Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00327
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/29/2007
PARCEL: 1 S133AD -02200
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE ZONING: R -7
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: WESTGATE BAPTIST CHURCH
Project Description: Limited energy for sound and lighting system. Job No. 0000376
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: SOUND /LGHT X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WESTGATE BAPTIST CHURCH
12930 SW SCHOLLS FERRY RD
TIGARD, OR 97223
Phone: Contact #:
Reg #:
FEES
Description Date Amount
[ELPRMT] ELR Permit 8/29/2007 $75.00
[TAX] 8% State Surcha 8/29/2007 $6.00 REQUIRED ITEMS AND REPORTS
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 through OAR 952 - 001 -0100. You may obtain copies of these
rules or dir que • s t' • N t 503.246.6699 or 1.800.332.2344.
Issued __ i l l
y: II �iL 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 Application , FoR. • USE ONLY
mo � �
City of Tigard Received g
Date / Permit No: L� O J , - 40.5 �
w . y
: Q` O 7
® 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T 1 GA RD Inspection Line: 503.639.4175 Date Ready /By: orris 65 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: ( ( G / Supplemental Information
TYPE OF WORK PLAN R EVIEW
aNew 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 0 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND, OCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 "1 -3 ",
Job no.: 069,13.. -7 Job site address: • • ' • ' /Qlj Six or or more. occupancy.
Gi .- �� 6 y wK ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: r � Qd'�'/ ( ' 2 2
/ ❑ Health -care facilities. ❑ Supply voltage for more than
i � � � 0 Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: /U,2—t4_, .54„�t1,- "4.7 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total ) •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
( Limited energy, multi - family
J 47 ' 4F L• 3 J J (' y . -s ( residential (with above sq. ft.)
75.00 2
1 ` Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑' CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: ‘4,0 w,t�.2/!,, S NC_ e n e rgy circuit(s) er or limited-
� � energy panel, alteration, or
Address: O extension. Describe: ( Page 2 2
City/State /ZIP: 10,- t a,e" 9 - 7 0 9 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (509 ) ' ,...S - --- 0-(C O I Fax: (, )3) 65 2- 7G Y Investigation per hour (1 hr min) 62.50
CCB Lie.: ? ?,g 7C Electrical Lie.: Z 7eq! tzSuprv. Lic.: y't k E-21 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES'
Suprv. Electrician signature, required: Subtotal:
Print name: �G'� y � 12 Date: ?Vey/0 Plan review (25% of permit fee):
�_ State surcharge (8% of permit fee):
Authorized signature: / � TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: ✓ ,Yej,../ Cam. Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building \Permits \ELC- PermitApp.doc 05/23/06 440- 4615T(I I /05 /COM/WEB
Electrical Permit 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:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
F - 1 Data Telecommunication Installation
n F ire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n N • urse Calls
❑ Outdoor Landscape Lighting*
❑ P rotective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I_\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00327
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/29/2007
Phone: (503) 639 -4171 ammilligiOl
Inspection Requests (24 Hrs.): (503) 639 -4175 _Al, L.
INSPECTION WORKSHEET FOR DATE: 11/19/2007 TIME: 7 :01AM PAGE:
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WESTGATF_ BAPTIST CHURCH
DESCRIPTION: Limited energy for sound and lighting system. Job No. 0000376
OWNER: WESTGATE BAPTIST CHURCH, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 11/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 069932 -03 603.672-7392 N
I VI IAA L, '-'-
Corrections /Comments/ Instructions:
D
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL I PALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: - / Date: `I / i 9 r i Phone #: (503) 718- 2-1y
l