circle
Phone: (5 ) 6 - C 7 u_c Fax: : (5,7 )( —74, 6 I 53 40 2
Sign or outline lighting 53 40 2
E-mail: Signal circuit(s) or limited-
t muyco ',:: I mr;ti .:;; energy panel, alteration, or
extension Describe. Page 2 2
Business name: -.I 6',....,, . A-5 ( ' Ar3t V r
Each additional inspection over allowable in any of the above
Address:
Per inspection 62 50
City/State/ZIP: Investigation per hour (1 hr min) 62 50
Industnal plant per hour 73.75
Phone: (57, ) G,51,_ qzos- Fax (5 - ) t,..5 - 7 4,6 7
5 5- 14#
CCB Lic.:
Electrical Lic.: . 2532 LES' Suprv. Lic • /_.._ /Z. Subtotal 76 4C ./C)
a . 0 4, ,z■...' i y
Supry Electrician i17 ,. , /40 /e ituired: Plan review (25% of permit fee) •
State surcharge (8% of permit fee) .tflt.)
Print name: Date:
Authorized signature:
A...,
.. !; TOTAL PERMIT FEE 67 . 00
This permit application expires if a permit is not obtained within 180
-
days after it has been accepted as complete
Print name:M/014-6C Z.._ - 0A,f es Date:crez((
* Fee methodology set by Tn-County Building Industry Service Board
** Number of uaspections per permit allowed
1 \BuildingTerrnits \ELC-PennitApp doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�,, NTIA�;�tiVORK= ONT1Y� _� _ - _��.•- _� ,���; =� �; •.
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
Ti Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System*
n Vacuum Systems*
n Other:
17,01
1 )CA�?VORKMONLY_ : ;° .rrs ?. n •...
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Ti Data Telecommunication Installation
❑ Fire Alarm Installation
Ti HVAC
❑ Instrumentation
Ti Intercom and Paging Systems
Ti Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
Ti Outdoor Landscape Lighting*
n Protective Signaling
Ti Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\Bmldmg\Pemuts\ELC- PetmaApp doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspectioiri Line; (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
p BUP
Received Date Requested h — / . - - - AM PM BUP
Location /a- Rs Suite MEC
Contact Pers Ph ( ) 6 .5 �
. � � PLM
Contractor 0 Y) Ph ( ) 7 y 3 `" 9 9s ( SWR
BUILDING Tenant/Owner cF 7 ELC
Footing
Foundation ELC
Ftg Drain Access: ELRv?/) C? Y ,a d
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors (14)
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation n �, 2 �1 �t/ d �1
Drywall Nailing 'W V /� �Jl�/7
Firewall C/4 1
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 (1 $ �ek l 7 v1( Smoke Dampers l !.�/
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
Slab
Low �,�/I
Low Voltag Raw
/ ► `
Fire Alarm �1
i 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: Ell Unable to inspect — no access
Fire Supply Line 6P
ADA /4
AY
Date 8-1L 0E( Inspector Z A1 t E � /�riYExt
Other: .
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
i