Permit CITY OF TIGARD RESTRICTED ENERGY
31j� ELECTRICAL PERMIT -
DEVELOPMENT SERVICES PERMIT #: ELR2000 -00228
ref J - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/6/00
SITE ADDRESS: 08048 SW SHAFFER LN NEW DURHAM PARCEL: 2S113B0 -00300
SUBDIVISION: &ORQAM ELEMENTARY SCHOOL ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of irrigation control device.
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:
INSTRUMENTATION: OTHER: IRRIGATION X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SCHOOL DISTRICT NO 23J DOWN TO EARTH IRRIGATION
13137 SW PACIFIC HWY 13075 SW PACIFIC HWY
TIGARD, OR 97123 TIGARD, OR 97223
Phone: Phone: 503 - 684 -3500
Reg #: LIC 5281
ELE 394CPI
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 10/6/00 $75.00 2720000000 Elect'I Final
5PCT CTR 10/6/00 $6.00 2720000000
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 o rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 -0010 through A 52- 001 -0080. You may obtain copies of these rules or direct questions to O1( at (503)
246- 987.
Issue by • -' ' Permittee Signature NJQ
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: 4/4 DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
t
Electrical Permit Application
AN
Date received: to -t! -GO Permit no.: 1.4,o2..2, -
_LI,l l•iI City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: UU B Receipt no.:
Phone: (503) 639 -4171 /���-
Fax: (503) 598 -1960 Case file no.: Payment type: ate, - i ,
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: 80 48 S - SLk icl, v F S Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: +Block: (Subdivision:
Project name: l7urZ►gaws socce.t- Fusco I Description and location of work on premises: r, csc..7
Estimated date of completion/inspection: lb .
CONTRACTOR APPLICATION FEE SCIIEDU,E
Job no: Fee Max
Business name Description Qty. (ea.) Total no. insp
(x.+ ,c.,1 - .� e.ln.t . - r nf1
Address: I U 7 QA t New residential - single or multi- family per
s. « lbw y • dwelling unit. Includes attached garage.
City: 'T(.(- a.t. o I State:0 -LCD I ZIP: ct 7 Z. 3 Service included:
Phone: 527; - to B ¢- 35 ax--. I E -mail: 1000 sq. ft. or less 4
CCB no.: JQ17 5- 32. .e, I I lec. bus. lic. no: 391-C e L 10•vO1 Each additional 500 sq. ft. or portion thereof
Limited energy, res 2
tty /metro lic. no.: / Limited energy, non- residential 2
t o ( b / . -c Each manufactured home or modular dwelling
'Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders- installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): Tt(iA✓t.c3 ;'kwl. Sast>oL DIS1• Z3 J 201 amps to 400 amps 2
Mailing address: 13 l 3 `1 s•t o . Ptac,i a e 14..- 401 amps to 600 amp 2
601 amps to 1000 amps 2
City: - h" o I State:o no I IP: q Z Z.2-3 Over 1000 amps or volts
2
Phone: 4 31 - 4 0 ) se I Fax: I E -mail: Reconnect only I
. 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, orrelocation:
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: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax E-mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure , alteration, or extensions / 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description: / t 1, /t7 /D/l-) (?j1 i- )T/ZCIL_.
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 7g . OU
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $ o
y State surcharge (8%) U
Credit card number: / / within 180 days aft it ha been g ( ) $ to
Expires accepted as complete. TOTAL $ 6 / • oU
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
•
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
4. Complete Fee Schedule Below:
Number of Inspections per permit allowed Restricted Energy Fee $75.00
Service included: Items Cost Total 4- (FOR ALL SYSTEMS)
4a. Residential - per unit Check Type of Work Involved:
1000 sq. ft. or less $147.15 4
Each additional 500 sq. ft. or ❑ Audio and Stereo Systems
portion thereof $33.40 1
Limited Energy $75.00 ❑ Burglar Alarm
Each Maniifd Home or Modular
Dwelling Service or Feeder $90.90 2
Garage Door Opener`
4b. Services or Feeders
Installation, alteration, or relocation ❑ Heating, Ventilation and Air Conditioning System`
200 amps or less $80.30
•
2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems'
401 amps to 600 amps $160.60 . 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
4c. Temporary Services or Feeders
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 .2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above.
Audio and Stereo Systems
4d. Branch Circuits
New, alteration or extension per panel El Boiler Controls
a) The fee for branch circuits
with purchase of service or Li Clock Systems
feeder fee.
Each branch circuit $6.65 2 .
b) The fee for branch circuits Data Telecommunication Installation
without purchase of service r - I �
or feeder fee. - I ' Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC .
•
4e. Miscellaneous
(Service or feeder not included) Instrumentation
Each pump or inigation circle $53.40
Each sign or outline lighting • $53.40 • El Intercom and Paging Systems
Signal pircuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control`
Minor Labels (10) $125.00
4f. Each additional Inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50 I 1
In Plant $73.75 I 1 Outdoor Landscape Lighting'
5. Fees: ❑ Protective Signaling
5a. Enter total of above fees $ D /� ^ Q -� ` /�� _f���
8% Surcharge (.08 X total fees) $ n Other / £ a t 6d / [ d Gv e.„,C� 77-O (_,
Subtotal $
5b. Enter 25% of line 5a for Number of Systems
Plan Review if required (Sec. 3) $
Subtotal $ • No licenses are required. Licenses are required for all other installations
I El Trust Account # FEES:
Total balance Due $ ENTER FEES $
8% SURCHARGE (.08 X TOTAL ABOVE) $
TOTAL . $ .
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
- 24 Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ BUP Date Requested ": / A M PM BLD
Location Uhl d 5 "' ✓ �n Suite MEC
Contact Person CSotR► Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner IP 4 y �� ELC
Retaining Wall ELR Z9t.'L - Uv 2 2,k
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab � f ri f� 7 / 0".1 / 1 3- X -6756-, SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
•ECECTRICAt
Service
Rough In
UG /Slab
Alarm
Fi -'
- ASS PART FAIL
-
Backfill /Grading
Sanitary Sewer .
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: Unable to inspect - no access
ADA /n
Other oach /Sidewalk Date /g---f2 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.