Permit i +
C ITY. OF TIGARD ELECTRICAL PERMIT
V PERMIT #: ELC2003 -00597
.' x,141 ' DEVELOPMENT SERVICES DATE ISSUED: 11/18/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135A6 -00100
SITE ADDRESS: /03So 5 ki L /NC01.-/4 ST
SUBDIVISION: TOWN OF METZGER ZONING: R -4.5
BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: Electrical work for new school
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: 3 W /SERVICE OR FEEDER: 222 PER INSPECTION:
. • 201 - 400 amp: . 8 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: 1 EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: 1 > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASHINGTON CLACKAMAS CO CRAWFORD ELECTRIC
SCHOOL DIST 23J PO BOX 2754
6960 SW SANDBURG STREET ALBANY, OR 97392
TIGARD, OR 97223
P hone: Phone: 54 812 - 1300
Reg #: 1C 541 - 81 B8
ELE 24 -147C
FEES SUP 2720S
Description Date Amount .
• Required Inspections
[ELPRMT] ELC Permit 11/18/03 $3,187.34
[ELPLCK] ELC Pln Rev _ 11/18/03 $797.00 Ceiling Cover Elect'I Service
[TAX] 8% State Surcharge 1 1/18/03 $255.00 Ceiling Cover Elect'l Service
Wall Cover Rough -in
Total $4,239.34 Wall Cover Rough -in
. Underground Cover Elect'l Final
Underground Cover Elect'I Final
Low Vulcdge h ispec,tlon
Low Voltage Inspection
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 -23
i
Issued B : y2 /1.4.—:-4L.' Permit Signature: ( _ - _ •
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: l _....d Q L.J ' .1 a .�� i■ DATE:
LICENSE NO: i
- Call 639 -4175 by 7:00pm for an inspection the next business day - -
A
1
•
• Electrical Permit Application FOR OFFICE USE ONLY
O Received Q A D s Electrical giA �p
• . J EC E � L L, D Date/By: a � 0 � rO0 Permit No.: CZ` •7
City City of Tigard u u Planning Approval Sign
Date/By: Permit No.:
13125 SW Hall Blvd. SEP 2 4 20�3 Plan Review Other
Tigard, Oregon 97223 Date-/By: Permit No.:
Phone: 503- 639 -4171 Fax: 5 8 -1960 Post - Review Land Use
Internet: www.ci.tigard.or.us d
C Y OF TIGAR � ('�� Date/By: Case No.:
A' 1 Contact J See Page 2 for O
24 -hour Inspection Request: 50 0 3 EN= . .�
Y V IS '_ " "' Name/Method: c . Su ® p plemental Information.
lAl
' - TYPE OF WORK • -. _ • , ' PLAN REVIEW (Please check all that apply) °
NCI
New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility N
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps -rating of ❑ Building over 10,000 square feet,
.. .CATEGORY OF CONSTRUCTION' . • •. • 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ® Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories El Feeders, 400 amps or more
El Accessory Building El Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
' JOB SITE1NFORMATIONand- LOCATION , Submit _ sets of plans with any of the above.
l - — The above are not applicable to temporary construction service.
Job site address: ,}6?.. — o -- -e , . .,.>ti _ .; FEE*. SCHEDULE- ' -
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: A.Q.Vzoket' 0, k -,�,t� ceIA44 Description Qty Fee(ea.) I Total L 7 ,0
lreet%Directions O job site: - T1 New residential - single or multi- family per v
Cr SS
dwelling unit. Includes attached garage. e.
Service included:
/ �„ �i,.- L 1000 sq. ft. or less 145.15 4
�-� ►�� c,J 1 Each additional 500 sq. ft or portion thereof 33.40 1
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
- - . ' ArAS0211 OF,WORK • ' , e . ' service and/or feeder 90.90 2
( ` - Services or feeders - installation,
h .n4 G m9."-A/ s P.` `err. 1 t t..‘atrK alteration or relocation:
�1 C 1 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
El/PROPERTY OWNER - . F. ❑ TENANT ' .. ; 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: 1„p, A ,q Reconnect only 66.85 2
Address: 646o Sc,) a.,,. Sk, Temporary services or feeders - installation,
City/State/Zip: alteration, or relocation:
�t o.r-� t. V R 417 2,x-3 200 amps or less 66.85 1
Phone: &(31- 4AO 3 Fax: 3 1 - Lip/) 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
NI- AP•PLI 5 , ' : ❑ coNTAcr PERSON • ' • Branch circuits - new, alteration, or
Name: t`lav, Ra d extension per panel:
(p & ti.-1 . / ` Co�c1 at,n S �j� A. Fee for branch r circuits each branch c purchase circuit �{ �vP l �P service or feeder fee, each branch circuit 6.65 2
City/State /Zip: P, , \ A q 2 .NG. B. Fee for branch circuits without purchase of
� 1 service or feeder fee, first branch circuit 46.85 2
Phone: q 3t - O -, V Z Fax: 2.AS ' %NV, Each additional branch circuit 6.65 2
E -mail: l:,4-tu,,. r ? O,,c.,v4A t nn • �� Misc.(Service or feeder not included):
CONTRACTOR a `1 ` Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: T /3 D C�,t � (t- C
alteration, e crti or extension Page 2
Description:
Address:
City/State/Zip: Each additional inspection over the allowable in any of the above:
ty p Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: °tiler - .
° o A� .Electrical Permit Fees *` - -
Supervising electrician e 4 t? Subtotal $
signature required: Ao , to f< Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Feel_ $
TOTAL PERMIT FEE $
Authorized -. N otice: This permit application expires if a permit is not obtained within Signature: / ` f Date: 9 '2q I W� 180 days after it has been accepted as complete.
3 t *Fee methodology set.by Tri -County Building Industry Service Board.
k « .r^. A, 1 av
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
r
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
Burglar Alarm
❑ Garage Door Opener
• Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
▪ Audio and Stereo Systems
❑ Boiler Controls
•
•
Clock Systems
Data Telecommunication Installation
0 Fire Alarm Installation
HVAC
Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control
▪ Medical •
Nurse Calls
O Outdoor Landscape Lighting
0 Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPemritAppPg2.doc 01/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
CRAWFORD ELECTRIC
PO BOX 2754
ALBANY, OR 97392
Electrical Signature Form
Permit #: ELC2003 -00597
Date Issued: 11/18/03
Parcel: 1 S135AB - 00100 L NC L,tl
Site Address: / D 3
Subdivision: TOWN OF METZGER
Block: Lot: 005
Jurisdiction: TIG
Zoning: R
Remarks: Electrical work for new school
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
WASHINGTON CLACKAMAS CO CRAWFORD ELECTRIC
SCHOOL DIST 23J PO BOX 2754
6960 SW SANDBURG STREET ALBANY, OR 97392
TIGARD, OR 97223
Phone #: Phone #: 54 812 - 1300
FX 541 - 812 -2448
Reg #: MET 00004045
LIC 58969
ELE 24 -147C
SUP 2720S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X La ...:Q
Signature of Supervi ing Electrician
If you have any questions, please call 503.718.2433.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date ? ( e AM PM BUP
Location (o 35 Suite MEC
Contact Person c 9
Ph ( ) ' - gSJ ( � PLM
Contractor Ph ( ) 93 a - 1 l SWR
BUILDING Tenant/Owner M ELC OZ 3 -o 7
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
.7
Insulation
Drywall Nailing
Firewall f �.�f P"
Fire Sprinkler j y
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
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Itel PART FAIL
SITE U Please call for reinspection RE: U Unable to inspect — no access
Fire Supply Line
ADA t/ p�
D (� b 1 Inspector ' _ 1� m- �r e Le i.e Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL