Permit ��A A CITY OF TIGARD ELECTRICAL PERMIT -
( ` ®� RESTRICTED ENERGY
13125 SW Hall BI DEVELOPMENT r , SERVICES
312255 639 -4171 DATES U ELR 0404 -00086
. i PARCEL: 2S102CB -00100
SITE ADDRESS: 1 S GRANT ST
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -12
BLOCK: LOT: 041 JURISDICTION: TIG
Project Description: Low voltage; data /telecom
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: • HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD - TUALATIN SCHOOL DISTRICT #23 VERIZON STRUCTURED CABLING
6960 SW SANDBURG RD 4155 SW CEDAR HILLS BLVD.
TIGARD, OR 97223 BEAVERTON, OR 97075
Phone: Phone: 503- 626 -9155
Reg #: ELE 34- 495CLE
LIC 49350
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 3/30/04 $75.00 Elect'I Final
[TAX] 8% State 3/30/04 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
Issued Qp
Issued by Permittee Signature n'-\ C �j f`"' .e C GCT
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
03/30/2004 07 :46 NO. 530 D006
Electrical remit A 1C t1O ' NED FOR OFFICE USE ONLY
C'tV of, aa d Received
A b Z Dateoay,, - - Q 7 Permit No,' v,6 eee81,
13125":31N Hall Blvd., Tigard, OR 97223 u 20 04 Plan Review
Phone. 503.639 4171 Fax: 503.598.1960 t4 /l + rri t' + DateBy: Other Penult Inspection Line: 503.639 4175 T 1 GA 1 _. I - , Date Ready/By: EI See Page 2 for
Internet: www.ci.tigard.or.us +`i�TY OF Nwfied/Merhod. i Supplemental Information
•
t:s•^x., " iS T • ,:: - If l�ryitt ^T�) t? 14 }, i1� it!r T . • �h. 11 1 {! Ir iii,, 7 w ri _tlrE 1 ,{ ; Y r I a > . 1 { i
} ..-`' _...,. _.- :+�' F IIila tt a — l i ll�l IItIlimG • r � jt::. 3 'ttl ] I' S. :: ,:,, . , , , !1l II 4, ,li t %i IlIllll r, ..i II . `1- `•'s }El�*1 y ' :�.:. � } i l : °.
si New construction ❑ Addition/alteration/replacement Please cbecic all that apply:
El Demolition ❑Other: ['Service over 225 amps, come!, ❑Hazardous location
f4�t d ry s 1 81 3 # ° t l 1 u 1 iA;�; a {i
,r ' c �� i i� l r il ' a i i ' Y i r Cpl t° S j 1 ' ] #)# # 1] ] I # J i f$y ❑Service over 320 amps - rating ❑Bw.ldng over 10,000 sq. ft.,
sr > Ifumlt�i . ti a : . . ...,r.,t!#is.sttiCitG 41c3rtu a 1,i1 ih i e?cet uinitlr,,b 1 11it ;� �l�t i 1 {l l lll � il l 1 ��i�ttll� o£ 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2-family dwelling 1st Commercial /industrial ['Accessory building ❑System over 600 volts nominal units tit one structure
❑ Multi- �anlily ❑ Master builder El Otkler: ['Building over three stories ['Feeders, 400 amps or more
} ' l �` i C l ` k i K iCl l {di l ❑Manuctured structures or
fa
F s � # {��( a(��t,I F t IT,� tiliLt �9�4311itil = .,� � & � !t t t'�'17�� ��ta � �Y' V� 3 i j t.I Itt 4 {�47�J S {] Z' (� kf} j I t I{ �{ � a �F:� "f ❑Occu p ant load over 99 persons }�V 1C
r' '}� t � , 3i11F► 'C .+ :•Cl is ilia e ... - it i i r. � h , ,.,.,rc1t,I 1l�u lu hxxN{ +iCn 4 ti it f #c Ek{ E Chill — i.�-.?r` ❑Egress/JJghtill$ plan par
Job no.: rob site address: l '- $&) /'$3 ❑1Elealtli taro facility ['Other:
Submit 2 sets of plans with any of the above
City/State/VT: 'Tlt,,c41.43 i 0 R on. 2'Z The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: I Project name; .J uJ C� 11 l,.Pelt.a D � i r iP f t � ] n1 It'.�,'. iii111 YY ill l l£ ., a II #ITV lII11111rI
Cross street/directions to job site: New residential single- or multi - fancily dwelling unit,
Includes attached garage.
• 1,000 sq ft. or less 145.15 4
Subdivision: Lot no.: Ea add'1500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel Do q l !f' !j{�j l j (�]k j {j #(k
' i a 1. IR r' ,. ! ;ail ` RV ESE ` `Ct {ri r}n� iI MIf l��lRINI l El# z N1�1 �1# #�tif;'r 1;lm Each manufactured or modular
75.00 2
1,E I 1....}51' f'kL L OK A. TAI eCzN. dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
p ( j ( [�! £{ j } j t 1 { [ E ( 200 amps or less 80.30 2 201 amps to 400 amps
,: F T ' it Alit .w <.; ' 'II ,,.,. #1 ,, %' _..�li iflli�4f 111111„ 111 �iC�tri Ii It�'r1 �l11 :1 1t C 1 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
200 amps or less 66.85 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
DOP im o r ( ti p){ , t 3 {` 3 1" it i1( y t t { + u f [ cu]731 , !:,lµlt} {,, tI {t! !' f ! i I i , A. Fee for branch circuits with
�R. 141 ,1 r 4 TraEi 1, _,., #1 l 1{ .:., „... ;sr t >81 11 lil 11 ''r hi Itllitl .k i service or feeder fee, each
Business name; branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
t y _rc ; l r1 'rN ;lk „ ;If9111iIJ LlI' t ; M.s 111115 11D1110 ;; 1111IIlflli N1111II 1111llillllll energy pan a ration, or
Business mai>ae: Descr t Page 2 I 2
v e 2► 1 ot) --,12.1,3c_TugleQ -i nl lv
Address: ?c 3V d y, � � Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: 13,g/aV l OP- Ci '10 (,p Investigation per hour ii hr min) 62.50
Phone: (503) (.a - G (rj S Fax: (5t7, ) -4 - 42 s 4 Industrial plant per hour 73.75
Illl :.. lli�l,C�.. llaU : ..�>. '. il;llt .A . ;h�in .111' iali ”' l
CCB Lic.:34- 4 (.1- Electrical Lic_: 48350 Suprv. Lie.: /19,5 Subtotal � ti tllil:
0?
Suprv. Electrician signature, required; Plan review (25% of permit fee)
Date: State surcharge (8% of permit fee) ID
Print name:
1 �1 ° i kRE/J DTI i�,� � / 3a /0 TOTAL FERTIUT FEE i
Authorized signature: This permit application expires if a permit i9 not obtained within 180
Jaye after it has been accepted as complete
Print name: Date: • Pee methodology set by Tn- County Budding lnduatry Service Board
" Number of inspections per permit allowed.
i.'BuiI&ii u'trmus\ELC- PmnitApp doe 12/03 440-46151(10 /02 /C01.trwnn
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
{� BUP
Received / 6 --Date Requested 7 - f AM PM BUP
Location /-; O rm=C Z7 = , Suite [ � / MEC
Contact Person Ph ( )5 `7 4 1` 7 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner C / �� ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR D � O �fo
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing // � l ' /Z � �/� /" ✓v T /%// - -/ J / /j
Insulation
Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm
/
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL Z.-- ���� 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 l,,
ELECTRICAL . �j s �" 0 EdwS r �7G� - « Z 7 7.<4,4 t '4' keit„,$
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
SS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 111 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Dat �' / Inspector .L Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL