Permit � T
• CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00443
DEVELOPMENT SERVICES DATE ISSUED: 9/18/03
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135AB-00100
SITE ADDRESS: E /0 35 6 5 I41 L 1 1 VC - .sr
SUBDIVISION: TOWN OF METZGER ZONING: R -4.5
BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: Underslab Electrical work for new school building.
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: 0 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: 0 > =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
Phone: Phone: 54 - 812 - 1300
Reg #: III 541-81Z-0W
r98
ELE 24 -147C
FEES SUP 2720S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/18/03 $350.46
[TAX] 8% State Tax 9/18/03 $24.54 Underground Cover
Underground Cover
Total $375.00 Underground Cover
Underground Cover
Underground Cover
Underground Cover
Elect" Final
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 obta in copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By: Permit Signature: X ,,,, / 4'{/l j r
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:_ c 7a() __
Call 639 -4175 by 7:00pm for an inspection the next business day
'2/2003 18:14 FAX 5035981980 CITY OF TIGARD 41007
• FOR OFFICE USE ON LA
lec2r><cal Permit Application �r 7 2-3 03 . NO.: C 2 `r3
City of Ti and RECEIVx . Date/By:
Planning Approval Sign - -• 13125 SW Hall Blvd. Plan RC/6"` Permit No : P�00 3 '00 `I � Permit
Tigard, Oregon 97223 .503 -5 . �lT.S►'w f, Post-Review Land Use n
g
Phone: S03-639-4171 Fax 98 �1�6 0 c _ Da : Cue No.: CU r coo 5
W
Internet: Www..ttgardDr.t19 JUL 1 _ ' C I ® See Page 2 for
24- hour Inspection Request: 503- 6t99r'173F . - / rC I Supplemental Information.
BUILDING DIVISION
.a:.:',.�,: - ...r %:.TYP: m LS.r:,ii:Wi::�'_'= rv:-.V . :•:i.:._ �= 4j:;.ff:tilil! 11ilEVILW clie'�
t (Pleai�.ICialY:thtMiTilji ...< ?: :.:. : 1:
New construction ❑ Demolition I& Service over 225 amps- - ❑ Health-care facility
cotmncraal ❑ Hazardous location
Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of 0auilding over 10,000 square feet,
�, ., y
.,(; A' �Oltl!(= (�P'I�Q},y�' -(�•: • : �;: �.., . _ _., t & 2 family dwellings lour or more residential snits in
0 1 & 2-Family dwelling Conunercial /Industrial 0 System Over 600 volts nominal ore structure
Budding over three norms Feeders, 400 amps or more
ID Accessory Building 1:1 Multi-Family .Oeupatrt load over 99 persons U Manufactured structures or RV park
_n Master Builder 1] Other: Egressnigtaing plan ❑ Other:
�:L��A ° l5[T'$111�Bf:1
i� lux�d IION - ...< Submit set's of plans with any of the above.
.. .� The above are not applicable to temporary construction service.
_ 'Job site address: •.' : . ! r. _; :; , :a;r ' i tl I+ . ,c;;..,,
Suite #: BldgJApt. #: Number of Inspections per permit allowed
Project Name: bit /24 e,- Et, Se iv° I or maid-family per 1 Qty I Fee (aft.) Total •
Cross street/Directions t6 job site. o dwelli g unit. Wades attached garage.
,SW G° e Ct t f Sf . Suttee Winded:
•
1000 se, ft or left 145.15 4
Each additional S00 s4• ft or portion doereof 33.40 1
Subdivision: 1 Lot #: ' Limited mow m residential 75.00 2
Limited energy, non residential 75.00 2
Tax in ...j. arcel #' Each manufactured home or modular dwelling
+ r i - '. tO WORK` ii Ez , service miller feeder 90.90 2 .
Services or faders - InstaOadon,
1 le rs rm b P le c /v fear alteration or relocation:
200 amoa or less 80.30 2
- 201 mops to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
ir.',: ?E,07: r - 'i; >i ii EE—,`(%a ?i: • c,, `.j'tea'�:.;: 6 601 atnteto1000amM 240.60 2
' '. -` ,, II - Over 1000 Nun or voles ' (- 454.65 %y ° 2
Name: S e p 114 pp 4 q I eam
e ect can 66.9s 2
Address: eft, SW Sol Lstrg S f • Temporary ser,iea,or feeder. installation,
alteration, or relocation:
City / State/Zip: T 9 4,1 L 0,-- i 4 /7 74_3 200 1 amps � Too 166.85 1 .85
P o ne: •! 3 -y?) you 3 1 �(0 , ". ! FF F lig t, ax: ' 1 .- N3 / - �oJ ? , 201 a,�, ampa 133.751 2
,'',,t :4 Sf ' L(L l.Vv : ':' ,
,.. :,Thli Oltii-xii1.:1 �f 1--. -. • � B ranc h drsaits - new, alleratioa, or
Name: `o✓ fi N2 C. S t. At g eat cmfm•'piepanel-
Address: 7 r y � /lt a c A / d / 'tf A Fee for branch circuits with purchase of
O SW d A N. ri ✓� sc ice'ohfe es eadtuht�h ennui, 1- ' 6 "65 I3. y � 2
City/State/Zip: Io ✓f Ia k g... o 6)7 g. 7 1 a Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.8S 2
Phone: 6Q3 - 715- - q ('4 F / 'x: Sol- 2 9s - /g9 6
Each additional lltateh circuit 6.65 2
E -mail: 04 14 , (. 0 1 8•0 ib ke --wt, i • Gp.44 Misc.(Serrice or feeder tat included):
>ti Tali:q:f n'.'tir' :i_` el;+ A j, '„ `0"ai4.: <'E. FadZ 53.40 2
"u. i��� ` ' Fie dpi m outline Ii 53.40 2
Job No: - Signal eheolt(f) or a limited energy panel.
Business Nam a �� — ate or eatetuion a Pace 2 , 2) .
e�
•
Address: .( . &15' ... - - ? ea add IaJpt%IIOn over th allowable in any of the — •
/State/_ �J �J d' P er inspect per htna (mm. 1 hen) 62.50
Phone: 5 1— $ j 3. /300 ax: r ' / y investigation fee:
CCB Lie. #: 5 Lic. #: aV- /�/ r�0 :'xrrfr -a ft,.. ,. "ai : 'ri 1 -. ;.:;;'i:Tr, „Ii, 4417:0',
Supervising electrician ' 1 -9-0, /O - / - o S Subtotal S s�. , -5 . 3
signature required: Plan Review (25 of Permit Fee) S r / 1 -9-y °i
Print Name: I Lic. #: 07„7 ,0S OA State Surcharge (8% of Permit Fee) $ ��?- � .
TOTAL PERMIT FEE S ,yVacsi . 1 ' a a
Authorized Notice: This permit application expires if a permit is not obtained within ,
Signature: . Date: 7 /1 j /i• 3 180 days after It.aaa been accepted as complete. 111�1�✓ •
`Fee ntetaodabagy aat.by Tri- County Building Industry Service Board.
- (Please print name) // _ .5 .l.. '
i :\DstsTermit Fomts\EkPcrmitApp.doc 01/03 l X , / O t( 1) A - f - r 6,0G •
v /,tc
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 -00443
Date Issued:
Parcel: 1 S135AB -00100
Site Address: /03S L / AJCD L
Subdivision: TOWN OF METZGER
Block: Lot: 005
Jurisdiction: TIG -
Zoning: R-4.5
Remarks: Underslab Electrical work for new school building.
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
tr'
Signature of Supervising Electrician
If you have any questions, please call 503.718.2433. --
ea