Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
;41 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00034
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/04
SITE ADDRESS: 14650 SW 97TH AVE PARCEL: 2S111AC-02700
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -4.5
BLOCK: LOT: 037 JURISDICTION: TIG
Project Description: Installation of limited energy for security system. Job No. 082
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: SECURITY. X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
UNION HIGH SCHOOL DISTRICT ELECTRIX LLC
NO. 3 JT 115 V STREET
VANCOUVER, WA 98661
Phone: Phone: 360 - 694 - 5094
Reg #: LJ60 -6951 t.;e, 15
ELE 37 -930C
SUP 4398S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/18/04 $75.00 Elect! Final
[TAX] 8% State Surchaq 2/18/04 $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 t• • ow ru - adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Is. ued by I / 4? -!� =' i / Permittee Signature SOf , aff-
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
Feb 1 8 04 09:23a ELECTRIX 360 6950670 p . 1
Electrical Permit App '1.1*,.:11_ OEIVED FOR OFFICE USE ONLY
City of Tigard Received •
Date/BV: '. fa a dil rairMiroM
13 l 25 SW Hall Blvd., Tigard, OR 9'7223
Phone: 503.639.4171 Fax: 503.598.1960 FEB 1 8 200 A.,,,,,wi0i. Plan Review
/a/ 'I Date/B : Other Permit; •
Inspection Line: 503.639.4175 - IL Date Ready/By: lurk fii Sec Page 2 for
Internet: WWW.Ci • tigard.or.us CITY OF TIGA'T " NotifiediMethod: Supplemental Information
•.:.. : "':..:•1: •• .. H . „,;.1r:.2b1A.A3R..: .:::::;'::,•••••!, :•;':. : .„ ;: • .,:t2 .. : ,.. '. •::-!:: . :,:•'NS1. • • _ • . 2
•
El New construction 2r Addition/alteration/replacement Please check all that apply: .
• OService over 225 amps, comml ['Hazardous location
0 Demolition El Other: pService over 320 amps - rating IDBuildng over 10,000 sq. ft.,
' . -:*:. • . A'r•t:diJi3: - :. • ••: • :.::':;- ..::--:,... ' ...''.. : . of 1- and 2-family dwellines 4 or more new residential
... . „.. . . . .„ ..., . .. . .
. : . . • . ..... . ... . .. .. .... ..
... .
0 I- and 2-family dwelling 2-Commercial/industrial 0 Accessory building ESystem over 600 volts nominal units in one structure
OBuilding over three stories [Weeders, 400 amps or more
D Multi D Master builder 0 Other: 00ecupant load over 99 persons ['Manufactured structures or
. . .. - . • JOB: SITE'ilmFoRmolols:: :. ,:. : ..!:::.::::.. :: ,:.:,,, . , pEgress/lighting plan RV park
Job
no- : Cie/1)' Job site address: ILI i so ci ii (we., 01-lealth-care facility nOther:
Submit 2 sets of plans with any of the above.
),6 -1 -:)...
City/State/ZIP: - 11 - , 34,v - a, 0 1 1 a .,:r oo The above are not applicable to temporary construction service.
.....c,
I . i--1 ' I \A , • 1 i . r ...: ' i -:•::!'t.:-:g''.:':,:1'1.:"-:..'#.:gE''-$.0titroutic.• • .. :... .., . I
Suite/bldg./apt. no.: Project name: Mk_ , k.,, t i I ,,,,, t...
Description 1 Qty. Fee. Total "*
Cross street/directions to job site: . New residential single- or multi-family dwelling unit.
• includes attached garage.
• 1,000 sq. ft. or less 145,15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 , 1
• Limited energy, residential 75.00 2
Tax map/parcel no.:
.. , , .,, ..„ , .... „ ,,,,, ,,, .,,,,,,,,,...,, Limited energy, non-residenti 5
al 7.00 2
" • • ": P.00411I.101,.f.';Pr' WORK . ::::•.:::-:*:.::;•:.•::::::''.:: '''''''''''' Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less , 80.30 2
:.:,:,::; • :.: 201 amps to 400 amps 106.85 2
.." (1 ri • " " ' ;..: ' ".' • .. 'ANT : - ' ':•:.
• . - El. PR....P.E_TY.'..IMINItR.:•:' ' ..::':.':.: '- ..: '''.. • -.::::',' , , .. , .: •.: ... • :.... .......
,- :• „ • ; ' ' ' ; • _,•• .. •••.',• ., • •:-• "- ,_,'• •• „, ..."' - • ' • • 401 amps to 600 amps 160.60 2
Name/k-1 vbil
v I 'LLitted r;u1 qi c,I- 'd,/).i 601 amps to l ,000 amps ,240.60 2
Address: 3 -1 sA) '41'c., t,-1AN 1 Over 1,000 amps or volts 454.65 2
Reconnect only: 66.85 , 2
City/State/ZIP:'\ w k...1(7 1 . , CD(1 3 1
Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 0 Fax: ( ) 200 amps or less 66.85 r 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 „
. . . • ... • . .. •.. • .. .... .........:,........ ::::„.,,... ........ - :•.••••• . : • A Fee for branch circuits with
. . •": P' AkkLICtlik' •:'i''• ••:' :':,: .1" '....:trostnimAtl , fEi serv Rsc* • -.: • .
ice or feeder fee, each 65 2
......-, , - i ,., 6
Business name: rcou -1,1 .,.._.. , 1,1_,L.., branch circuit
B. Fee for branch circuits
Contact name: _ iflik‘Cilf2.-17) without service or feeder fee,
46.85 2
each branch circuit
Address: us V ,Stv.e Each add'I branch circuit 6.65 2
... Cl , .....,
City/State/ZIP: AL,f/tt nit, t"-'I7 to A -1 r (0 (9 / Miscellaneous (service or feeder not included)
-
Pump or irrigation circle 53.40 2
Phone: ( uci(4 ..ccf-1 F ax: ' 311 OS -bit) - 3 1 ) Sign or outline lighting 53.40 2
E-mail: A.e 1-4. t ,p, (c JJ.4v's t 5 7 7 , Signal circuit(s) or limited-
4.
• • • ' '' :. •• ' ' -: CONTRACTOR .: •••;: . :.•" . . -. „ . :....:., s ., ,. .:.:. .. s • - : t • :. energy panel, alteration, or
. . . 5, . .... ...„ .... .
extension. Describe: Page 2 2
Business name: i'lpa'v i 1 j i j t . , 1
4,.../
Address: LL V CZ'7"kt Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: VAvv.:, , i A- q Aitt I Investigation per hour (1 hr min) 62.50
Phone: (1.4 ) (i2 ‘1 0 , 6t Fax: (1j(» k611 ... -1-12 Industrial plant per hour 73.75
. , :tii.00#..T.e.-At'ttlai:17 MS*.: : . " . : • :: :
CCB Lie.: illt6G,t:t. Electrical Lie.: '31 .ci3oc„. Suprv. Lic.: 1-4 Subtotal - 7 5 -
■ j,
Suprv. Electrician signature, required: •- eeijerk_...." Plan review (25% of permit fee)
. State surcharge (8% of permit fee) ‹..'
Print name: i\A,k( A 1 .-- it _ c. ., v 0 Date: a 1 .
TOTAL PERMIT FEE
i:s ___. -
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri-County Building Industry Service Board
— ** Number or inspections per permit allowed.
',Build moPerreitsTI-C-PermitApp. doe 12/01 440-46151-00/02)CONVWEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
) BUP
Received / 2 Z / (' // Date Requested 4` r/ 1 �, St AM PM BUP
Location /' KO 5(') �' f [) Suite MEC
Contact Person 04 Ph (_,S,43) </ 9 — 7 ?S7PLM
Contractor // Ph ( ) SWR
BUILDING Tenant/Owner c�: �1 X ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR V-- �(J/
Crawl Drain
Slab Inspection Notes: '- SIT
Post & Beam //4�1�,
Shear Anchors !/
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -�l n 2
Firewall Fire Sprinkler k AiD ) ' ° [ S y� \ 49
Fire Alarm \O t'L\
Susp'd Ceiling ` I 1c
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole C -
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 4 4 -
C' Low Voltages t
Alarm
PAS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspe tion RE: ❑ Unable to inspect — no access
Fire Supply Line / /
ADA D ate / G Ins ector - � \ l Ext
Approach /Sidewalk P
Other:
Final DO NOT REMOVE this inspection record f om the Jo site.
PASS PART FAIL