Permit ELECTRICAL PEI MIT
�� ®� TIGARD PERMIT #: ELC2002 -00315
„41,`rAi( DEVELOPMENT PMENT r O
SERVICES 639 -4171 DATE ISSUED: 9/9/02
SW
PARCEL: 1S133AD-02200
SITE ADDRESS: : • '
SUBDIVISION: /07 3 0 /3 d S44 ZONING: R -7
BLOCK: LOT : JURISDICTION: TIG
Project Description: Shell electrical
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: 6 W /SERVICE OR FEEDER: 6 PER INSPECTION:
201 - 400 amp: 1 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: 1 PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: X CLASS AREA/SPEC OCC:
Owner: Contractor:
WESTGATE BAPTIST CHURCH NW ELECTRICAL SPECIALTIES
12930 SW SCHOLLS FERRY RD 2110 NW ALOCLEK DR.
TIGARD, OR 97223 SUITE 609
HILLSBORO, OR 97124
Phone: Phone: 503 - 844 -4788
Reg #: ELE 24 -450C
LIC 121328
SUP 4622S
FEES Required Inspections
Type By Date Amount Receipt Underground Cover
PLCK CTR 7/11/02 $217.29 2720020000( Elect'! Service
Rough -in
PRMT CTR 9/9/02 $869.15 2720020000( Elect'! Final
5PCT CTR 9/9/02 $69.53 2720020000(
Total $1,155.97
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 f w-rule opted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -008 . You may obtain CC, ies of these rules or direct questions to
Permit Signature: jr, I sued By: k /
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 : " ' %:r_ // y / it�, DATE:
,
LICENSE NO: `�' [� a-P-S
Call 639 -4175 by 7:00pm for an inspection the next business day
c, • ,-/Z :r7 I J - 24' --
1
w Electrical Permit Application
Date received: / 7 --- l / 4 . Permit no.: �9� , 3/ 2
_�g�
, ti`. ? City of Tigard • Project/appl.no.: / Expire date:
Address: 13125 SW Hall p, vd; TigardO 97223
City of Tigard � ateissued: B5 Receiptno.: [ j tilr� , o ■
Fax: (503) 598-1960 `k ase file no.: Payment type: . •
Land use approval:. NI 1 i' ' pn" ► gh.d/0- ' ��
. . 'TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory W O-Eo ercral/tndustrral 1( ''' ❑ Multi- family ❑ Tenant improvement
N New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
,i.,..?,,,, • JOB SITE INFORMATION .
Job address: ] q 3 0 5 ( S C j -/ 0 L L S GFiP/i Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: ISubdivision: /Q , ..
Project name: W 657 7f QR P! /ST I Description and location of work on premises: NF_W 4111/.0/46 - S%YeLL 44/b
Estimated date of completion/inspection: 5E, T / S , 2.00 Z-
4 >--,:c9PITjRA TJO :APPI4CA .I4)1 4.`:. , 4 + 3� 1F ;1(SCHE l .Lg. :.;: .t::< _. f .
Job no: Fee Max
Business name: Description Qty. (ea.) Total no. insp
NW El e r t r i r a l S p e c i a l t i e s New residential -single or multi - family per
Address: 21 1 0 NW A l o c l e k Dr., Ste 609 dwelling unit. Includes attached garage.
—
City: H i l l s ho r State: op' ZIP: 9 71 7 4 Service included:
Phone: 844 . 844.4788 ) - Fax8 4 4. 952 'c E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 1 21 3 2 8 I Elec. bus. lic. no: 34 . 45 0 C 2
Limited energy, residential
City /metro lic. no.: 004899 - Limited energy, non - residential 2
Each manufactured home or modular dwelling
Signatur o s nits ng e cian required) Date 7 /g /O a. Service and/or feeder 2
•
Sup. elect. name (print): R. . - License no: Services or feeders— installation,
' ' alteration or relocation: ' 4A)
PROPERTY OWNER 200 amps or less 30 •,tfp 2
Name (print): 201 amps to 400 amps / /ht,, /06.4S 2
401 amps to 600 amps 2 �}
Mailing address: 601 amps to 1000 amps / 44,64 "O. &V 2
City: I State: ZIP: Over 1000 amps or volts 2 \ .
Phone: I Fax: E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - N
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2 (A
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name. _ _ A. Fee for branch circuits with purchase of 4
Address: T service or feeder fee, each branch circuit t`C 65 / y a 2 -
City: State: . ZIP: B. Fee for branch circuits without purchase
of service -or feeder fee, first branch circuit: 2
Phone: Fax: E -mail:
Each additional branch circuit:
PLAN. REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial ' ❑ Health -care facility Each pump or irrigation circle 2 ' Z
❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each signor outline lighting 2
family dwellings /"! Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories A Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: .57/ill, 6I(/ per inspection
Submit 2 sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ 4 (o ' ' 1 S
Not an jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at %) $ 7, LR (
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ ' S 3 G
Expires accepted as complete. TOTAL $ S S .. ��
Name of cardholder as shown on credit card
Cardholder signature $ Amount 440-4615 ( KI M)
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) ¢39 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
e-A 'r s BUP
Received /a q 36 Date Requested 3 — z v AM PM BUP
L do /. Suite MEC
Contact Person Ph ( ) S 7,2 -7,3.:Z PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner Cg6 3 od VCrd
Footing • - UD . 3/.
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam •
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear LAQi` ALA -- el
Framing 1 5 GES�I�1( -1J` , P{1N 1=L
Insulation -1 _ \ C \ �N /
Drywall Nailin• l" "1. C�� 1 �OIJ —
Firewall \-•\4..,--L S 62 ~003L.5`
Fire Sprinkler t.. on G.-
Fire Alarm 1-4GVL S /ZVI C- MA- 1 C (
Susp'd Ceiling
Roof
Other: V1
Final \ `� .
PASS PART FAIL _ • ((����� � ��,, - ,��
PLUMBING - I - 1b 1» 8V.11
Post & Beam .
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Basin / Manhole --p gr3Cip W1 e .4r 6Z • 601120
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL ' ` N45,5a)` P� AL OIS •
MECHANICAL 1
Post & Beam W
Rough -In
Gas Line W
Smoke Dampers
Final •
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage A SE ` 4,\,-
Fire Alarm \_ •S"
SS PAR FAIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 0 Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA - 22 -- 0�
Approach/Sidewalk Date Inspector 1 ' o� Ext
•
Other:
Final DO NOT REMOVE this Inspection recor from the job site.
PASS PART FAIL