Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00355
L- A 1 7 A' DEVELOPMENT SERVICES DATE ISSUED: 07/06/2001
FAIl
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134CC -01700
SITE ADDRESS: 12325 SW KATHERINE ST
SUBDIVISION: MARY WOODARD SCHOOL ZONING: R -4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (1) 200 amp service /feeder. Low voltage for fire alarm and running
conduit only for Data.
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: 1
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS
ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
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:
SCHOOL DISTRICT #23 JT ATLAS ELECTRICAL CONTRACTORS
13137 SW PACIFIC HWY 4403 SE ROETHE RD
TIGARD, OR 97223 MILWAUKIE, OR 97267
Phone: Phone: 659 -2212
Reg #: SUP 2581S
LIC 1532
• ELE 3 -2C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 07/06/2001 $230.30 2720010000( Elect'I Final
5PCT CTR 07/06/2001 $18.42 2720010000(
Total $248.72
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1-800- 332 -2344.
Permit Signature: Issued By: Al /
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: 0, .(�,1,�, f b DATE:
LICENSE NO: c9•5 J
Call 639 -4175 by 7:00pm for an inspection the next business day
•
r-' )) _ov.D-65.
Electrical Permit X� - i'l' cation
JUN 2 zoo Date received: (0 0 / Permit no.:R( — £ 365
,..f _j City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Bl � igar j 1.- ENT Date issued: By:' Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: -
TYPE OF PERMIT • •
❑ 1 & 2 family dwelling or accessory 111 Commercial /industrial ❑ Multi- family ❑ Tenant improvement
0 construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
.:.e , JOB SITE INFORMATION
_ Job address: 12325 SW Katherine Street Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: ISubdivision:
Project name: Mary Woodward Ell Description and location of work on premises: Electrical for modular class.
Estimated date of completion/inspection:
.,,;,..,. • TRACI '_ <' un t ,- _ � -. te -;;_ ._ FEE =SCH I ULE. Job no: #8733 Fee Max
Business name: Atlas Electrical Contractors Description Qty. (ea.) Total no.insp
Address: SE Roethe Road New residential - single or multi- family per
dwelling unit Includes attached garage.
City: Mi lwauki e I State :R . I ZIP:9 7267 Service included:
Phone: 659-221 2 I Fax: 659- 4 9 4 l4 -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof •
CCB no.: 1 532 I Elec. bus. lic. no: 3_2c
Limited energy, residential 2
City/ 'tro lic. no.: Limited energy, non- residential 2
6/2 1 / 01 Each manufactured home or modular dwelling
Signature of supervising elects ran (required) Date Service and/or feeder 2
—? Services or feeders — installation,
Sup. elect. name (print): _ , . a • • - -•.A. _. - .License no: 2581S
alteration or relocation:
• . . PROPERTY OWNER - • 200 amps or less 1 80.30 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: • 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
v. -, ENGINEER Branch circuits - new alteration,
',/ or extension per panel:
Name:
A. Fee fo b circ with purchase. of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service �rfeedernot included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting . 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 2 ,75 si` � a -
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* - 1 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park ' Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ 230.30
Not an jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $ _
Credit card number: / / within 180 days after it has been State - surcharge (8 %) .... $ 1 8 _ 42
Expires accepted as complete. TOTAL $ 24R...72
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
•
Electrical Permit Fees: Limited Energy Fees: ,
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 0 Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 IT Burglar Alarm
Limited Energy $75.00 -
Each Manufd Home or Modular n Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 n Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2 ❑
601 amps to 1000 amps . $240.60 2 Other
Over 1000 amps or volts $454.65 2 •
Reconnect only $66.85 2
TYPE OF WORK INVOLVED COMMERCIAL ONLY Y
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. Audio and Stereo Systems
Branch Circuits n Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 : 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service " n F ire Alarm Installation
or feeder fee.
First branch circuit $46.85 n HVAC
Each additional branch circuit $6.65
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n Intercom and Paging Systems
Each sign or outline lightin• $53.40
ignal circuit s or alifnitTd energyilk /
jpanel, alteration or extension $75.00 /,�� n Landscape Irrigation Control .
•r s • $125.00
n Medical
Each additional inspection over
the allowable in any of the above n Nurse Calls
Per inspection $62.50
rer hour $G2.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: n Protective Signaling
Enter total of above fees $ n Other
•
8% State Surcharge $ Number of Systems
25% Plan Review Fee * No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application.
Fees:
Total Balance Due $
Enter total of above fees . $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts \forms \elc- fees.doc 10/09/00
CITY OF TIGARD Bl' °'.DING INSPECTION DIVISION MST •
24 -Hour Inspection Line: 6;,_ 4175 Business Line: 639- 1
BUP
Date Requested �� AM PM BLD
Location / 2 3 m.3 Koz--13eA_ Suite MEC
Contact Person Ph PLM
Contractor . ) G < L /pc 7 C Ph _ - Z 12 SWR
BUILDING - :: '; Tenant/Owner ,jij _, ' I ELC 2-61 / — 663S75
Retaining Wall i ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation A D r , n �,� v/ (" Drywall Nailing j
Firewall
Fire_Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final •
• PASS PART FAIL
•
PLUMBING: ,eA
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains %
Final
PASS PART FAIL /
( A
MECHANICAL e ° ` _ ; /
Post & Beam
Rough In - ✓
Gas /
Smoke e Dampers 4
Final -
PASS PART FAIL
ELECTRICAL
CService7) --
Rough In •
UG /Slab
Low Voltage
Fire Alarm
F ART FAIL
Backfill /Grading -
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA -
Other oach /Sidewalk Date `,Z 9 --6 / Inspector art Ext - -
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION G 37p
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location -� .. - -% Z3 A - A Suite MEC
Contact Person S'G4ll a Ph Gil Z Z / PLM
Contractor Ph SWR
BUILDING e r Tenant/Owner
ELC /r"
Retaining Wall J ,./35 ?
Footing
Foundation Access: FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: - /J
Final L�•�� /„ / ✓� �,
PASS PART FAIL
PLUMBIIYG`N'-
Post & Beam
Under Slab
Top Out
Water Service 4h0K
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL y
Post &Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ervice
Rough In
UG /Slab
Low Voltage
Fire Alar
PASS RT FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA —
Approach /Sidewalk - v L = O
Other Date Inspector �� • Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job. site.