Permit :'� ;
•
CITY O TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
All � A DEVELOPMENT SERVICES PERMIT #: ELR2004 -00035
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/04
SITE ADDRESS: 08048 SW SHAFFER LN NEW DURHAM PARCEL: 2S113B0 -00300
SUBDIVISION: SOROMa ELEMENTARY SCHOOL ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of limited energy for securty 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:
SCHOOL DISTRICT NO 23J ELECTRIX LLC
13137 SW PACIFIC HWY 115 V STREET
TIGARD, OR 97123 VANCOUVER, WA 98661
Phone: Phone: 360 - 694 - 5094
Reg #: L1€0 -6951 ,'t9:5
ELE 37 -930C
SUP 4398S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/18/04 $75.00 Elea! 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 ` /�L / Permittee Signature
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
jp/F EN 18 04 09 : 23a ELECTR I N X 360 6950670 p . 4
RECEED .
Electrical Permit Application - , FOR•OFFICE USE ONLY
FEB 18 20011A Received
13125
City of Tigard Date/13 : §NYA re I i t MI 1:= I MP 7 I I I I f- - o , /AA .
kb
SW Hall Blvd., Tigard, OR 97223 ni -ry (.) TIGAR ri . Plan Review ,
Phone: 503.639.4171 Fax: 503.598.1960 w" ' —F 4 ,..... .,. ,
Date/By: Other Permit:
Inspection Line: 503.639.4175 BUILDING DIVI....-4.47.1-..(11 .. Date Ready/By: Anis: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
:.:'''', :.; .4 1 . :' ,.:::7ii .-- 1: . : : :, 4ir
0 New construction 121Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l ['Hazardous location
0 Demolition D Other: ['Service over 320 amps - rating OBuildng over 10,000 sq. ft.,
-•-• ::: :.!,:,. :.!._ :- ':. :': -2 - :. • .: • :' ::-,:;: !.0AT-P09RY',Cq0C9P1:§110JCTV.4.4::!!:::::::',i1:::1:!..!iiu,:.!•:7,:;:::•;.::'::::::: of 1- and 2-family dwellings 4 or more new residential
E I- and 2-family dwelling ErCommercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
0 Multi-family p_ Master builder 0 Other: , . . ['Occupant load over 99 persons 0Manufactured structures or .
' '.. r,f:g DEgressflighting plan RV park
Job no.: / 6 1 ? - Job site address: g
" - PI a - X.h 4 e-Ht 'n DHealth-care facility ['Other:
Submit 2 sets of plans with any of the above. •
City/State/ZIP: --f*ez4, a...— The above are not applicable to temporary construction service.
(,.
Suite/bldg./apt. no.: j Project name:LM/UV% ,-X,W.I hi Description I I:2 C Y' I F"' Total 1 ..
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 I 4
Subdivision: Lot no.: Ea. addl 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
•
Tax map/parcel no.: .. , ,. _. Limited energy, non-residential 75.00 2
• S's , r''i s- •,' . .i ..... ,..7 1 , . - ,+ .: , i .. ;'.. ".': ....:.::...:..::: g .- . .:i !: 0....,00114#01S:;j:**$00::!". Limited
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
, -..-: ..::..... ...-,• - -,,- - • ,...,• - --,--- f , ...- -- ::•-,: ink 201 amps to 400 amps 106.85 2
• '''• •*.,: !.!-•!;;:■.....,:!!'..:...n.71.q:!r,: ii.;'.-;•:-:,,:‘,.:::::-.5;::;!.!!::
t L i - - ' ... 1 7 . - . ..._ 401 amps to 600 amps 160.60 2
Name: tu , IL o .. go I 5t. 'D- 601 amps to 1,000 amps • 240.60 2
Address: (..1 rb 131 51./.) -Paal-A_ ktahl Over 1,000 amps or volts 454.65 2
Reconnect only I 66.85 I 2
City/State/ZIP: i ,,-8 Ey2_, j 1 ?-?-- Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 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 I 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
;.* ,•::..,.. , s . :'1f . :-;; j:1„!*ppkt•Aspj...:.:,t,64:,:=.r:t;:V:::..:;:ijl.:il,EM3t.00.0.1?:V.W.NVFilij.-=:'.:: A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: €1 y L,L,(1..., branch circuit .
B. Fee for branch circuits
Contact name: ‘ \ ( 34,..f vywr- without service or feeder fee, 46.85 2
each branch circuit
Address: kic t 94 Each add'l branch circuit 6.65 2
City/State/ZIP: ki ytyq . kAiVt C I bip L j Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 1 2
Phone: (3it D ):0,11.4,57Lcp4 Fax: : (ij) AS- GioTO Sign or outline lighting
53.40 2
\ • • .
E-mail: ‘t-11.-oft (6.. (to . v ,.5... , Signal circuit(s) or limited-
'!..i'-1e,;!li:V.•;j:;-.:tAtTlinilli!:.33,0 , 104101§5;;:j , ;,:l r ybiiifq6.0g51U.i i i,W;i..!..;:ligN, , , energy panel or
, alteration ,
extension. Describe: Page 2 2
Business name: al C-171 r , IL C., ,
Each additional inspection over allowable in any of the above
Address: tic t S-iNit r Per inspection 62.50
City/State/ZIP: ‘)01A( tilt ‘,0 ft cl tip(' I Investigation per hour (1 hr min) 62.50
Phone: ( 'N0) Vlti4 - ) Fax: NiD) Vtc - C1,7 0 Industrial plant per hour 73.75
,i •
CCB Lie.: I 4 Electrical Lic.: 1 . Suprv. Lie.: i-1-39 b5 Subtotal
Suprv. Electrician signature, required: iill' - • 0
Plan review (25% of permit fee)
t
Dae: a( itit.i State surcharge (8% of permit fee) G
L
Print name: tv't. TA- TOTAL PERMIT FEE 5 I —
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:\BuilOinsTcrmils\ELC-PcrmitApP.doc 12/03 440-4615T(1W02/COMAVED
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested � - a o q AM PM BUP
Location 5 F Suite / MEC
Contact Person )0a.,/,___e Ph ( ) 3/ (� G/ PLM
Contractor �/� Ph ( ) SWR
BUILDING Tenant/Owner �� /[,( ELC
Footing
Foundation ELC
Access:
Ftg Drain
ELRdo• V eB-5
Crawl Drain
Slab Inspection Notes: • SIT
Post & Beam Cam(;
Shear Anchors
Ext Sheath/Shear
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/Slab
•w Voltage , ,
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk
Date z 8 - 2 V Inspector/ / /Art Al/1-56 Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL