Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES FATEIT S: D
DATE ISSUED: : 1 11/251!,.,/9/9
27
l.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S11ODC -02200
SITE ADDRESS...:1557O SW PACIFIC HWY
SUBDIVISION -WILLOW BROOK FARM ZONING:C -G
BLOCK • LOT •011 JURISDICTION: TIG
Project Description : Add internal lighting to a new •onuuent sign for an existing
church.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 - 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 0 201 - 400 amp • 0 SIGN /OUT LINE LTG..: 1
LIMITED ENERGY • 0 401 - 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 - 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 - 400 amp • 0 1st W/0 SRVC OR FDR.: 0 PER HOUR • 0
401 - 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 - 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS • ) 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
TIGARD CHURCH OF GOD type amount by date recpt
PYRODYNE AMERICAN CORP. PRMT $ 40.00 GEO 11/25/97 97- 301053
15670 SW 98TH AVENUE 5PCT $ 2.00 GEO 11/25/97 97- 301053
TIGARD OR 97224
Phone #:
Contractor:
BLAZE SIGNS OF OREGON $ 42.00 TOTAL
PO BOX 23910
REQUIRED INSPECTIONS
PORTLAND OR 97281 -3910 Wall Cover Elect'l Final
Phone #: 639 -3262 Underground Cove
Reg #..: 000643
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 188
days of issuance, or if work is suspended for more than 188 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 881 -8818 through OAR 952 -881 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling 158312 1987.
Permittee Signature: Issued By: / 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: //A� 47
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
- Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit #
Date Issued G�- 6117'7 ---(77"
/ty . „
'I �I Phone (503) 639 -4171
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: n 4. Complete Fee Schedule Below:
o•
Name of Development roQ f-i-Q. Jd o-c. Number of Inspections per permit allowed
Address I SC. l c) 5 to q Service included: Items Cost(ea) Sum
City /State /Zip j v ()0,1-,-,e 62-, s . 9 ) 0 "- / 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business).,. C$�.. -+c e, ,4 Each additional 500 sq. ft. or
VV portion thereof $25.00
Commercial Residential ❑ Limited Energy $25.00 1
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Electrical Contractor Installation, alteration, or relocation
200 amps or less $60.00 2
Addr 1 C) 1I2-,,trt- g3 to 201 amps to 400 amps $80.00 2
City State Z q I a s / 401 amps to 600 amps $120.00 2
p 601 amps to 1000 amps $180.00 2
Phone No
I 3 a 2 Over 1000 amps or volts $340.00 2
Job NO. /5 d Reconnect only 350.33 2
contractor's license NO. .26 3 1' Q C- (_5 4c. Temporary Services or Feeders
Contractor's Board Reg. No. Installation, alteration, or relocation
Signature of Supr. Elec'n 200 amps or less 201 amps to 400 amps 2
$
License No./S g (i^ Phone Nob . 346 401 amps to 600 amps $75.00 2
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $ $5 . 00
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting j $40.00 q 0 . o c)
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $36.00
Per hour $55.00
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ qa.re)
NOTICE 5% Surcharge (.05 X total fees) $ _ c )
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. word\comdeNeiec- ❑ Trust Account #
$
prm.app
Balance Due $ et'a.aa
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location /cc 1-4-7L(7 ite MEC
Contact Person Ph PLM
Contractor 13/4Z Ph 6 - SWR
BUILDING Tenant/Owner 0.4 or az, ELC /7 71� p
Retaining Wall ELR
Footing
Foundation FPS
Ftg Drain NOT REQUESTED
Crawl Drain FOUND DURING RESEARCH SGN
Slab NO INSPECTION(S) IN FILE SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing /� �`� „� . ft iferr.[.lrrrr e.._.7 C
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling A Roof 5
Misc: J /, n
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
ASS FAIL •
EL CTRICA
rvice
Rough In
UG /Slab
Low Voltage
Fire Alarm
Fii..•-
4:1> PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: _ I [ ] Unable to inspect - no access
ADA
Other oach /Sidewalk Date 44 � / Inspector ►_ 4 , _
Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.