Permit . *' ELECTRICAL PERMIT CITY OF TIGARD RESTRICTED ENERGY
� DEVELOPMENT Tigard, SERVICES 639 -4171 DATEESSU 7% R �0 -00203
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE PARCEL: 1S133AD-02200
SUBDIVISION: ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
Project Description: Limited energy 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 BORING, OR 97009
Phone: Phone: 503 - 558 - 9224
Reg #: ELE 472LHR
LIC 135118
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 7/13/2004 $75.00 Elect I Final
[TAX] 8% State Surchart 7/13/2004 $6.00
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 o • ow r• - adopted by the Oregon Utility Notification Center. Those rules are set for in OAR 952 - 001 -0010
tr ough OAR 952 -0• -0100.2y • . • stain copies of these rules or direct questions to 0 C at (503) 246-6699.
-sued by :� ....24t l / Permittee Signature b S c�w,•� -�
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application FOR OFFICE'USE ONLY
'' `J o Tigard
Ti A, , and
Received
Permit ut No.:
13125 SW Hall Blvd., Tigard, OR 97223 :
Plan Re ,`iii/ -'Q��
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
'NP�'t�'I'�. DateB Other Pemit:
Inspection Line: 503.639.4175 r "'ter Date Ready/By: Suns 0 See Page 2 for
Internet: www.ci.tigard.or.us Notifed/Method: Supplemental Information
Y,�', •re °'i^-t#" '�°: ':�!z� ,,.;r�.� .�Nr:x s.,� y5, �.a� r> �..� �w , - , e• w ;:t;r:
;°;, 'rte T r.�_. O .. +r k ' . at -, ,'F Y ??' d: -. : ~'WFry- ._ :; < 1 : :.1 '= . .
,re `��.�.a:��.��:.::. � `�.� eX.PaI�', :� ; ;t fi - : ,. ��P�'AN I2!��'I��.VS'� .
..m�zt�s -�a�t �ez..� � s+ a+r wr°a�: ... "._r�`r.._. .�... -- ....,s i?rt° r �• ` :<.x,=:','ia
ew construction ❑ Addition/alteration/replacement Please check all that apply:
1:1 Demolition ❑ Other: ['Service over 225 amps, comm'l ❑Hazardous location
H , t , ' ; r, "4 4 --. n ;., ; , t h ., e. w y ,, ; , k ,- , . ,;,
,, ,, a ; ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
�a > .. es. �,.
e r.' .. CA E G.b QF' CO S IM0 O a '' *a fir'c:c�.'k»; , t4 - l it- ` of 1- and 2- family dwellings 4 or more new residential
�-' t'�x"'s >xav .R. �.•.�x�;�s �a:'6>:i€�a.., ; z- .t,_.�xies:'a�.;ct>rs
❑ 1 - and 2 family dwelling ommercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder ❑ Other: ['Building over three stories ❑Feeders, 400 amps or more
• � Master ['Occupant load over 99 persons DManufactured structures or
"
<��,; . .. ��
_ �. ; .,.�,;. ,�,- ��--
JOB 1. ..?�,,��::.i NEF1R.: ��� l A,trol " .. O X11 O 't = a $ park
;*r u. 4 '�� .� ,`� � ❑Egress /lightingp1an RV P
tT 3U Ski 1 J J a ,. v . . " ❑Other:
Job no.: Job site address:/ 7 /
['Health-care facility
,. �._ - r Submit 2 sets of plans with any of the above. •
City/State /ZIP: �` r_l c! , The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 0 I Project name: 02.) 1 4 l , 0 f i` "lt *f S ffiit, V `.' .
n�:�3 . # �:w....F,....w,.,....s'"a,,. v�•"?. •':� '�� :�' � �• r'.::.:
r cription Qty. Fee. Total
Cross street/directions to job site: V New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
��, , rte te e., ,.� �� - ,_ Limited energy, non - residential 75.00 - 2
it t np r ogv t ; 5C CRT? N� U' T+ r - 7 , �. 0^ 4 t ,
..s,, „_, Y ', , - ectr -.z„ a it �k 44 Each manufactured or modular
J I / dwelling, service and /or feeder 90.90 2
{- 11 V a i A I ( Ye l �d V Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
ek * a..*Mitk s ¢ ,: �- . . Ar n •< ..,: 201 amps to 400 amps 106.85 2
� _ ;���:�` P
-ks4„� � r • Ir® FSR . , Q s:. « t '�, . �r v I Ny T 7: '', �. ,,,
401 amps to 600 amps 160.60 2
Name: �
PJ eV �a i d IA 4- 601 amps to 1,000 amps 240.60 2
�, _- 4--
Address: ( ,7 30 _si /30.... el _. / 40 , Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 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 600 amps 133.75 2
Owner signature: Date: 1 Branch circuits - new, alteration, or extension, per panel
r y iX, .`k -'.M� ".... rrep - . , ' , .n. qt r 7l q a .c., :! Y.:<.�'s' � rh.: i° :FY = ' (te .'
a. r H '
�Pf C � � . s O �` �3. A. Fee for branch circuits with
w �` -
,»':1 ..�: ." - '. is Rim:. '. ..:424, f�- :" t `.i 2 �a "�k .�. ' a;. service or feeder fee, each
�-p branch circuit 6.65 2 B. Fee for branch circuits
Business name: y f r U r �y /1-
Contact name: 1111
/ / x iea , e J without service or feeder fee,
Address: n each branch circuit 46.85 2
7 D- a �1 — o -"- �( CA e l Each add'I branch circuit 6.65 2
City/State /ZIP: -C; �` r Miscellaneous (service or feeder not included)
Phone: (41:0 ) ;( - S l' °- 9',ZZ+-( J Fax :: ( ) Ss - 9/ 2 fL Pump or irrigation circle 53 2 •
II !! ( Sign or outline lighting 53.40 2
E-mail:
-‘ t e r - t - u co_, 0,46. c "7 .1e-7 Signal circuit(s) or limited -
<F 4- `�. T eTay� , IL4 �TORX -.ya i n aria e , energy panel, alteration, or
Business name: extension. Describe: Page 2 2
Address: �} / Each additional inspection over allowable in any of the above 1 : i le-,--.. s
7 2 O `1 , C L — ,ir?. -rte Y t r� / "\ Per inspection 62.50
City /State /ZIP: de� �i h r - ( c 0 Q t Investigation per hour (1 hr min) 62.50
) .r c,- T,,,,, ` F ax: ci J e _ 9/z Industrial plant per hour 73.75
Phone: (SZ23 (Sp ) `� i „ �" r LR 'P _,.,�' °=;:.:
CCB Lic.: /'s)/ ' Electrical Lic.: ' '79.I. f/-2 Su Lic Subtotal
y_ L �_
Suprv. Electrician sY ilfe,'"required: Plan review (25% of permit fee)
Print name: Date: ' State surcharge (8% of permit fee)
• TOTAL PERMIT FEE
Authorized signature: (// a ,g, , A This permit application expires if a permit is not obtained within 180
� — / days after it has been accepted as complete
Print name: m re Y A e vt r,1 Date: U i / f Q i * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Pemuts\ELC- PemutApp.doc 12103 440- 46I5T(10 /02/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: " (03) 639 -4171 MST
Vi 7(� BUP
Received Date Requested AM PM BUP
Location (07 ( Suite MEC
Contact Person XL) Ph (03) 67 E- PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC Access:
V-0
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: Err 4 — CO P
Post & Beam Eag cev 303
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Drywall Nailing p/ y 1
Dryl{ N l'� �� ��� � _��' �/ P4/� 0/1
Firewall �T /1 l 77 LEP W &S
Fire Sprinkler
Fire Alarm
Susp'd Ceiling / /� �— n
Roof CD �l v� j i l fl n r S 3/ l i G�725
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer PAS F 4(41 •
Rain Drains `�
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
-
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
LECTRICAL
Rough -In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE: ❑ Unable to inspect — no access
Fire
ADASupply Line
Approach/Sidewalk
Date I ✓ Inspector I . a Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL