Permit l v '' - CITY OF TIGARD ®D ELECTRICAL RESTRICTED ENERGY PERMIT
° . 0 COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00219
J ARE_ 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/15/2008
PARCEL: 1 S 133RD -02200
SITE ADDRESS: 12930 SW SCHOLLS FERRY RD ZONING: R - 7
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: WESTGATE BAPTIST
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:
WESTGATE BAPTIST CHURCH INTERIOR COMFORT SYSTEMS
12930 SW SCHOLLS FERRY RD 17200 SE HEMRICK RD
TIGARD, OR 97223 DAMASCUS, OR 97089
Phone: Contact #: PRI 503 -558 -9224
FAX 503 - 558 -9124
Reg #: ELE LHR7
FEES LIC 135118
Description Date Amount
[ELPRMT] ELR Permit 7/15/2008 $75.00
[TAX] 12% State Surch 7/15/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 ''cation - .ter. ose rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0 40. You may obtain copies of these
rule or direct questio = o 0 :t 503.246.6699 or 1.800.332.2344.
Is ued By: /0 I 0 _ . 4 . / I 1 P ermittee Signature: A ,��_, ``
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 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
• Electrical Permit Application )7 ' y '1,-'1,411-4§1.11A001- Ic bsisl ° ., '
• City of Tigard Received ill K C.,_() Permit No.: / '9 • ' , 9�(a l
Date/By: (
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 _ _ /i n ' ?' � ,.< ?, DateDate/By. Other Permit:
Inspection Line: 503.639.4175 u ' 1 i Date Ready/By: Juris ® See Page for
Internet: www.ci.tigard.or.us Notified/Method I Supplemental Information
1 OF WORK ' PLAN REVIEW
• ❑ New construction Ifi Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGOR CONSTRUCTION of 1 - and 2- family dwellings 4 or more new residential
❑ I - and 2 family dwelling om mercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION . RV park
['Egress/lighting plan P
Job no.: Job site address: G ``'�� S � - (" / ['Bea e acility ❑Other.
V JGh II ft ,f plans with any of the above.
City /State /ZIP: Gc r� 4r# r oZ Z he above are not applicable to temporary construction service.
°� FEE* SCHEDULE •
Suite/bldg. /apt. no.: V Project name:
Description I Qty. I Fee. I Total I ..
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
(� Includes attached garage.
_
5 I 4 ± f a� a GI J 7 P c ./ 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF W RK Each manufactured or modular
— i c e _ .. r -
dwelling, service and/or feeder 90.90 2
v �'^ ^ e / Services or feeders installation, alteration, and /or relocation
V° I .. < �^ • 200 amps or less 80.30 2
( / r � p 6....r i / il 5 p 1 t__ J f ' r .�'\
El O PROP OWNER ER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
' ' `) cPv r1 C
• / -(
Name: p
` 1
-t J ' - ( j u P r/- � 601 amps to 1,000 amps 240.60 2
Address: / 2t t� 1 8 +� n [
J L 17"--1- r Rol O� Over 1,000 amps or volts 454.65 2
! /}�
City / State/ZIP: ""7 `/!"/ /� 66.85
Reconnect only
Q V C � , Temporary services or feeders installation, alteration, and /or 2
S relocation
Phone: ( ) `' I 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 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT . 1 ❑ CONTACT PERSON A. Fee for branch circuits with
- -
r service or feeder fee, each 6.65 2
Business name: ` t o C M . l o 5 - 40 r s branch circuit
Contact name: B. Fee for branch circuits
Or C( �4 � 46.85 2
without service or feeder fee Address: CC� each branch circuit
f Wt.')
-., �-z Each add'I branch circuit 6.65 2
City /State/ZIP: � J �` Ci 7 o Miscellaneous (service or feeder not included) -
Phone: ) S i -91.2._„z — y l Fax: : (s�_j) ,s- ! // Pump irrigation lighting 53.40 2
E -mail: e i 53.40 2
(J✓r ` b / �� �- 9 � � Sign or r outline g / 1!( rr7 " ar- ' ., 6r �r a ' � (• ,- irk Signal circuit(s) or limited-
CONTRACT energy panel, alteration, or
Business name: _ Pi extension,p�cri ` Page 2 2
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) 5/3/09 I Fax: ( ) Industrial plant per hour 73.75
1 li' ELECTRICAL PERMIT FEES*
CCB Lic.: /s , d I Electrical Lic.: L tf 7 1 Suprv. Lic.: Subtotal
Suprv. Electrician ` signature, required: U earn D -, q , J 6/ 1 1 E Q Plan review (25% of permit fee)
Print name: /ja fo. ` Oa !' (°J_ l Date: �' State surcharge (8% of permit fee)
( ? j TOTAL PERMIT FEE
Authorized signaturet' a efa, This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: ,�y Date: " " Fee methodology set by Tri- County Building Industry Service Board
el 1 vl ^ 668 ,,4_,,,., w ?1- J t� !�
/ Number of inspections per permit allowed.
i : \Building\Permits\EL.C- PennitA p.doc 12/03 440-46IST(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 7. Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK .ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
i COMMERCIAL' WORK ONLY ,1
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pennits\ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2008.002t9
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 71.5/2008
Phone: (503) 639- 4171 "' i ���
Inspection Requests (24 Hrs.): (503) 639 -4175 s
INSPECTION WORKSHEET FOR DATE: 3/2/2009; TIME: 7:00AM PAGE: }(}
SITE ADDRESS: 12930 WI SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: F7.F.S1 GATE BAPTIST"
DESCRIPTION: Low volt ago for HVAC
OWNER: WF TGATF BAPTIST CHURCH, PHONE #:
CONTRACTOR: INTERIOR COMFORT SYSTEMS PHONE #: 503- 558 -9224
Inspection Request Scheduled For: Date: 3/2/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
189 Electrical final 080946-03 503 - 572.7392 N
f
Corrections /Comments / Instructions:
PASS ❑ PARTIAL APPROVAL fI CANCEL n NO ACCESS
(l FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G • t 6 Li Date: • -: Phone #: (503) 718 -1-'1 414