Permit =CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
IA I I ' DEVELOPMENT H OPMEN a Tigard, � 639 -4171 DATE SSUIED: EL R2004-00012
S PARCEL: 2S102CB -00100
SITE ADDRESS: 1 a3 SW GRANT ST
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -12
BLOCK: LOT: 041 JURISDICTION: TIG
Project Description: Limited energy for HVAC controls.
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:
TIGARD - TUALATIN SCHOOL DISTRICT #23 ARGONAUNT CONTRACTORS LLC
6960 SW SANDBURG RD 7330 N WAYLAND AVE
TIGARD, OR 97223 PORTLAND, OR 97203
Phone: Phone: 503 969 - 5294
Reg #: LIC 154699
ELE 26- 1157CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/22/04 $75.00 Elect'I Anal
[TAX] 8% State Surchart 1/22/04 $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
yo follow m - adopted by the Oregon Utility Notification Center. Those rules set forth ' 952 - 001 -0010 throuc
I ued by ,,L
by „ : , Q7 ��� Permittee Signature 7
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
Electric ermit Application
t .
..• ,, , • ,.;. ,, ,•;, ,FoROFFWE USE ONLY
City of Tigard Received
Date/B Permit No • ' ,.1 Oz) ti - 000 1 2 _,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639 4171 Fax 503.598.1960 I P% t !lid\ Date/B • Other Permit
Inspection Line: 503.639.4175 II!' , Date Ready/By Jut is Ei See Page 2 for
Internet www.ci.tigard.or us Notified/Method: Supplemental Information
41 Lratk r 4i:Itar :rgr:'w'avi**IF:ykp',for y''I' TI'''cl. ' r;:- , i '.:
0 New construction 0 Addition/alteration/replacement Please check all that apply•
EService over 225 amps, comml 0 Hazardous location
0 Demolition 0 Other:
_ _ ,, ,,,, Service over 320 amps — rating OBuildng over 10,000 sq. ft ,
PORAftnicalii4'00:47:011*03: WEAK r';',1„iiIk
''' of 1- and 2-family dwellings 4 or more new residential
El I- and 2 dwelling 0 Commercial/iridustrial 0 Accessory building ['System over 600 volts nominal units in one structure
Li Building over three stories OFeeders, 400 amps or more
0 Multi 0 Master builder E Other:
,,„, 00ccupant load over 99 persons EManufactured structures or
520,4,1i, EWSA:1 --H
1 19Z,t , 1 ::., ::,,.•,. ElEgressilighting plan RV park
Li Health-care facility ElOther
Job no.: Job site address: 1.2 -- si ..--) (...„,_ t___ n.„
----- ,-- c.".... ,‘„,... _ _ Submit 2 sets of plans with any of the above.
City/State/ZIP: T () 9 ---- t 22:S , The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: 1/4 ---- ) Project name: C 1 - 0 , r - :7 !P FEE S C...
1 i t--A.V Description 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 I
Limited energy, residential 75.00 2
Tax map/parcel no.:
_ Limited energy, non-residenhal 75,00 2
f ifOagttktR ; tA*Nik*Wr - T)O f t*gC W I: ° -*NSkrti M? Each manufactured or modular
dwelling, service and/or feeder 90.90 2
a ( ID-, 4- .,,,) Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
'.J' -6•ij ;i:Ov" . ..i.4;i.,.4k ! tki,i 7 ; .14,6ixm.4 : • ,.,,?. „I , :. ;: 201 amps to 400 amps 106.85 2
, 41;•:.7- . Mt,,,ti.,.■s,.KZ:;ot, .' ',"' " l''' ;.i" ,',1e .. ' ',r V. , , . , - . ,4. ' - -, , ,"- - ',
401 amps to 600 amps 160 60 2
Name: ----14 4./ -
601 amps to 1,000 amps 240 60 2
Address: (04 A ii, - Over 1,000 amps or volts 454 65 2
Reconnect only 66.85 2
City/State/p_P.,--rFaver) 0 . 7.:9 - 4 2 3 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 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
TI111 ri ,:,liw ortoT,atAtv,f A Fee for branch circuits with
service or feeder fee, each
6 65 ?
Business name: branch circuit
B Fee for branch circuits
Contact name: without service or feeder fee,
46 85
each branch circuit 2
Address:
Each adcP1 branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53 40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53 40 2
E Signal circuit(s) or limited-
Agrea;;Iirmsi,vEnf,moywo , , , A,, , , f , ; : ,w energy panel, alteration, or I/
extension.Wk Page 2 2
Business name:
!AI. volt -I 1111.40.
Address: -7 a •- : ,.., r , A ) / I 11 ,
L _.4 Al Each additional inspection over allowable in any of the above
. _.../1._ IIIII
Per inspection 62.50
\ City/State/ZIP:Th DR darn 0 Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
'•• Phone: (St:) \) Ola cil ___,..? Ct Li Fax: ( ) /0
'M::`,Etttotkie,o,wiipftwt:Et
.... CCB Lie.: 1 .. co on
Electrical Lic.:
. u,Q 9r - 1 i S 7CLE Suprv. Lie.:
Subtotal g5 ad°
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ep.a
Pnnt name: Date:
TOTAL PERMIT FEE 5 ,e,c)
Authorized signature:
_ . _ 1 i , ■ illb .
% 4 16 -,•11 This permit application expires if a permit is not obtained within 180
_
days after it has been accepted as complete
Print name: 1110„ c" i ll EMI. Date . Fee methodology set by Tri-County Building Industry Service Board
I ** Number of inspections per permit allowed.
i Uluilding \Permits \ELC-PermitApp doe 12/03 440-4615T( I 0/02/COM/WE13
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
h ;a4DEN TIA WO f :15t v °, ii 1aanA
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
0 1u TR,CIAL' WORK =ONLY . ::
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems •
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical •
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i \Bu lding\Pemuts \LC- Perm0App doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (5103) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received / g (5 Date Requested ' ✓ 1 4° AM PM BUP
Location Suite MEC
Contact Person /Q' J\ w Ph ( ) e.e29 �a� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner C`� ELC
Footing
ELC
Foundation Access: rr�� ,,,, (Q 4
Ftg Drain ELR �v-
06
Crawl Drain
Slab Inspection Notes: a A n SIT
Post & Beam C-�X Y om? J
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm ► _
Susp'd Ceiling In WV • /L ���'
Roof FOIL- M
Other: /
Final 5 �(°� �/�!� CretA iv lrJ I bf 13 r .E�5 —
PASS PART FAIL l \
PLUMBING At 07 to ✓Ezi5 ,
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final •
/ PASS PART FAIL
f 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.
PASS PART FAIL
Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA / �, , - I nspector
� Ki9- Approach /Sidewalk Date 7 (6 / fritM Aft CE Y Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL