Permit CITY O F TIGARD ELECTRICAL PERMIT
RESTRICTED ENERGY
ol1r" DEVELOPMENT SERVICES PERMIT #: ELR2004 -00011
r � J l - 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 1/23/04
SITE ADDRESS: /D3.50 Std /-/N c o�� �� PARCEL: 1S135AB-00100
SUBDIVISION: TOWN OF METZGER ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
Project Description: Low voltage for 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:
WASHINGTON CLACKAMAS CO ROBERT LLOYD SHEET METAL
SCHOOL DIST 23J 4485 INDEPENDENCE HWY. 51
6960 SW SANDBURG STREET INDEPENDENCE, OR 97351
TIGARD, OR 97223
Phone: Phone: 503 838 - 3863
Reg #: LIC 62476
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/23/04 $75.00 Elect'I Final
[TAX] 8% State 1/23/04 $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)
246 -6699. PP
Issued by AALcA--&-a,...,112..e_h_.> Permittee Signature 4-y\
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
01/20/2004 12:24 FAX 5035981980 CITY OF TIGARD Lii1007
.
FJECEIVED .•
Electrical pillnit Ann lica on FOR 01410E USE oNLy
City of Tigard 'JAN 2 1 21A Received
Date/B . 4 '2. 1 W" 61 Permit No.! _ , 0
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 •
1•• ' Dater/3 : Other Permit:
Inspection Line: 503.6:4.4175 CITY OF TI i ,
f , I !,''. i
.,,-„...,... - ..1 ___ Date Ready/13y; Mil a See Page 2 for 1
internet: www.cisigard.or.as PLANNINEWE c NEERING NotiftecVMethod: Supplemental Information
i :
1 ;11 .1 " 1 .. 1 .!W...:I .::: tri!j I Mi'..:i l . EF. 11 .1.:.. ...,:-1:;*# 0 ,- '-:: . : ..- -:-'i:: : -, • :i i .'' . ... : : P LAN
D New construction Igi Additiontahcrationireplacernent Please check all that apply: •
°Service over 225 amps, comml °Hazardous location
101 1'
Demolon 0 other: Cisewic. over 320 amps - rating 0Buildng over 10,000 sq. ft. ••
':P1• n'il-gi;li.!i:'difiied0Iiilf:••13F1tibftliidit)14
•-• • 2 • 1 : 11 1 1 '.:''• ' ' : ....- ' ,11 7 1 1j of 1- and 2-farraly dwellings 4 or more new residential
- .1, .....:61,..t.11.....!..mi:.:!...P,Iiiii . • •• - ........ -......:;,.. ... • . .. • ............ . ,•••-, :..! : • • ., • 1 • ..:::1.1.., _
0 1- and 2-family dwelling XI Commercial/industrial 0 Accessory building USystan over 600 volts nominal units in one structure
0Building.over three stories I:Waders, 400 amps or more
13 Multi 0 Master builder 0 Other °Occupant load over 99 persons OManufactuted structures or
W., .'-tl•.[''•jnr,?.•,14;,1'tikitf..R11•*rAgti4O10.k:*Rq.t 00410N::0:$0ii::::..:7.:.::41. 1:1EgressAig,hting plan RV park
.... 00ther: .
•
Job no.: I Job site address:49 c
['Health-care Liility
• - Submit 2 sets Opine with any oldie above. •
•
Cjty/State/ZIP. P RI. LA NI 0 1 0 R. Si 2 7..77) The above are not applicable to temporary construction service.
ii:::;! : i::::•;.•,•: .. . 1 .•:
Suitc/bldg /apt. no.: I Project name:
nutrition 1 Ctirj Fm I Tma t -
Cross street/directions to job site: C Ro sS ,...---rREET L ...ft -
i ti New residential tangle- or multi-famlly dwelling unit.
'''"'"' r'" — Includes attached garage.
1.000 eq. ft. Or less 145.15 - 4
Subdivision: I Lot no.: Es. oddl 500 sq. R. or portion 33.40 .. 1
Limited energy, residential 75.00 2
Tax map/parcel no.: . ,. , Limited energy, non j 75.00 2
1 1 ; : 'f••Elr.13010.44P.1041.!**A*Vri..11.1l10iii i tll' i j.) 1 ' l kil : ,- Each manufactured or modular
• C
I V Fct. 5 `- S I E AN .. dwelling service and/or feeder , 00.90 ,
11 . Services or feeders installation, alteration. atid/ar relocation 2 •
SYSTEM 200 amps or less 80.30 2
IrR'-iii1; k
g .,:::....:......;::illi.,.!N'...:1•1:11.ra.Hy...4iii,jot :: • ,:...: ...::• : Oa - q r. . :: 201 amps to 400 amps 106.85 2 1
' 2
401 amps to 600 emps 160.60
Nam: T.16; R(?_T) -a u r 1 Prct t- Ci-i-obL. 0 1ST . 23.) 601 amps to 1,000 amps 240.60 2
Address: k Go s e s-r. 0,4,1,000 amps or volts
•
Reconnect cmly 66.85 2 •
City/State/ZIP:--r I gi Arab O R E. • 9 7 7, 2, ""S Temporary services or feeders installation, alteration, and/or
, , relocation
Phone: (503 ) ‘f 31- -1,coo j_Fax: (503 ) ti 31- , --uo L. ( 7 200 amps or less 66.85
Owner installation: This installation is being made on property that 1 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 ..
1.1;:',•13:1:1;i1s :... ::1,051001t0.4Ft..„..;. 1'.'0.:iii•:..:;;.:;.filaygoittiA01.../i•.,,•••:....:' i : it. .... '..::: A. Pee for branch circuits with
SCrACC OF feeder fee. each 6.65 2
Business name: R o_ae... . k :c - L ... EET mETAL 11,1c . _ branch circuit .
B. Fee for branch circuits
Contact name: without service or feeder fee, / •
46.85 1
Address: t.4L5 I NDEPENDEA HWY Si .. each branch circuit
Each add, branch circuit - 6.65 _ 2
City/State/ZTP: t kj DE,pEN1DENC.. 7 OR . GI 1 35 I Miscellaneous (service or feeder not included)
Phone: (565) B 3s - 3s c I_ Fax: : (50'5) e3c6-39.(OH Pump or irrigation circk
Sign or outline lighting - 53.40
53.40 2
2 - '
E-mail: Signal circuit(s) or limited-
•:1;1:'::1.-f;•••••!!!::■•••11iFili1:11■•..-5:•::••••4.5;0)14T1104VPRIAK;.::.F'ViTI::;:d•At;it Itl:Pli:1;•.1:::: . l' :,Ti energy panel, alteration, or
extension. Describe: Page 2 2
Business name: .5 c , y ey3 F, 4'3 R. p pc, I c 1 20..cr .
Address: t( /( Each additional Inspeedon over allowable In an of the above
Per inspection 62.50
City/State/Z1P: /t 7( I( . .. Investigation per hour (1 be Mid) 62.50
Phone: (S $38 -3S4,3 - ax:(Scz.3 / :: I Ti ' 314'41 Industrial plant per hour 73,75 -
I
. k ., i i!:1•!.I'111":""!:!!!..VILBOTREIOMIAPERMITIVE•ES1:'::" ''':!•,•::'1:;: . .,
1 1 -, ci A
.
CCB Lic...82 7 ( Electrical IIV ow 70 I f 1 i
' ',. . c.: . 5 i L Subtotal 5 C) - 7s -
- i-
su Electrician signature, required: , / / 0-- / - (9), Plan review (25% of permit fee) ,
Print narne:
/ D . : State surcharge (8% of permit fee) or00 6
TOTAL PERMIT FEE L nc
Authorized Signature; IC — / '2 — " De_ fts This permit application expires If a permit Is nut obtained within ISO
day. after It has been eccepted complete
Print name: . I Date: • Pee methodology set by Tri-County Building Industry Service Board
, .,., manber of Mr:pectoris parPanall allowed - -- - - ,
Bair rithAELCor Cf lilit ADP . .12103 e50461STIIIYOVCOMPKIB q i 101
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested Co — ° Z3 AM PM BUP
Location Suite MEC
Contact Person r a 3 5 - ' 1.- Ph ( ) l 3 - O d 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner TE 6&_erieti ELC
Footing
Foundation Access:
ELC /
Ftg Drain ELR �v `f - Mc /
Crawl Drain
Slab Inspection Notes: el V c® � L SIT
Post & Beam ,
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 11 VA-C � 0 Si5 ,Q 2y� FS L,
Drywall Nailing 1'1 /T / 1 „ �P�
Firewall - A
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
Rough -In
UG/Slab
Low Voltage
F i farm
N PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line z �J G
ADA Approach/Sidewalk D ate 6 J 2 -!m J Inspector 1 `�� Lo v ty Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL