Permit A - CITY O F TIGARD ELECTRICAL PERMIT
I K PERMIT #: ELC2003 -00444
��� DEVELOPMENT SERVICES DATE ISSUED: 8/26/03
�"'` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S102CB - 00100
SITE ADDRESS: l-2 i9-S G RANT ST
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R
BLOCK: LOT : 041 JURISDICTION: TIG
Project Description: Electrical conduits underslab inspections only. 3 hrs @ $62.50 ($187.50). A new permit application,
plans, and review will be required for any work beyond the slab.
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: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 3
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD - TUALATIN SCHOOL DISTRICT #23 SHAW WEST COMPANY
6960 SW SANDBURG RD PO BOX 1427
TIGARD, OR 97223 TUALATIN, OR 97062
Phone: Phone: 682 3723FAX
Reg #: '%2 -3939 221s
LIC 63142
FEES ELE 34 -70c
Description Date Amount
Required Inspections
[HRTAX] Hourly Rate Tax 8/26/03 $12.27
[HRELC] Hourly Electrical 8/26/03 $175.23 Underground Cover
Elect'l Final
Total $187.50
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 b one -in.ac rdance 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
fort�OAR 952 - 001 -0010 th augh OAR •• 101 -0100. You may obtain copies of these rules or direct q stions to OUNC at (503) 246 -6699 or
1- 00- 332 -2344.
Is ued By: 079 0 /4 1 ` Permit Signature: -C G / ' 0
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: Q . .t)i teiJ? DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
• �OR ' OFFICE USE ONLY .: < ` '
'`
Electrical Permit Application Received 7 F 0� Electrical � _ � .»
Date/By. :� Permit No &-C e n Z 7 ( '� 9
CIt of Ti and Planning Approval Sign
y g Date /By Permit No
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
/ /�i � �� �a� Date /By: Case No. ■ Internet: www.ci.tigard.or.us �� �'li
Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method Supplemental Information.
s�'�'s' v �� ;, '"`; <''• °'t�`:°` :a x .:�: ..,'k .w -,�,.. ,.r;?.�.., Y:"`.".? +.�- �ba4�:z " "4• x�:� .a-s..' ^"ies",4ru�,�,m,:...s � .a .e - a.: - tea°=' ; "..: � -..3tc , :�r�.',�e�'�.� �;�K'?* ;:z .z: �
to ; , �atai a �I'E0®0?' ?O1a :T ;X n Ma�3.d,. ° V � r ;=�:P W:W lease ,ch ck. llitl : P fY)�` K: .�...
N construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
°,
Addition/alteration/replacement El Other: El Service over 320 amps- rating of ID Building over 10,000 square feet,
s, ="fie ° G tto `r QF;� "'�O =, :—, T TI®.1fT: <�' `,G,` - 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 stones ❑ Feeders, 400 amps or more
❑ Accessory Building n Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress /lighting plan ❑ Other:
t` " "� ' "``` " 01.3iSY ll0.0 70 a ' L`f}.C''` itMit`,,,, Submit sets of plans with any of the above.
� �� ✓ The above are not applicable to temporary construction service.
Job site address: /2--g f_- > • � �� - - f �, � v
.?��. �._.�. Via. " ,,
$'_., . _ ._
��..,��..
Suite '#: /o: g55.- Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: C/— / i fr a z ia3 _ji-e escri tion Qty Fee (ea.) Total
New residential- single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
WA 0r— 1000 sq. ft or less 145.15 4
Each additional 500 sq ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75 00 2
Tax map /parcel #: Each manufactured home or modular dwelling
" . y,' °- a t�� _ S service eans feeder
� a4 � �Q 77E � � i � , �— a l alteration od/or r feed - installation, 90.90 2
JC S alteration or relocation:
4(4 Q r, /l0 � eC��� e- A 0s � 200 amps or less 80.30 2
/- �f` 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
i; = : i'1 _ �,''' �,,4 " � 601 amps to 1000 amps 240.60 2
_ �_• �?1'J�R�T?�'°f1W1`FER.���. zt., ?PEI�TAN�T .•���;I . "w �,�� �i:� "�: ���.
/ ver 1000 amps or volts 454 65 2
Name: / /G, /,_)4(.....14-77,0.-Se-4- . , .2-n — Reconnect only 66 85 2
Address: %4t-.t _ Temporary services or feeders - installation,
City /State /Zip: - e-,42ap C //�+ � alteration, 00 m le ss 66.85 1
relocation:
200 amps or le
Phone: F 201 amps to 400 amps 100.30 2
eta .r = ,,, : 401 to 600 amps 133 75 2
"; ' ?L1 N }° `^ ' ill' -0 / � � IW T- � Branch circuits -new, alteration, or
Name: . J 400? s; C -e. . extension per panel:
Address: / x !
T je) / ��- 7 A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip:. 4- 47 L J ��j� B. Fee for branch circuits without purchase of
i 97 service or feeder fee, first branch circuit 46 85 2
Phone:.. -6e2-3939 Fax:. -h8'z 377 3 Each additional branch circuit 6.65 2
E -mail: ,(-e i/G �.� Sha(.1)teles.1`. L' o Misc.(Service or feeder not mcluded):
�; ' SON + ; ®R'tt' +'r °, <. ".{ _ Each pump or ungation circle 53 40 2
AI i yry, "' ` �" ? ';.iati _' : :4,it e Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business N e' �l j 6, Description:
or extension _ e 2 2
Descripti on:
Address: . D 664.s. /iL2..:7
City /State /Zip: � d Each additional inspection over the allow ble in any of th above:
C,i . ! f kJ Z' Per inspection per hour (mm 1 hour) c 62.50
Phone: 57:53.-&82-_-3% `3 Y
r Fa..: .. 3 6,62....-3 2 3 lnvesti_ation fee A
,/ M Z* Other /�i 1114 -G 1��s' ln! „ WItilVi
ve e m.
CCB Lic. # 6
: '"'�$>� i . Sleectr e :Tees* a1..
Supervising electrician btotal $
signature re uired: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized n� I � / c Notice: This permit application expires if a permit is not obtained within
Signature' ' ' ' D ate: 6 —24... -03 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
D-4-ii it. L . y
(Please pnnt name)
i"\Dsts\Permit Forms \ElcPermitApp.doc 01/03
I
Electrical Permit Application -,City of Tigard
Pagel - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
• • Check Type of Work Involved:
I Audio and Stereo Systems* •
n Burglar Alarm •.
In Garage Door Opener
Heating, Ventilation and Air Conditioning System
Vacuum Systems
n Other
COMMERCIAL WORK ONLY: '
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
Boiler Controls -
j Clock Syste s`
Data Telecommunication Installation
•
n Fire Alarm Installation
Ei HVAC - •
n Instrumentation ,
n Intercom and Paging Systems •
n Landscape h Control
In ' Medical
n Nurse Calls
ri Outdoor Landscape Lighting
n Protective Signaling
[ Other
Number of Systems•
* No licenses are required. Licenses are required for all •
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
'�I
„, ow avow ay. .I. ;I: /AA 0U4011111.115U CITY OF TIGARD l007
,
A *-- *1 ,'
- lectr Veal ermIt Application ,.
Received / - .,/
Deday, I
i / 7 v Pans No.r?-49v0 -woo „
City of Tipr Approval
DoterBy: Permit No . , ,,,
13125 SW HO 131v . ' Plan Revieoi Pt NG,. X ,449,g—m17/5/ :7
.;,.:•, '...,.,, Tigard, °regal 9723 oceray
".. ': Phase: 503-6394171 Fax 503-598-1960 Post-Review c ; eu/a003 -crro,P. J
. 1
..,- 11,1:-- ' -Emma: www.ci.lialard.or.us , 14 --1 I contact Juno . I Si See Pap 2 te
r `if ” 24-hour Inspection liRequest: 503-639-4175 - '" ' ' NameNethod mental le
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7, 1 r ■: , ' __ ,'". /. ::' ., 4 .t?4, .? e rf w ' clietkr 1 ! ' =Cr; tiMirtiniattigi , . .',.-
, ... - . • .n IN Demolition r:, Service over ns tin • Holth-cate : My
' : ' '• v
- -....' :
III Addition ▪ ' • commercial CUialardoid location
/ - aoral —lacement IIII Other: LI Service OVET 3/k amps-ruing of ZS Building over 10,000 square feet, ' .1
..,:..:''',' . ?I' 1 a 2 lamely diveltinp bur or more residential units in _ s'
1111 1 & 2-Famil a llin 1. Ira omm tri
ercial/Indusal D S ystern over 600 vots l nominal 16 ,one sink:twee ..4.
Building over threc storim Feeders, 400 amps or mon ,
. '':-' ' III Aseessery Ittaik : III Multi-Family Occupant load over 99 persons Manufactured souttures or RV park
III Other EftrusAillherld Plan 0 Other
,.,::,;:. , - ,isingt . ,147: 1 r', t:,_ T go 7 7:1 '. oN. • . . Salornit is or plans with any of the above.
- The above are ,... , It! ,..-..a_La, ._..lii_......._., ...Ma
. a
kb sfte address: 2. , 0 S 4r / a *-- 4 ..:. vier. ,,; ,; ,._ ; , .." fat
BI a 1 JA a t.#: Number of In - , s ._,,. . -risk -.
lEniti=111111M111111 „„
Pro' - t Name: c €0414 , s A )11/MM
. - ..‘ mile er wooki-hotally per ,
rstreeteireC • to job s ( (
''' ite: 4.4 ir /el F.. a dn4t es attached prop.
4 • vtf) Semis
1," :: 1000 . ...ar ie 145.15 .
''' '' ' SW 4 0t) \ s5 . / -- " er4rs If.
'`.."141 Each sdtbudisiel SOO - to or . - whereof . •
\
. • Ifir27TITAIIIIM11011111111111111•11•11EMENINIIIIFI
: * Subdivision: \ I I.ot #: liwlirr. .;. rgill11111111011MIIIIM11111111111
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Saving et feeder, - , r
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der( a , 4 , e e ; a
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, ,,, or vats •1111111112Eall 11 ,
▪ Name: 5 - ilti.A 'eel e.-. Rumen - . MN 6655 II
Address: , ' 0 g Sart ••44..ei jf. Temporary orrice' or feeders - in • , . ,
.'•-i• '''t.- ',' 11OEMIIIjillnIIIIMSIIMIIII alteraties, or relocation!
A. II II ,
. ,z 4 , 200 Ur. Of WI 66.Si
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Branch artists - new, alternbe or -,
• .Name: e. e ft 441 tvke C ri s j . Me . ' \ oziensioo pot pan* 1
, 1--4„,,‘ 1 A. Fee for.tranch circuits with of
Address: Pi to : S w M a tit dot Ai AVe I Re' t,ro Euv e ruder _ , . 13 c iac k at •
._v,.,.. tt ' ... 1 of A n I DA: 4 2 3 , \ a Fee for br ,"" - ' • : purchase of 1111.0111111111 111. .1
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' or feeder •.L.,..- wan Illik-710131 .
Phone: q03 / r-: b 0 Fax:/ 51?)- 2tc- I te 1 ir frriv0: , .rr - 11111tioctii ta • a, • : 01. pt , 0 co i 5 - lent wt i • ,M Fill MI 531
27+r ; "L:- Pin 5340 Ilnl
• i / Signal : . II . 11 Unli • soup panel. MiNiii./.1111 ,
, , - - . : Of , !MA wri. • simmomilia
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SuperviSing electriian ' Subtotal
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11 :" " e quired Plea Review W% of Fee ,.
.". -`, '''' ' ' . t.Nanie: ' / Lic. 0: State Sur e % or Permit Fee S • I . 5
i
PERMIT FEE ' $ 9 3 • cow
.•' --J 'i Anditoriiled 7 / 4 , t A i Neck.: ma permit applention expires it a prink is not obtained edible -w •
Upsilon: / / ps t Dow 7 3 o3 ISO der after after It has ban steeped Id eromplese. ,
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1:011.0Permit PonesielererrnitApp.doc 01103
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RUG -27 -2003 08:32 SHAW WEST 503 682 3723 P.02 /82
C A I T ur I iw iw
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
SHAW WEST COMPANY
PO BOX 1427
TUALATIN, OR 97062
Electrical Signature Form
Permit #: ELC2003 -00444
Date sued: 8/26/03
, ,Z $ Parcel: 2S102CB -00100
Site Address: 1-2850 GRANT ST
Subdivision: NORTH TIGARDVILLE ADDITION
Block: Lot: 041
Jurisdiction: TIG
Zoning: R -12
Remarks: Electrical conduits underslab inspections only. 3 hrs @ $62.50 ($187.50). A new
permit application, plans, and review will be required for any work beyond the
slab.
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:
TIGARD - TUALATIN SCHOOL DISTRICT SHAW WEST COMPANY
6960 SW SANDBURG RD PO BOX 1427
TIGARD, OR 97223 TUALATIN, OR 97062
Phone #: Phone #: 682- 3723FAX
682 -3939
Reg #: SUP 221s
LIC 63142
ELE 34 -70c
AN INK SIGNATURE IS REQUIRED ON T IS FOR/
X -,I
Signature of Supervising Ele
If you have any questions, please call 503.718.2433.
TOTAL P.02
fa `\
Cep iv
fipv `' J� ed CITY TIGARD
August 22, 2003 OREGON
Cornerstone Construction Management
John Cornerstone
5410 SW Macadam Ave.Ste. 250 Phone: (503) 705 -4640
Tigard, OR 97223 Fax: (503) 295 -1896
RE: ELECTRICAL PLANS REVIEW
Dear Mr. Cornerstone:
Project Information
Permit: ELC 2003 -00444
Tenant: C.F. Tigard Elementary School
Address: 1-2450-S.W. Grant Ave.
/off F5"T —
This plans review is based on the 2002 edition of the National Electrical Code (NEC).
The revised plans received on August 21, 2003 for this project have been reviewed and are approved for
construction subject to the following:
1. This approval is for in -slab installation of 48 conduits and two floor ducts of miscellaneous sizes only
2. NOTE: The approval of this installation does not address the adequacy of these raceways for any future
feeders and/or branch circuits
3. A completed permit application by an electrical contractor is needed prior to the issue of this permit.
A permit fee of $ 937.50 is needed to cover fifteen hours of inspection for this part of the project.
4. The approved plans including all schedules, calculations, specifications, and reports must be available at
the job site for the field inspector at the time of inspection.
5. Changes to the approved plans shall be submitted and must be approved by the City before the
installation covering the changes can be inspected
If I can be of any additional assistance, please feel free to contact me at (503) 718 -2446.
Sincerely,
Herb Stabenow
Plans Reviewer
HS
file
c: file
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
/
OFFICE COPY
dLOSIP •••
aTY 4tF TIG . .`
August 22, 2003 OREGON
L.
Cornerstone Construction Management
John Cornerstone
5410 SW Macadam Ave.Ste. 250 Phone: (503) 705 -4640
Tigard, OR 97223 Fax: (503) 295 -1896
RE: ELECTRICAL PLANS REVIEW
Dear Mr. Cornerstone:
Project Information
Permit: ELC 2003 -00444
Tenant: C.F. Tigard Elementary School
Address: - - . «..: - 7 /,;), SS S e-----
This plans review is based on the 2002 edition of the National Electrical Code (NEC).
The revised plans received on August 21, 2003 for this project have been reviewed and are approved for
construction subject to the following:
1. This approval.ns for in -slab installation of 48 conduits and two floor ducts of miscellaneous sizes only
2. NOTE: The approval of this installation does not address the adequacy of these raceways for any future
feeders and/or branch circuits
3. A completed permit application by an electrical contractor is needed prior to the issue of this permit.
A permit fee of 5 937.50 is needed to cover fifteen hours of inspection for this part of the project.
4. The approved plans including all schedules, calculations, specifications, and reports must be available at
the job site for the field inspector at the time of inspection.
5. Changes to the approved plans shall be submitted and must be approved by the City before the
installation covering the changes can be inspected
If I can be of any additional assistance, please feel free to contact me at (503) 718 -2446.
Sincerely,
Herb Stabenow
Plans Reviewer
. HS I
file
c: file •
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
./
•
,/L ,� UIIP14
T TIGARD
August 21, 2003 REG ®N
•
Cornerstone Construction Management
John Cornerstone
5410 SW Macadam Ave.Ste. 250 Phone: (503) 705 -4640
Tigard, OR 97223 Fax: (503) 295 -1896
RE: ELECTRICAL PLANS REVIEW
Dear Mr. Cornerstone:
Project Information
Permit: ELC 2003 -00444
Tenant: C.F. Tigard Elementary School •
Address: L2$ &-S.W. Grant Ave.
M &SS
This plans review is based on the 2002 edition of the National Electrical Code (NEC).
The plans received on July 23, 2003 for this project have been reviewed and are approved for construction
subject to the following:
1. This approval is for in -slab installation of 21 conduits and two floor ducts of miscellaneous sizes only
2. NOTE: The approval of this installation does not address the adequacy of these raceways for any future
feeders and/or branch circuits
3. A completed permit application by an electrical contractor is needed prior to the issue of this permit.
A permit fee of $ 625.00 is needed to cover ten hours of inspection for this part of the project.
4. The approved plans including all schedules, calculations, specifications, and reports must be available at
the job site for the field inspector at the time of inspection.
5. Changes to the approved plans shall be submitted and must be approved by the City before the
installation covering the changes can be inspected
If I can be of any additional assistance, please feel free to contact me at (503) 718 -2446.
Sincerely,
Herb Stabenow
Plans Reviewer
HS
file
c: file
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
CITY OF TIGARD 24 -Hour : '
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received J? 5i3 Date Requested 7 AM PM BUP
•
Location LSZA-) • Suite MEC.
Contact Person Ph ( S Z 7 PLM
Contractor Ph ( ) SWR // /
BUILDING Tenant/Owner C-F / /� ELC — 00 C - `AZ
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear .
Framing
Insulation
Drywall Nailing r
Firewall
Fire Sprinkler
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
Rou•h -In
U /Slab
Low To tage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. .
mot PART FAIL
Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line /
ADA Date / G I 0 3 Inspector if Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL