Permit y d A CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
" " ' • COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00089
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/2/2007
PARCEL: 1S133AD-02200
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE ZONING: R -
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: WESTGATE BAPTIST CHURCH
Project Description: Low voltage for HVAC wiring.
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 4/2/2007 $75.00
[TAX] 8% State Surcha 4/2/2007 $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 952-0014100. You may obtain copies of these
rules or di qu- ions to qUNC at 503.246.6699 or 1.800.332.2344.
Issued 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 OFFICE USE' ONLY •
City OfylirI y � Received
• gAr`( Daze /B . ®07 Permit No.: ``,O 6)670 i 9
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 41.r.Ihf i i+? . pme/B Other Permit:
Inspection Line: 503.639.4175 $ 4.4. c L L Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: BEI Supplemental Information
• TYPE OF WORK PLAN REVIEW
D'New construction ❑ Addition /alteration /replacement Please check all that apply:
❑ Demolition ❑ Other: 0 Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
. CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential
MI I and 2 family dwelling Co mercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
ID Multi- family ❑Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
• / 0 73 0 s ` , .' o at, , 0
V ❑Health -care facility ❑Other:
Job no.: Job site address: (� 1 a
Submit 2 sets of plans with any of the above.
City / State/ZIP: --r- Q /� .. e t t The above are not applicable to temporary construction service.
j or
n /) i ' �,1 ,, - s FEE* SCHEDULE
Suite/bldg./apt. no.: Project name: t � 1 r ✓all I t
Description I Qty. I Fee. I Total
Cross street/directions to job site: d New residential single - or multi- family dwelling unit.
Includes attached garage.
l fez -, ±- ,..cG a /4 - - 40, d/ 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no Ea. add'I 500 sq. ft. or portion 33.40 ' 1
Tax map/parcel no.: Limited energy, residential • 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WO Each manufactured or modular
/� f dwelling, service and/or feeder 90.90 2
" !re ,) '" rn o c.0 � a 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
401 amps to 600 amps 160.60 2
Name: (Ve Q I�� / � a-(/4 601 amps to 1,000 amps 240.60 2
•
A ddress: / O 7 3 0 S' V I ? Q 1' r l „ Over 1,000 amps or volts 454.65 2
' i / (,( Reconnect only 66.85 2
City /State /ZIP: I ((4 r 0c , 7 7- 2.) 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLIC T • ` ❑ ONTACT PE SON A. Fee for branch circuits with
r service or feeder fee, each 6.65 2
Business name: n Cr- for a "h. 4 r 1--- J9Ci s branch circuit
B. Fee for branch circuits
Contact name: A s y et r f- ' ^ e without service or feeder fee, 46.85 2
Address: / 7,2_0 0 1C 14 CAM Y r C each branch circuit
1c
0 Each add'I branch circuit 6.65 2
City /State/ZIP: b el r•► a J r (...1 V 7 7 0 P Miscellaneous (service or feeder not included)
c
�/ Pump or irrigation circle 53.40 2
Phone: (��3) 6 E q22 y Fax::(-C ) Sri" 91 2 1
/ � Sign or outline lighting 53.40 2
E -mail: j . J-e /Low e ) o - f ` ,) co, G.c1.f / . r, e, 7- Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or �/ �
J ( f extension Des f ibe: / Page 2 (5 2
• Busness name: `Th ir/ ° r (D - f 1 - tJ (/)1-e/
J / Each additions inspection over allowable in any of the above
Address:
I 7 a v o `Se- e d,. r r C t � Per inspection 62.50
City /State /ZIP: p A ,,. ot f r u, 7 7 a PI Investigation per hour (I hr min) 62.50
Phone: (r e i 3 S ji - 9 z). Fax: (d0 3) S`y ,p 1 i Z Industrial plant per hour 73.75
ELECTRICAL PERMIT 'FEES*
CCB Lic.: 133 /hp Electrical Lic. 6 [ Subtotal 7:57D0
Suprv. Electrician signature, required: LH 7/ /03 Plan review (25% of permit fee) "
Print name: Date: State surcharge (8% of permit fee) t. pp (� • eC)
j TOTAL PERMIT FEE V l , CO Authorized signatu e: /„ G Q This permit application expires if a permit is not obtained within 180
1 days after it has been accepted as complete
Print name: . J ' Dat e: Q .i/ I 2 �a 7 t Fee methodology set by Tri - County Building Industry Service Board
r r r • a ., r• e'...) - 1 )
•' Number of inspections per permit allowed.
is \Building\Penn its\ELC -Perm itApp.doc 12/03 440 -46 IST(l0 /02/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:
❑ 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 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 \Permits\ELC -PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FLR2007-00089
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/2/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 ,„,
INSPECTION WORKSHEET FOR DATE: 11/19/2007 TIME: 7:01AM PAGE: 2
SITE ADDRESS: 10730 SW 130TH AVE MULTI CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WESTGATE BAPTIST CHURCH
DESCRI Sanctuary - Low voltage for HVAC wiring.
OWNER: VVESTGATE BAPTIST CHURCH, PHONE #:
CONTRACTOR: INTERIOR COMFORT SYSTEMS PHONE #: 503-55D-9224
Inspection Request Scheduled For: Date: 11/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 059932-02 503-572-7392
Corrections/Comments/Instructions:
\\\\\
i■ PASS PARTIAL APPROVAL CANCEL NO ACCESS
E] FAIL Ej CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: G" t\K)e) Date: C lO r ) Phone #: (503) 718- 1-141410
. CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00089
13125 SW Hall Blvd., Tigard, OR 97223
A DATE ISSUED: 42/2007
Phone: (503) 639 -4171 jifI
Inspection Requests (24 Hrs.): (503) 639 -4175 �_!� `__..•
INSPECTION WORKSHEET FOR DATE: 9/7/2007 TIME: 7:00AM PAGE: 5
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WESTGATE BAPTIST CHURCH
' DESCRIPTION: Sanctuary - Low voltage for HVAC wiring.
OWNER: WESTGATE BAPTIST CHURCH, PHONE #:
CONTRACTOR: INTERIOR COMFORT SYSTEMS PHONE #: 503558 -8224
Inspection Request Scheduled For: Date: 917/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 055342 -08' 503 -572 -7392 N
Corrections /Comments/ Instructions:
'T N I pi C M V ` F i
010 7 SS k) LA 0C—Cl fie.
r
•
PASS ,PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: CS- iNICti3 LS Date:: 11 1(On Phone #: (503) 718- 9.144,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00089
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/212007
Phone: (503) 639- 4171atlu�li'�
Inspection Requests (24 Hrs.): (503) 639 -4175 I
INSPECTION WORKSHEET FOR DATE: 8/16/2007 TIME: 7:00AM PAGE: 2
SITE ADDRESS: 10730 SW 130TH AVE MULTI PURPOSE CLASS OF WORK:
SUBDIVISION: . LOT #: TYPE OF USE:
PROJECT NAME: WESTGATE BAPTIST CHURCH
DESCRIPTION: Sanctuary - LoV'Slfi age for HVAC wiring.
OWNER: WESTGATE BAPTIST CHURCH, PHONE #:
CONTRACTOR: INTERIOR COMFORT SYSTEMS PHONE #: 503-558-9224
Inspection Request Scheduled For: Date: 8/15/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 054059 -01 503-572-7392 N
Corrections /Comments /Instructions:
CL-2_ CAZLE.
•
I PASS PARTIAL APPROVAL CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Ci 1\V6(6 _+ Date: / b / � ' ) Phone #: (503) 718- lift1G