Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT H BMENT Tigard. � 639 -4171 DATE PERMIT
7/9/p 003 -00197
- 13125 SITE ADDRESS: 12325 SW KATHERINE ST PARCEL: 1S134CC-01700
SUBDIVISION: MARY WOODARD SCHOOL ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
Project Description: JOB NO. 082
Security for the entire school, security panel located in the main office
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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SCHOOL DISTRICT #23 JT ELECTRIX LLC
13137 SW PACIFIC HWY 115 V STREET
TIGARD, OR 97223 VANCOUVER, WA 98661
Phone: Phone: 360 - 694 - 5094
Reg #: LB60 -69516 46) :5
ELE 37 -930C
SUP 4398S
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 7/9/03 $75.00 Wall Cover
Elect I Final
[TAX] 8% State Tax 7/9/03 $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 I Permittee Signature, _44 �� _ 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:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Jul 07 03 07 21p ELECTRIX 360 6950670 p.3
4.
Electrical Permit Application OFFICE USE ONLY
r r�v r ,n, i n a �
mu , I� II V It, Date received: Permit no.: ('L LI7
,,,, City of Tilgar t� Project/appl. no.: Expire date: I
City of Tigard Address: 13125 SW Hall V L Tiga, 101 7223
h f Ti 1 d Date issued: By: Receipt no.:
Phone: (503) 639 - 4171 lJ ZUUJ
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approvaiUILDING DIVISION
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- family 0 Tenant improvement
0 New construction ¢tl Addition /alteration /replacement ❑ Other: • 0 Partial
JOB SITE INFORMATION
Job address: I, 3.S 5 Ls 44- {- Il St. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: WpoLtut,Ct r 4 fl I Description and location of work on premises: T IA silt l I cp - .. v- r S 'y Ste'-1
Estimated date of completion/inspection: •
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: D S' Z Fee Max
Business name: t Q C.41(1 X Description Qty. (ea.) Total no. ins
Address: i s C�� Qe New residential- single or multi - family per
dwellingunit.Includesattached garage.
C Va. ix e-oLR t/ -pc- I State:LV4 - I ZIP1 S ( to / Serviceincluded: .
Phone: tog 650 .gsp i I Fax: Zjp 15 01,7d E- mail :I /44i p i , - r, 1000 sq. ft. or less 4
CCB no.: Iie gto05 Elec. bus. lie. no:v.: we biz Each additional 500 de ft or portion thereof
Limited energy, residential 2
City/metro lie. no.: 15 3' ' Limited energy, non - residential 2
/ C-4,5-011? .f- '7i Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Services or feeders - installation,
Sup. elect. name (print): m i t , e O A License no: 1.13.1 alterationorrelocation:
PROPERTY OWNER p 200 amps or less 2
Name (print): M(tl_Ir W OJel wiz rd'e- eiyti N -Fa c�c�rt.t?/t 201 amps to 400 amps 2
J 401 amps to 600 amps 2
Mailing address: I. 01- Sw IL Q,') rl.e Si = 601 amps to 1000 amps 2
�
City: . Sa rA I S State: j),L I ZIP_ Over 1000 amps or volts 2
Phone: I 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 relocation:
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: IState: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail:
of service or feeder fcc, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
CI Service over 225 amps-commercial ❑ Health-care facility Each pump or irrigation circle 2
L3 Service over 320 amps- rating of 1&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,
U System over 600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories Ll Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan ❑ Other: Per inspection I I I 1 •
Submit sets of plans with any of the above. Investigation fcc
The above are not applicable to temporary construction service. Other
Permit fee S '7' - 0 0
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) S
Credit card - number :_ __ / / within.180 days,afer it has been State surcharge (8 %) S _ 6 . 0 0
Expires TOTAL $ I . 0 0
accepted as complete.
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
off/ / ? BUP
Received gig / 2'd `t Requested v /l 10 C AM PM BUP
Location 1-7
. /Z G(, ` ' Suite MEC
Contact Person 2 3 a-S 0) ccd)2. Ph ?- 21 (1 PLM
Contractor Ph ( / ) SWR
BUILDING Tenant/Owner - CC/],>! Y.RA), C „da, • ELC
Footing
Foundation ELC
Ftg Drain Access: ( EL � Q (9i 7
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam 1L.
Shear Anchors /1
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm •
Susp'd Ceiling
Roof
•
Other: •
Final / -
PASS PART FAIL PLUMBING 24/7/
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-1n
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
Slab
ow ,, 6 F p
ow Vo tage �7
ire arm g
Fina^ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• PART FAIL
SITE Please call for reinspection RE: - p Unable to inspect — no access
Fire Supply Line
ADA / / � o f
Approach/Sidewalk Dat® / — / Inspector . t
Other:
Final DO NOT REMOVE this inspection record fro the Job s e.
PASS PART FAIL
•
/i