Permit I o
� r r., �
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
�A► DEVELOPMENT SERVICES PERMIT #: ELR2004 -00037
' �' � ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/04
SITE ADDRESS: 10865 SW WALNUT ST PARCEL: 2S103AA -00101
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
Proiect 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:
SCHOOL DISTRICT NO 23 J ELECTRIX LLC
13137 SW PACIFIC HWY 115 V STREET
TIGARD, OR 97223 VANCOUVER, WA 98661
Phone: Phone: 360 - 694 - 5094
Reg #: L1450- 6951085
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 fol ru - .dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Issue y ` / J 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
f
)1111F 1 43 04 09:25a ELM( 360 6950670 p.7
RE J ��
Electrical Permit Ap_plicatipAN4 FOR OFFICE USE ONLY
City of Tigard FEB 16 LL Received � ���wJ / /y �) 2
Date/B � Tie/t/ /
13125 SW Hall Blvd., Tigard, OR 9 OF TIGARIP Plan Review
Other Permit:
Juri
Phone, 503.639 4171 Fax 503 5 G C � L . Date/By:
�f ILD ■ Li,„ " Date ReaReady/By 0 See Page 2 for
Inspection Internet. Line. . igard. r.us lJ ,� " " I.L. "' Su
Intemec www.cl.agazd.or.us Notificd/A4etlto .�.rl�� lemental Information
,_1c:.:c'' -.ar:. -- , i .M,_., IL'4;': :4 ,�.,_ rk,-"' 1: - e :¢n = - ., .RII —'''''-.1( iii :' _ -' _
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❑ New construction Addition /alteration /replacement Please check all that apply
over 225 amps, comm'l ❑Hazardous location
❑ Demolition ❑ Other: ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq ft ,
CATEGORY • ;ICONS :IiKUG'1It N' :,' ;' , , of 1 -and 2- family dwellings 4 or more new residential
❑ I - and 2- family dwelling atommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
OBuilding over three stories [Weeders, 400 amps or more
❑ Multi - family ❑ Master builder LI Other: ❑Occupant load over 99 persons ❑Manufactured structures or
: JOB;5IiT4>F� 1NF,O RIVYATI0N' Ali!ib,`- LC:4�TION , • , ., - ❑E/lihtinlan RV park
�' ':.1,': '�. . O „ _ °;';'� :�,;,,,,- . , g ress g g p t 0 D 0 -) i' U A ❑ Ha of p tth care ay
❑Oil
Job no.. Job site address: D All 'r Submit 2 sets of plans with any of the above
City/State/ZIP: 1— iCirCt. MeL ' The above are not applicable to temporary construction service.
r ' r'xdl.'•' =,,.. '', 4 I•`A . - . i. '.�` '',*,'',4! -C 'i0,. ' _. " .'
/a , no.: j
Suite /bid t: Project name :li V `
�'• p � r � f I ��• i t+
sL•L ` "� Description � - ., .. Qty. I Fee. I Total I ' -
Cross street /directions to job site• New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 1 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: J Limited energy, non-residential 75.00 2
-- - , • F Dl soR IoN or• Woi . : ±,Tr.- R _ Each manufactured or modular
�� ,a1N
dwelling, service and /or feeder _ 9 0 .90
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 ' 2
❑ : 201 amps to 400 amps 106 85 2
)'I201'ERT Y;OVfN EI� i ' .. - . ; :' hIA1tIT _, = {' ., 160.60 2
L, i 401 amps to 60 0 amps
T 601 amps to 1,000 amps •240.60 2
Name: f �L � LW, iC'( :V1 t1 lW I Ic-, _ ✓
r 454 65 2
Address: l,J i ? j 1 � �� ,� �(G ( �'i LL L Over 1,000 amps or volts
Reconnect only i 66.85 � 2
City/State/ZIP: 1 i'( � 1 � �� C Temporary services or feeders installation, alteration, and /or
l j f relocation
Phone: ( ) �J Fax: ( ) 200 amps or less I 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps , I 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
Q Fee for branch circuits with
service or feeder ee, each 6.65 2
Business name: Lp � L branch circuit
Ll t ` �� �' ' ^ B. Fee for branch circuits
J li
Contact name: i ,�,V / V 1 without service or feeder fee, 46.85 2
each branch circuit - Address: ITS k S e 4 _ Each add'l branch circuit 6 65 2
City /State; ZIP. v ,yc `, J}i C , Miscellaneous (service or feeder not included)
i,,� r, Pump or irrigation circle I 53.40 2
Phone: ( (g(�) �l y _S -7 `f Fax : : (. ) (Gi"l c' D 67 v Sign or outline lighting
2
E-mail: Je 53.40 i- ill\( c., b Z Signal ci r
. - ; :, , O / I l
r l l k - . _ , . ',:;,;� , energy pan
-. • - - alteration, . � ; :..; :, ... ='.. - .. .,. i� -_:: �r: _•• �r•,, :..; : :p :;! : : :' : : extension. Describe: Page yage2 2
en o
Business name: L•L(1,,,
Each additional inspection over allowable in any of the above
Address: its V �- { Per inspection 62 50
City /State/ZIP: Investigation per hour (1 hr min) 62.50
/�' I . ((,,ff �• Industrial plant per hour 73.75
Phone: ( " `ft 7I ) (4"'6`'1 �� Fax: (22,5 U/'ti�' ��� . i , 'EatirlZ1e 1 itti )yliT, ` v ": :t;: = .
CCB Lie ' j Electrical Lie.: 3 c),l.� Suprv. Lie.: `"f `•'J Subtotal .15
Suprv. Electrician signature, required: / 4 1 4( ' . V J Plan review (25% of permit fee)
+y �r (( I `�� �' { State surcharge (8% of permit fee) �
Printname:'�1� r1GV [ yl v Date: j1101vy
TOTAL f ERMIT FEE g 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 `Hu, Id ngWPerm,sNELC- Perm,tApp doe 12/03 440.4615T(10102/COMJWEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
i BUP
Received / 77 20C) Date Requested AM PM BUP
Location /0 U // 61)0 Suite MEC
,Contact Person 60cuctLe Ph (_ < ) 5/ 7/7f PLM
Contractor Ph ( ) c SWR
BUILDING Tenant/Owner -d:? ,1 )--P4Z, fT - a • ELC
Footing
Foundation ELC
Access: (
Ftg Drain EL
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam a' 4. i pA-6(_) - 2,
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
ow Voltag
rm
final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line '
ADA 6 p'
Approach/Sidewalk Date Inspector Ext
Other:
Final • DO NOT REMOVE this inspection record fr ., the J site.
PASS PART FAIL
•