Permit r
CITY OF T I GA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
- � E,li�� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00039
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/04
SITE ADDRESS: 06960 SW SANDBURG ST PARCEL: 2S101DD -00701
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: I -P
BLOCK: LOT: 004 JURISDICTION: TIG
Project Description: Installation of limited energy for security system. Job No. 082
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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: SECURITY. X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD - TUALATIN SCHOOL DISTRICT ELECTRIX LLC
6960 SW SANDBURG RD 115 V STREET
TIGARD, OR 97223 VANCOUVER, WA 98661
Phone: Phone: 360 - 694 - 5094
Reg #: LI60 -6951! r7. r■ c 5
ELE 37 -930C
SUP 4398S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/18/04 $75.00 Elect'I Final
[TAX] 8% State Surchart 2/18/04 $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 throuc
Issued - /� Permittee Signature V.,,�
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
Feb :, 04 09:56a ELECTRIX 360 6950670 p . 4
.. • N
Electrical Permit 1 7 ._ 0EIVED FOR OFFICE USE ONLY
A . Received irMilMOWIPrilLMI
City of Tigard • Date/I3v: ____.AA. AO lit
13125 SW Hall Blvd., Tigard, OR 97223 FEB 1 8 2004 AN,\
. Plan Revie
Phone: 503.639.4171 Fax: 503.598.196 .' . Date/By: Other Permit:
Inspection Line: 503.639.4175 pa
hriS: sa See Page 2 for
Internet: www.ciligard.orus CITY OF TIGAR ...""--- ---. Noti ethIBL: 40 Supplemental Information
- . if'. ' 2P0,,,,,g,-,wogl,•,,,,,, ..y.e.,,,,,,,,,,,,,,,,,u!,,,,,,,,,,..• / ,,,.nty tov . .,,,.:,,,t,,,,,
, . t:iii:..7 .i„.. -.. ':.'' - .',! ...,' - : '-':'. ..',;■.
D New construction 0 Addition/alteration/replacement Please check all that apply:
• 0Service over 225 amps, comm'l ['Hazardous location
E Demolition El Other: . . ...... ......„ .. . .... OService over 320 amps — rating 0Buildng over 10,000 sq. ft.,
•:!.,..:,,..:;....;: Th. .. cATIVippgrif ;
. . ...„,,; i, ,..:;:..■:,...,,.: ; .% - , - of l- and 2-family dwellings 4 or more new residential
1::1 1 - and 2-family dwelling 0 Commercial/industrial 0 Accessory building 0System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
E Multi-family D Master builder 0 Other: DOccupant load over 99 persons 0Manufactured structures or .- •
';;-,,,:.•;: ;;.; ; i ,:;;•;.; :; ;;;::,; .. .. H . F_OlsOlgiovN*Ng..1,10 - 9001:140::',A , ,Fiy,j . : ;:.','AlAi', , ,:,, ; 0Egress/lighting plan RV park
,, " 0Health-care facility 00ther: 1
Job no.: q-. Job site address: L.fli NA) ...).4./fle...91,‘„(1..,.19f Submit 2 sets of plans with any of the above.
v ,e-
City/State/ZIP: i w OW_ e-ii r'.-er The above are not applicable to temporary construction service.
. ' OtiratrAtinipfire..40,01:Stimagilit:;1,:':gM.:V:fff=7..:::;0:::
Suite/bidg./apt. no U Project name: itgAIN,i Ai 50201)Y6/1.. UV ". ---'' ' ...— -." .."-- ' --- 1 '. ...'' . '... To ' .. -.... - .
Description I Qty. Re I
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'I 500 sq. ft. or portion 33.40 1
. Limited energy, residential 75.00 2
Tax map/parcel no.: . Limited energy, non-residential 75.00 2
:.; - : .-,..:;:•'':' i i. -::.•10§YVArqi: f9,Sif'NYMMT.::ii.rii:sr:':•:;9.:!:41,5::•M4...gin3 Each manufactured or modular •
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' 201 am s to 400 am s
414141*;P:1':Nr1.:;i10. amps 106.85 2
.. ' - --,-- -."- " -'• ----: 401 amps to 600 amps 160.60 2
Name: • per • Ati 1/- ›C 1 VtAtl" a
'' . A • tkt) 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
.
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 44'7, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
,...;..-tik,•ok_4104:e...::-!,.;,,;.:R.:.:::,:!!.;WL.q-E-Itioiqx4t.,p-gjoy se
,in,;:: A. Fee for branch circuits with .
Business LA:../siness name: t. 1 V I
— aii- h: .. rvice or feeder fee, each 65
branch circuit 6 2
1 - . B. Fee for branch circuits
Contact name:,3€4.4.... vA without service or feeder fee, 46.85 2
16 \i SK-Cir each branch circuit
Address:
Each addl branch circuit 2
City/State/ZIP: V fynt /t
61,r01/ tiVA C i i4ols i Miscellaneous (service or feeder not included)
Pump or irrigation circle I 53.40 I 2
Phone: (31 ) L Li _ soci 0 Fax: : (34 ) 16C/5 ..- Up 1 0
Sign or outline lighting 5340 2
E-mail: . )64 try\ (0 ..ek_tchil t .k ; Signal circuit(s) or limited-
1„a,P.;;A:i;TdoSigkistAtfti.!;O:r;•'6iilA-E.11;i!1:ii6;:..:glati extension. Describe: Page 2 2
i,;i energy panel, alteration, or
Business name: fl i (JO y
Each additional inspection over allowable in any of the above
Address: 1 tc V 9trevi Per inspection 62.50
City/State/ZIP: V tic.,11 011 8 La (p I Investigation per hour (1 hr min) 62.50
Phone: (910) toCill . 4- -IN 4 ,..,.-: ...,...A
Fax (7 i .0) t5,v
. Industrial plant per hour 73.75
Petit:PZ
CCB Lic.: it...( Electrical Lic.: ig- 430L. Suprv. Lic.:45g s5 Subtotal
Suprv. Electrician signature, required: (WI i . Plan review (25% of permit fee)
LI - , I V -' - State surcharge (8% of permit fee)
Print name: kAlli CM, C NJ j Date: 0 I INbil, -
. TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri-County Building industry Service Board
- ‘• Number of inspections per permit allowed.
i:\Building‘PermitAELC-PermitApp.doc 12/03 440.4615T(10/02/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION' Business Line: (503) 639 -4171 MST
BUP
Received . 3 3 Date Requested l7 ci AM PM BUP le)
Location rte?'/ 4 ,ZLtA_ GQ.J/U/l _ •Suite MEC
Contact Person ( ) cl / q I — 7 'V '7cT v PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner _', 1 ' ! ': ELC
Footing
Foundation ELC Access: Z
2
Ftg Drain EL11, ) K -C 3
) D
Crawl Drain
Slab Inspection Notes: pp / 0 SIT
Post & Beam . ( 1 LeA ()A i
/
Shear Anchors q �'/ I
Ext Sheath/Shear �C�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
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/S
Low Voltage i '
ire• -
AO Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date - �7 — e Inspector l �
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL