Permit • CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
'" I DEVELOPMENT SERVICES PERMIT #: ELR2004 -00265
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/19/2004
SITE ADDRESS: 09000 SW DURHAM RD PARCEL: 2S114AA-00100
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Phase 1 HVAC.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SCHOOL DISTRICT 23J ELECTRIX LLC
13137 SW PACIFIC HWY 115 V STREET
TIGARD, OR 97223 VANCOUVER, WA 98661
Phone: Phone: 360 - 694 - 5094
Reg #: L1€0- 6954146, :5
ELE 37 -930C
SUP 4398S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 8/19/2004 $75.00 Elect'I Final
[TAX] 8% State Surchar€ 8/19/2004 $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 �, Permittee Signature ►�� O\ /
OWNER INSTALLATION ONLY u
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
08/17/2004 21:54 3606950670 ELECTRIX I- O � • / �1j PAGE 02
Eleci.rirca ermi .L!!•J , U)i+• ()I' I I(;I: USE ONLY
_
ti h �• d.e. R I r
eceived �1 ,Ir P
• r ermit Na.: my 00 0 5
Date/Br a_
City of Tigard -/ (�`y
1 3125 SW Hall Blvd., Tigard, OR 3 18 2004 Plan Review Other Permit
Phone, 503.639,4171 Fax: 503,.5 60 , ^ i t �l iPilj • Date /By'
Inspection Line. 503.639,4175 , !.1r ., DatcReady /BY' Iv 13J ® Sec Pone 2for
Internet: www.ci tigard.or,us CITY OF TIGARD Notified/Method: 1 I lr Supplemental Information
,, . a » i i • - . a�n :in. }i S ,{ 'Lf`�7 i^ It II} l( 1 - i il?`!!�' g't.' `' + 'f • ' 46 . „,Vi ill { ,.� • "i .•,I . � "''.l, :' i' '
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New construction Ir Addition /Alteration /replacement Please check all that apply:
CIScrvice over 225 amps, comm'l Ell-lazardous location
❑ Demolition ❑ Other �l,i� ❑Service over 320 amps — rating ❑ Buildng over 1 0,1100 sq. ft .
i'ij , }I #�j l fI ` 7'l" IV'lkli;Hulll, I' of 1- and 2 g more new residential
' , � • � �', � ��I�'�{ 'f �; }il
i� }ill j l 1��j'If 1!ljli�l tly dwellin s 4 or mo
❑System over 600 volts nominal units in one structure
❑ I- and 2- family dwelling Commercial /industrial ❑ Accessory building ❑Building over three stories ❑Feeders, 4011 amps or more
Master b uilder ❑ Other; r
❑ Multi-family ❑ �� []Occ> p ant load over 99 persons ❑Manufactured structures or
' ,i1 ! ai'; • „ > „I'n8 ;y c RV park
....r:... ;�,,.::� ''I`;fJ lfla,�i. a an „ r,l „ �Z; ;FI,I�j�l i '1 ❑F,Rress /lighting plan
•• :.... ° { „ are fac t
lob no.: Job site address; r ,w� p' ,0,1 ❑ Health -c iii y DOther:
Submit 2 sets of plans with any of the above.
C ity /Sta1e/ZIP: • 6 T� v The above arc not applicable to temporary construction service
11
nracrlptlnn Qty. ir tol
111 ii?1” wi , ,,,,, i1 , !
3 l � , „';I;IJIIG.v 'ii ll;af ,.;_ i X3 }l a' :;1;�:1.
nT ''
Suite/bldg./apt. Project name: t h e 'I ta '
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: L no.' Ea. add'l 500 sq ft. or portion 33,40 1
• Limited energy, residential 75.00 2
Tax ma / arcel no.: non-residential 75 00 2
%'
p P Limited energy, non -resid
,'• # i' o`;'i ,•,. + �. i ,j , ,. 1`, - it kOr 6 1 i I 1 ii 1 j "a ' 4 � 1 ;i in , i l ., , ' j. Each manufactured or modular
hit,
dwelling, service and /or feeder _ 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
2 0— , --.7 , 1 amps to 400 amps 106.85 2
• f � ,,y;,..,., i 1
ii' P' c ; { ' , , #II " ;1 ; , j �N -l i 3 #ilj " 1 1 i ;i iil i fijillil
,.;,,.t •,,,,!. I .� ••.,•... ;' �I #,iA:� . "; ? ii li l��� # ,.� � n�ir� .9 i # 401 amps to 600amp5 _ 160.60 2
Nam _ 601 amps to 1,000 amps 240,00 2
Address: ``? f ? 'j 7 ., Over 1,000 amps or vntts 454 65 2
1 Reconnect only 66.85 2
City /State/ZIP; q ' ?' Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) — Fax: ( ) 200 amps or less 66 85 1
Owner installation; This installation is bcing 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 447.449.6'70, and 701. 401 amps to 600 amps _ 133.75 2
Owner signature: Date: , Branch circuits — new, alteration, or extension, per panel
,
r ^ ° 1 i ' . , ' Fcc for branch circuits with
, I ;;,i ; � i;�•�iI 1 • • i„•r,'i l; r''is ifl�; =.i'3 :if�'i'�';r i 11c sl ^� �'� i IN Jf "Iln a � s(.41� { l,ll ##� � A
„, i i "' �!' rt i '+tl>�tt I service or feeder fee, each
6 65 2
Business name: .6 e cicriX U branch circuit
B Fee for branch circu
Contact name; without service or feeder fee,
each branch circuit 46,85 2
Address: DS ii S.Y LE T co Each add'I branch circuit 6.65 -- I 2
City /Slate/ZIP: V a (atl.f/,eii/ W4 �l foie Miscellaneous (ervic or feeder not included)
( 30) 6)e 914 I Fax:: (360) K5_, Dib 96 Sirup or irrigation circle 53.40 2
Phone: Sign of Hotline lighting 53,40 2
E -mail: titZG (d Q. U-G' y" .1.I)"./2....- Signal circuits) or limited-
”; ,, I . vi;; ',,� ! lI ' 'p' Y; ;,,, ' i `' I energy panel, alteration, or
'�,y ! liilEiili; 11611i. E'i' I ,(4 (( 11 , a ll, Iii il�j)�� #lil !ix p
('' � •, �� `, - , �� • �� - , . . n YV , i. .,. I ., J .n : ). ,. #�'( j�11 }�! #li1i 1 1 11 / i 11111 Nl7D ` ' I ' L� 2
'�" !'�' � extension, Describe: Page 2
Business name: r '( �� _
Address: l IS • Each additional inspection over allowable in any of the. above
Per inspection 62,50
City /State /ZIP; ( Ae / �'� {pI Investigation per hour 0 hr min) 62.50
Phone: Industrial plant per hour 73.75
o ( t9 S 1 Fax (�(��j) �D l� 110 6 i'IR i,, "Pt�lirr;,'i,;+li' .tilAtmeIr'dp#�i(ll'; ;I i '' I?1 i ,
• (� nh�iii
CCI3 Lie.; ?L' A (0 O J Electrical Lie.: 3' ;q g.. Suprv. T „ic : Subtotal /S
Suprv. Electrician signature, required Plan review (25% of permit fee)
Print nanie: Ch - e L 1 i u t ehtl r 5 Date: Oils/ u Slate surcharge (8% of permit fee) (0 "
TOTAL PERMIT FEE ' 1
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- Co Building Industry Service Boatd
"• Number of inspections per permit allowed
1. \n doe 171 440 I O /o2/COMIWBB
CITY OF TIGARD 24 -Hour
BUILDING Inspection_ Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested — AM PM BUP
Location J D
O 0 0 uA.1 4 Suite c� MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR o 00 4( ,4S--
Crawl Drain
Slab Inspection Notes: SIT ���
Post & Beam
Shear Anchors W/
Ext Sheath/Shear
C .,
Int Sheath /Shear ,,
Framing
Insulation t,( � ,A� tAft ) G I(, I �-_ „ / S -i &V c-E
Drywall Nailing l� t f/ � V
Firewall 1 ' ? 191-5 �� ,� my F-234- F/' , 1 j
Fire Sprinkler , 2 1 - - ''v
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.
PAS PART FAIL
E ❑ Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line ✓ /',/ fh j��� t
ADA a Approach /Sidewalk Date D C ( Inspector
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL