Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
44 P4 , - 0 1 4 . DEVELOPMENT SERVICES , PERMIT #: ELR2004 -00085
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/30/04
SITE ADDRESS: 10350 SW LINCOLN ST PARCEL: 1S135AB-00100
SUBDIVISION: TOWN OF METZGER ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
Project Description: Install data and backbone cabling.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON CLACKAMAS CO VERIZON STRUCTURED CABLING
SCHOOL DIST 23J 4155 SW CEDAR HILLS BLVD.
6960 SW SANDBURG STREET BEAVERTON, OR 97075
TIGARD, OR 97223
Phone: Phone: 503 626 - 9155
Reg #: ELE 34- 495CLE
LIC 49350
•
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/30/04 $75.00 Elect'I Final
[TAX] 8% State 3/30/04 $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 0627 ,r-dU Permittee Signature \ 4244. e..4
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
. '04 07:46 NO.530 D003
.a)I Permit AEeEli .. ED
, Tigaid n�as o $b on Permit No.: --494') 75
11125 Sw Hall Blvd., Tigard, OR 97 r M u 2004 Plan Revi
1 a .
Phone: 503.639.4171 Fax: 503.5981 .: " .; ` kd Alb I r DateBy: °r ° 0006
Inspection Line: 503.639.4175 ! i• "� Date
Notified/Method: J 9$5
Internet www.ci. tigard.or.us CITY OF TIGAf�D Ready/By: - jk I El See P age 2 f or S Supplemental Information •
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M New construction ❑ AdditjOZI /alterarioa/r'eplacement Please check all that apply:
❑ Demolition ❑Other ❑Service over 225 amps, comm'I ❑Hazardous location
' _. * .:•. —. =: "..,:t1.-t, , ;T,_it:;;Ihupn _ ;:l, 1l,, 1_I : I,; ;: : I: ;: ; : , : ._ , ,,:. ' *,,!, ❑Service over 320 amps - rating ['Bulldog over 10,000 sq. ft,
F � F �: h f , , - . l � � t i ,: Ii I lli l I, ui ta: i r �r C t dwellings or more new residential
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' 1'. } , r_,_ � _ter11..41 ; :!.:qkH,;,- tlI -II1,i I I:.T, t,r,b_ ,.,,. .,: J.,. of ol dz- fa 4
❑ 1- and 2- family dwelling [a'Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal 'mils in one structure
❑ Multi - family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
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['Occupant load over 99 persons ❑Manufactured structures or
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Job no.: Job site address: 102,5 01.‘ `� • ❑health - care facility ['Other: '
Submit a sets of plans with any of the above.
City /State/ZIP: G1NRb c> - • 2 3 The above are not applicable to temporary construction service.
Suite/bldg./apt no.: Project name: --``__.. 11 \\ ^ , ,1,_ ;1•,.. k 1,1.: ,i,.,lI :`,;,I ; , „,-fir ia' , {, , _
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Davipdw
Qty. Fee. Toil
Cron street/dixectionS to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. it or less 145.15 4
Subdivision: Lot no.: ' . Ea - add '1500 sq. ft. or portion 33.40 1 _
Tax map/parcel no.: Limited energy, residential 75 2
T f „ „i r1, _ �,_ :; h .:. Limited energy, non- residential 75.00 2
i” 1 , 1 �� 1 ' �. 1 1 � 111 r 1 1 N f- t-, 1} � � � , nl�llt�t # ' 1 rt )I {iii , f t � l f( f i rf � t , 1 r r � 1 1 , # I I f ,. , . (�
#`I, .h: s: , .:a :s, ., �' :c:,r , . ,! 1.,;:1;1;';;;!1 {;il;,:•,: s : j� � �1r } JII �II !!� , afhl �! I I ` Each manufactured or modular
dwelling, service and/or feeder 90.90 2
V +� • -• -, Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
, L,'I , 1!16 J °. vii)lan• } t i 1 ' k i r "II N i ' {!n p;m r•Jnl: #�i ' 1 I f l 201 5 to 400 5 106.85 2
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v � Ir I 11 . 17 tl t J f t J � r lilr II'1 I �r ¢q h 11 ! 1 # 1 1 l 1 .� amp ��
E .,, � ..ui� - 1 L. - ", J �,� rt� : •.1 I J , , ! }. , : , , J it 1.1 i ;. u, ,l!1111 ti, 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts . 454.65 2
City/State/ZIP: Reconnect only 66.85 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
• 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
t t{
i
�, p I ' ! IIIf , 11 J 7 s jo { i f `1{ 'i•!1=''' "!ll! A Fee fbr branch circuits with
B, Lf , . !;, . .I f . ? . u iA Ifu 11,1i4... . ,1>: # #LII:' l ? : ::# service or feeder fee, each
Business name: branch circuit 6.65 2
Contact name: without Fee for branch circuits
without service or feeder fee, 46.85 2
each branch circuit
Address; Each add'l branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E-mmail: , circuit(s) or limited -
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!l 1i , i # l ,f f „ L l l' .. I , � i : , . !.: ;: > ' 1 1 0)0U panel, alteration, or
.
Business name: extension. Describe: Page 2 , 2
Vtt \Z w.L. `S -
Address ; ��� Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: 1 - V� Q • , ■ 1‘,,,, . Investigation per hour (1 hr min) 6250 '
Phone: (503 ) Industrial plant per hour 73.75
lot- b-q \ss Pax- (303) . Ztp-.1 : r „, ; , , ; ,• ! I{ ' I G. c-
I1i1.,-- iln III II t II F. .1� U ' ?i 1{ 1h(!::,datiil i'�:I :kl,._
a ��S't C .. _ -- ..... -.. . .3573 Suprv. Lie.: 0 5 c Subtotal '1 S °°
Suprv. Electrician signature, required: Aj ate . `, f , - j , • Plan review (25% of permit fee)
Print name: Wf4 kRzN F::,,, € Lt_.� Date: 330 State surcharge (8% of permit fee) 4, ...v0
• TOTAL PERMIT FEE g‘-'
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it boa been accepted as complete
Print name: Date: * Fee methodology set by Ili -Comity Building Industry Service Board
•• Nub of inspections per permit allowed.
imiuilding\Perm u'm.C- PavmaApp.doe 17!03 44046151(10/02/COM/NEB .
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -417 MST
0 UP
'/
Received Date Requested 7 °�i AM v .P-- BUP
Location 2 573 Suite MEC
Contact Person Ph (77 / ) - r <- `S 3 '/ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR69_21.6
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear 4 /4 7/e'
Framing /v
Insulation
Drywall Nailing Nlvec D �l tso ��U f T Z !�A F A '
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling �'
Roof
Other: ° �� L' / //- A-49 ✓i1 N� _
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
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
6 ::r PART FAIL
Please call for reinspection RE: _ ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date ` QY Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL