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Permit • V `� CITY OF TIGARD COMMUNITY DEVELOPMENT ELECTRICAL PERMIT lig ° PERMIT #: ELC2008 -00683 D ATE ISSUED: 12/23/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S 133AD -02200 SITE ADDRESS: 12930 SW SCHOLLS FERRY RD ZONING: R - SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: WESTGATE BAPTIST Project Description: (5) branch circuits. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS • 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 4 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: WESTGATE BAPTIST CHURCH NORTH LAKE CONTRACTORS 12930 SW SCHOLLS FERRY RD 12900 NW LOVEJOY CT TIGARD, OR 97223 PORTLAND, OR 97229 Phone: Contact #: PRI 503 - 709 - 0985 FAX 503 - 641 -3168 FEES Description Date Amount Reg #: ELE CI3 [ELPRMT] ELC Permit 12/23/2001 $73.45 LIC 154178 [TAX] 12% State Surchar 12/23/2001 $8.81 SUP 4891 S Total $82.26 REQUIRED ITEMS AND REPORTS 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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions t NC at 503.246.6699 o 1.800. 2.2344. Issued By: 4Dak (p 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 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 ApplicationRE FIVE — FOR OFFICE USE ONLY City �'1 V eceived PePenult No. U PI ° 131 of Tigard SW Hal Blvd., Tigard, OR 97223 Pla Rev w 2 n8 �� V 008 • 00 ( � ` L 2Q!,,;� Plan Review Other Permit: 2 ' Phone: 503.639.4171 Fax: 503 DEC 3 Date/By: T I G A R D Inspection Line: 503.639.4175 . Date Ready /By: Juris: ® See Page 2 for Internet: www.tigard -or.gov ARMING A OF TIGARD Notified/Method: T t (2� , Supplemental Information TYPE OF % WH. SING DIVISION PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling yr ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ", Job no.: Job site address: 1 F I OOHP or more. occupancy. 1 � 3- •� �446U-`s 1 612/!1 QO ❑ Six or more residential units. ❑ Recreational vehicle parks. City/ State/ZIP: �'• tG ��� �'� Z 1 d 3 Ell Health-care facilities. ❑ Supply voltage for more than 4 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 1 1' ..c- ‘ 0 Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: 5C,atol,ts F t tza.y , kl0k1, Description I Qty. I Fee. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 I Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) r! Limited energy, multi- family (0 , (lk ( (� ) qtA.) 14 4t' — ec4 ill 1 1 (Z) Er` R-t L residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation F4 ANA / I' etc 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 113 es Tc, Art Z erPns , - C rt0ac 1-1 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 1 2A 3O s tI SG NdU.S . y R D Over 1,000 amps or volts 454.65 2 City/ State/ZIP: � �� q7 ZZ� Temporary services or feeders installation, alteration, and/or relocation Phone: ( sea) s L i4 / I Fax: (50 3) 5 z y 454 6 200 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 599 amps 133.75 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ A$PLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2 Business name: each branch circuit i b U Tl'a IV 1g erne) n t L 1 t•.14 B. Fee for branch circuits Contact name: • without service or feeder fee, 46.85 2 t � N u ja first branch circuit ' Address: Each add', branch circuit 4 6.65 2 I b r 7 3 S I� L it t`gS FoReser ` a 1_ V Miscellaneous (service or feeder not included) City/State/ZIP: l.,„„..K ? St) t?4 O Oa e c 7a 3 S Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: (503 ) . n a 735 L Fax: : ( ) Reconnect only 66.85 2 • E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 r U Signal circuit(s) or limited - Business name: N 0 its T qt. �K reIU i U. energy panel, alteration, or Address: + Z C 1 Ob N tJ LA0vcrOV CTI extension. Describe: Page 2 2 C ity/State/ZIP: pd to- LKoIN 0 kO cjj r- Z.2 1 Each additional inspection over allowable in any of the above / Per inspection 62.50 Phone: ( ) q - Fax: ( ) 7� 1 � Investigation per hour (I hr min) 62.50 CCB Lic.: 154 I �) g Electrical Lic.: C 13 Suprv. Lic.: y $ei i -3 Industrial plant per hour 73.75 --1' 1 l\ 1 O • .�10 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: S � Subtotal: 7,3 .4 > ti Print name: ,, r t 1� Plan review (25 % of permit fee): a i, 1 1 1 i f Date:) 2� ( 8 l� g State surcharge (12% of permit fee): S' , C 1 O . Authorized signature: TOTAL PERMIT FEE: R 2 • 2 Print name: Date: This permit application expires if a permit is not obtained within 1 0 days after it has been accepted as complete. • Number of inspections allowed per permit. I: \Building \Permits \ELC- PermitApp.doc 05/23/06 440-46I5T(II /05 /COM/WEB E lectrical Pernut Application - City of Tigard Page 2 - 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: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 - 309 - 0000) Check Type of Work Involved: El Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation p Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: • 4 No licenses are required. Licenses are required for all other installations t:\ Building \Pennits\ELC- PermitApp.doc 03/23/06 — — CITY OF TIGARD , BUILDING DIVISION PERMIT #: ELC2008.006t33 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/230008 Phone: (503) 639 -4171 i 111 Inspection Requests (24 Hrs.): (503) 639 -4175 " :_ INSPECTION WORKSHEET FOR DATE: 3/2/009 TIME: 7:00AM PAGE: 9 SITE ADDRESS: 12930 SW SCHOLLS FERRY RD CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: WE.STGAl E BAPTIST DESCRIPTION: (5) branch circuits. OWNER: VVE.STGA E BAPTIST CHURCH, PHONE #: CONTRACTOR: NORTH LAKE CONTRACTORS PHONE #: 503 - 709.0985 Inspection Request Scheduled For: Date: 3/2/2009 Pour Time: Code # Inspection Description C z ofirm -# Contact # Message 12U Electrical rough -in t 80946 -04 503- 672 -7392 N Corrections /Comments /Instructions: C.0 N F- i S b 5 Cte* l) 6E t> i II) k_., Pic;` A A(et -\,n k) J (c ❑ PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ?:I FAIL y] CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED J " ,,,,'' llII II i Inspector: G--._ N_� Date: 3-2--, Phone #: (503) 718- 2i'T CITY OF TIGARD i BUILDING DIVISION PERMIT #: EI_C200l O0683 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/23/2008 Phone: (503) 639 -4171 Ars I "'' ` l Inspection Requests (24 Hrs.): (503) 639 -4175 IL. INSPECTION WORKSHEET FOR DATE: 3/2/2009 TIME: 7:OOAM PAGE: 6 SITE ADDRESS: 12930 SW SCHOLLS FERRY RD CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: WESTGA1 E BAPTIST DESCRIPTION: (5) branch circuits. OWNER: VV STGATE BAPTIST CHURCH, PHONE #: CONTRACTOR: NORTH LAKE CONTRACTORS PHONE #: 503 Inspection Request Scheduled For: Date: 3/2J2O09 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical finial N080946-05 603.572 -7392 N Corrections /Comments /Instructions: Co N)c Li £'r; 6 -- ga4mN fe 5 N c��® t..yrt G e � . fkdq- ii (e3 11b1(11/4 n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS 1; FAIL 71 FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: • 1\) 0 e L Date: 3. 21 Phone #: (503) 718- VP IL L