Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00510
Am �1 ,,, `DEVELOPMENT SERVICES DATE ISSUED: 8/15/03
A � - - " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134CC-01700
SITE ADDRESS: 12325 SW KATHERINE ST
SUBDIVISION: MARY WOODARD SCHOOL ZONING: R-4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: JOB NO. 21 - 566 Add one plug in the mechanical room
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
SCHOOL DISTRICT #23 JT 3D ELECTRICAL SERVICES INC
13137 SW PACIFIC HWY PO BOX 173
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: • Phone: 503 - 657 - 9173
Reg #: ELE 3 -460C
LIC 135234
FEES SUP 4478S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/15/03 $46.85
[TAX] 8% State Tax 8/15/03 $3.75 Elect'l Final
Total $50.60
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 or
1- 800 - 332 -2344.
Issued By: ` Permit Signature: -4YL
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 7:00pm for an inspection the next business day
AUG - 14 - 2003 THU 10:49 AM P.001/001
, Electrical PermitApplication
—"` Daterooeived: g/ 0 3 Pe rmit no.: 6k, a m3_073576
�„�! :i : City of Tigard Project/appl. no.: Expire data:
� ityo fTtgar Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By; I Receipt no,:
Phone: (503) 639 -4171
Pax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
'l v l'IC OF PICHi\
❑ 1 & 2 family dwelling or accessory [Commercial/industrial 0 Multi - family Q Tenant improvement
0 New construction 0 Addition/alteration /replacement ❑ Other: 0 partial
.10)11 5117: INFORM AI R)N
Job address: 1,2. zS Bldg, no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: txsb ∎sM L') L. C. 'Wm 11/43 yr4, �.I . a , -
Project name: !Description and location of work on premises: 4 dt (.9 l vtk •
Estimated date of completion/inspection: A - r 41-0141.. / ('111: 1111,1i: i •
Job no: 2 - _c` be Max
Business name ; -RD jj, crk.∎ vCS (2_,10,CL Description Qty. (ea.) Total no. Insp
Nonresidential .single ormulti- family per
Address:
%'c r 1 -rs dweWnguttlt. Includes attached garage-
City s /`L fri 1 State:De, I ZIP:9170 ys' Senvicelncludedt
Phone: , S - 7 Fax: .,,,. s 13 -mail; 1000 sq. ft. or less 4
no.; '4��' Elec. bus. lie. no: ,- at } �
Bach additional 500 s .. ft, or orlon thereof
CCB no;
Limited onar y, residential 2
City /metro tic. no.: * I' 1.: ri titedenergy,non- residential 2
- • r w ct=1 ' •Q Each manufactured home or modular dwelling .
Signature of su. ervisin . electrictan (re. uircd) Date Service and/or feeder 2
Sup, elect. name (print : t "-,, 'i License no:
��� Servlcosorfeeders— Installation,
alteration orrelocationt
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I state: IMP: Over 1000 amps or volts 2
Phone: ,{ Fax: . 113 -mail: Reconnect only 1
Owner installation: The installation is being made on property Y own 'temporary services or feedam - , -
which is not intended for sale, lease, rent, or exchange according to lnsiallstlon, alteration, orrelocation:
or
ORS 447, 455, 479, 670, 701. 20 amps to lase s 2
201 amps to 400 amps 2
Owner's signature: Date: , 401 to 600 am .s 2
ENGINEER INEER Branch circuits • new, alteration,
Name or extension per panel:
A. Pee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City; State: ZIP; B. Pee for branch circuits without purchase
Phone: Pax: $ -maSl' of service or feeder fee, first branch circuit: I 1 w , 2
Each additional branch circuit:
PLAN 11I':Viil%% (I'Irace check all that apply) Min, (Service or feeder net included):
O Service over 22.5 amps commercial ' C] Health- carofecility Each pump or irrigation circle 2
O Service over 920 amps- rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2 _
family dwellings C Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or ex tension* _ 2
tIl Building over three stories ❑ Feeders, 400 amps or more *Description:
OOccupant load over 99persons Gl Manufactured structures or 1 1Vpark chadditionallnspectlonarer_tlie .ellorrablelnarty_flhoabnrs>; _
❑ Egtess/Jlghtingplan ❑ Other. - Per inspection 1 i I . .
-L
Submit _ sets of plans with any of the above. Investigation fee _
The above are not applicable to temporary construction service. Other its., ' Not all Jurtedlcdons accept credit cents, please call judsdictton for MOM informagoo.. Notice: This permit application Permit fee $ (e
'[visa ❑ Meat :rl 1. expires If a permit is not obtained Plan review (at „^ %) $ "�
' • . tome ember; j• 10 adHs, O ,� 9 / /0T within 180 days after it has been State surcharge (8%) $
%c, A MINa, = asp b iti o accepted as complete. TOTAL $ �O • • o
�. =rrr-
Cardtml • .r gnat - mount , 440.4615 (StOWCOM)
•
CITY OF TIGARD 24 -Hour .
BUILDING - Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested c(-1a 0 AM PM BUP _
Locati • i P a s < • - , • Suite MEC
ontact Perso ' , ' - Ph (2�) F q 9 — Co 7 - • PLM
_ . CQged) - Ph ( , ,) q60 9 - S'3 0,- (4 SWR _
BUILDING Tenant/Owner n Vv CP 3- oo_ ) O
Footing
Foundation ELC
Ftg Drain Access: - ELR
Crawl Drain
Slab Inspection Notes: ? SIT
Post & Beam
Ext Sr Sh ea Anchrs
th /SSh ear 7 ?
Ext eah/h
Int Sheath/Shear
Framing
Drywall ll Nailing � t CP / X3
Dryll Nailing _ - �� _ _ r /'U S /
Firewall
Fire Sprinkler Fire Alarm k_rci.-2 -
Susp'd Ceiling
Roof I . a • Jr
Other: % —
Final .
PASS PART FAIL )2 ;L 04---1 Lr
PLUMBING , - _
Post & Beam „-----
Under Slab
Rough -In
Water Service ,
Sanitary Sewer 10/ �, r �
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
E CTRI C L ; •
ervice
Rough-In i ,
UG /Slab
Low Voltage „1n
Fir= larm
4P El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
( PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line -
ADA
Approach /Sidewalk Date g '„90 Q3 Inspector _*/ . A - Ext
Other:
Final DO NOT REMOVE this inspection record from the job site. • •
PASS PART FAIL
•