Permit CITY O TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2003 -00205
11 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/16/03
SITE ADDRESS: E/033 S J L /NGOL/✓ ST PARCEL: 1S135AB -00100
SUBDIVISION: TOWN OF METZGER ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
Project Description: JOB NO. 60 -6062
Voice /data cabling to (3) portables. ONE CONTROL BOX FOR ALL 3
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:
WASHINGTON CLACKAMAS CO BROADWAY ELECTRIC - COCHRAN INC
SCHOOL DIST 23J 626 SE MAIN
6960 SW SANDBURG STREET PORTLAND, OR 97214
TIGARD, OR 97223
Phone: Phone: FAX - 238 - 2098
Reg #: U£4- 65600072942
SUP 3447S '
ELE 37 -546C
FEES Required Inspections
Description Date Amount Elect'l Final
[ELPRMT] ELR Permit 7/16/03 $75.00
[TAX] 8% State Tax 7/16/03 $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 throuc
Issued by l Permittee Signature _j/
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
.I�'
' Electrical Permit Ap 'cation
. . A
Date received: Pemut no4� 0 /07,3 _ e p�o5
City of Tigard � � Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW + �'. rgard, Q �� " 223 Date issued: By: I Receipt no.:
Phone: (503) 639 -41 ' •
- L v
Fax: (503) 598 -1960 ,� 6 Case se file no.: - Payment type: .
Land use approval: ` . x :1 1 O p 0\��5 - - •
. '-.- . __... TYPE OF PERMIT_ '' ` a > _
❑ 1 & 2 family dwelling or accessory e. Commercial/industrial ❑ Multi - family ❑ Tenant improvement
O New construction • Addition/alteration/replacement ❑ Other: ❑ Partial
��' JOB SITE INFORMATION -
Job address: �fi�- �!� ' _ - o.: Suite no.: Tax map /tax lot/account no.:
Lot: (Block: JSubdivision: t LL /I J�
Project name: (,}=, e E4 Mb.s.ar Description and location of work on premises: Vol l to /DAL G`( is. TO 1. LL
Estimated d of corr tie
.L,- CONTRACTOR APPLIC . TION FEE SCHEDULE
Job no: t) , 0 Fee Max
Business name: P ( o 0.111%, A j . E te.C.F-✓j (r single o multi ) Total no. insp
Description . Qty. (ea
New residential - single le omulti-multi-Wilily - ily per
Address: % A. r dwells gunit.Includesattachedgarage.
Cit )3z,‘
p / 1 - a I State:0/'t I ZIP: ' 7 Z/ 9' Servicelncluded:
Phone:
3 - ‘ ',��, tf Fax: Z 3r-2t) g 9I E-mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 7 2.4 .1 I Elec. bus. lic. no: 3 7 - sq ` (. Limited energy, residential 2
City /me *c. O.: / Limited energy, non- residential 2
`, / is / ? Each manufactured home or modular dwelling
Signature of supervise g electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): .AN u c_ _ _ License --/-_5 Services or feeders — installation,
e,,
alteration or relocation:
PROPERTY O11'N ER 200 amps or less 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:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600am 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits 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 or feeder not included):
O Service over 225 amps-commercial O Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1&2 0 Hazardous location Each sign or outline lighting • 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ' •
O System over 600 volts nominal more residential units in one structure alteration, or extension' // JJ 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Egress/lighting plan O Other. Per inspection I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ �•
rm
O Visa Cl MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card numbs / / within 180 days after it has been State surcharge (8 %) $ .
Expires accepted as complete. TOTAL $ • n 0
Name of cardholder as shown on credit card •
$
Cardholder signature Amount 4404615 (6/00/COM)
CITY OF TJGA�iD 24 -Hour
BUILDING k Inspect L e: (503) 639 -4175 MST
INSPECTION DIVISION Busin me: (503) 639 -4171
.
,.l �( BUP
ld 3rj'b L /COLA �— i 1 AM PM pP
Received Date R equested
Location 7D ckt Suite MkC
Contact Person 6Yu Ph ( ) go — Re.S,Sq PLM
Contractor btc tiu ag - CnrA1ra., E7cS'riG Ph ( ) 34 H,S SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
g Access:
Ft Drain ELR — n v -- ).-‘25
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam /�h S`9�
Shear Anchors 9 cs . .s ll"> � _ / � ()k / �
Ext Sheath/Shear i 7]' .
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler 4
��y 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
iK-14
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
. owVot -.1:.
ire Alarm
1=1 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
E PART FAIL
S ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA � 03 Inspector Approach/Sidewalk Date J9 . � p a E - EXt
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL