Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00252
11 DEVELOPMENT SERVICES DATE ISSUED: 5/11/2004
'�' II 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S133AD-02200
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE
SUBDIVISION: ZONING. R -
BLOCK: LOT : JURISDICTION: TIG
Project Description: First floor, south side foyer, (4) NC units
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FOR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 13 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WESTGATE BAPTIST CHURCH KELSO ELECTRIC INC
12930 SW SCHOLLS FERRY RD 545 SE 3RD
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: Phone: 503 - 648 - 6360
Reg #: LIC 116254
SUP 4270s
FEES ELE 34 -433c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/11/2004 $133.30
[TAX] 8% State Surcharge 5/11/2004 $10.66 Ceiling Cover
Wall Cover
Total $143.96 Elect'l Final
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 direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: Permit 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 639 -4175 by 7:00pm for an inspection the next business day
FROM RECEIVED
' KE ELECTRIC I NC F 0000000000 May. 10 2004 01 : 05PM P1
MAY 1 0 2004 . " ( )-. 4 .' 14- "
CITY OF TIGARD
BUILDING DIVISION
EeCt.rical t!..er tit AiNAIca.tfon,i r < >,�ur>l;rtci;,l+s �
el�trloal
'• .�r pcs , N•.. 1 . _, Oa der °26 :2•••-
City of Tigard Test Form Pluming Approval
RMIIIIIIIIIIIIIIII
l 3125 SW Hall Blvd.
. DausB :
Timed, Oregon 97223 Dave Review ether Permit No %._.i- a p • — p0
Pboae: 1Q3- 639.4171 Fax: 543 - 593.1960 Peal•Revdsw
FEIIIIMIIIIIIIIII
Isomer. wvrvr.cl tigard.or.ua ' ' � f / � ` na. _ .
24• -hour Inspection Request: $03- 6394175 ''` ' ' — Contact , ■ Sam Page n for
tau• core ■ra! 7nto rrnmtloh-
l D 73 ° ' 56 () /3e r - ikk-e . .• -: i. . <...1; : : :,Fii'1'.?P;Es T <A: ° :.,;, ; }:1;6 , .?!.,r,+•,i; 777 .1P 31'M :V EW - ; le:siaChyc�f';e11t�iat'.a I
► ew construction ■ Demolition 0 Sorvica 0wer 225ampa- 2 Wealth- aarcfacility
Ad din on/alt�eranon/re•lacement III Other: 4
commercial Hazardous loaoon
�: -•;;, - ., • ❑ Unfito OW 320 amps - toting of 0 Bufldiny over 16,000 solve tact,
. e.;. , eis .. • :' s ". I CON Migl°31t. s L f.; `'. 01 :
�>;(�'� 16c 2 family dwellings faunas awe tvsidengal ur:.s In
1 & 2- Family dwelling ' ►:'Commercial/[i'idustri*l 05w/flow 609 volts nominal ono mature
AC CC�sO $t21141II Building aver time Amin ;readers, boa c ce more
a Multi- Fannil - occupant load Ova' 99 persons Manufactured structured
or RV pu;J
Master Builder a Other: ❑ EarcuiligAdng plant ❑ Other:
• . IOB S.IT;" - iT' ` ol2Mt1rZONlind 'i.'IJZ:A ? __ A; Submit act4044as with any of the above.
Mb _ �_ _ The above t ablew Ir(1Lb, co ns:
ob sir add ress: - °ta r
t pit ruecinn terviea.
Suite Or': � Ap t;RE�;, :$•_ .,_ ...,.. ;.'al'' •._ .
Number orinsptctioai per peratit allowed
Project Nance: A'STiA77' I4. " 4MARC E! 1)1341'000n Qqr Pte (<►.) I total 1
Goss street/Dit CO job site: New rarldoatl:t- rtnZSe or mule L •mmpy NI I s
dwell tag vett- InNudw attached Qaraea. ! 1
setvtu la /
Sri / f; 0 l 044 sa. h ar lcra _ 14s.15 4
Each addiIiemol 34g.sslt. o+• oist can thfrvot 33.40 t
S divi,� Lot: - . LUn a 7s,44 z
Llrlir44 tram. rroer,I,4ddial MOO 2
Tax t^. ap/Baroe11*: Each macuracntred home or modular dwoMug
• '7kS.0 ?P OI"LOP WG 17.1. eecvicetad/Orfi.d + r 5 4( 2
Services or loaders - i tuta1latioo.
r / G a►umtbs or irtoes .m....-- J 1-/ ' w - - 200 imM or lea sa�4 i 2 2
341 torus b ernvr _ 14615 2
401 amw to 00 amps 16040 Z
1 PROP 3-S^Q. t 1.. :.: , .. , 1::.. 4, __ Sxn;;? <:? ?'r #Ii.,.� .,. ���,�,: s! ki p to mufti A Z49...E 2
Name' Over 1004 amts or volts 454.65 2
I Adc}teas' #Lmsonne4FOnir 66g5 2
Temporary services or teainra • inatallttioa,
Cl /StS Ie✓ Z l ■tteranlor or retention:
209 imp* w 1,013 66-85 i
I Phone: Fax: 19 arfflluto4a?rent !00.30` 2
=0 i4PP. iC .N21" - :H?' _. i�; :;i: 4 :;; ai ® oNTAkal.PEltwj02!T� �! ;; 4.1 t° 600 "''r' 133 .75 _
'' i " Branch eircrits - hew, altorttioa, er t
Name: _ estNSlo0 per welt
' AddrCSS: w Fee for porch eksulq with purchase of
4c0v 1eG or fader toe, ash ranch circuit 6.0 2
, City/State /Zip: 11. Pet for branch circuits without purchase of
• $ 2
Phone: Fax:
Wiles offisdrrfee, grst .95
brtncil circuit 46 _ ,
E-mail: ach ,• .. b . L s eirarit i .. 6.65 a/g
ri Miac.(Setviu of fesdar not included):
-
- - -. - .... -' CONTRACTOR ; ;<.' c .. - . , sc ;:;: /WI A1rnp Of lrrtaa t5r n Clrcls 53.40 2
} T 3 0: E.t.d.. st or outline iighry a 53.40 2
Business � — - if rdrmit(s a r isited dimly panel,
1 �' ,7 i� �.. . ; �c� �i �s ov
Address: T
- tZ�
Ciry /State/Zip; 0iL�lj ', RG m q'i t•• } Each additional laspection ever the allowableIn arty of the abore:
'
Phone: > 2, , . Fax: F�'' (per hour • min. i hour) i 6150
I _
i . � Lnv t� o 4�r ( Prot
C C13 Lic. Lic. if: _
1 S upervising electrician ,Ii / r .•:4 : :; : ° :. `T`. ` l c l Paimtr;$a •:;v : •• :•;L'4∎ : `
I signature required: s 1\ 4 • Plan Review ,ale tai 5 1 , 2f j _,t
I Print Name: ( MS % of Pernsir Fee) I S
Liz. #: • �' -
Ststc S tar b.irgs (SV. et tat Pee) I S J (T< f
Authorized
( TOTAL PERM:7 FEE 1 s I
Sir affe: Date: Nodes 7als permit eppliaitloa =Ores (Its ycrralt Is not obtained within 113 days altar it has Cosa sosaptad a complete
(Flux Print nrcuc) 'Fee rastlso.delogy toe by Trl- County Dvilelloy Industry Saw stand.
tand.
W . 342.42a..0 .L CF %IAA, /_- • / s ,
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: ' (S03) 639 -4171 MST
(� / BUP
Received Date Requested _ ( ( 7< AM PM BUP
Location (0? tic3 Suite MEC
Contact Person I A-0 Ph ( 7 Z 7 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 2Z
Footing
Foundation ELC
Access:
Ftg Drain ELR ° 0 0
Crawl Drain
Slab Inspection Notes: F- ErP2Cz- 4-00P147
Post & Beam E(-R c za3
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
insulation _ • _ , 11 i
Drywall Nailing .e6' �� . aL
Firewall /Pr LEP WA - U_,S
Fire Sprinkler
Fire Alarm / 4
Susp'd Ceiling
Roof ( 14 4
i jZ i 1, t r S �" � 6-a S 7
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service � l l v
Sanitary Sewer P4% / (
j !
Rain Drains v '` - �
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
L
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Fi
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 17 --- �y IV Approach /Sidewalk Date Inspector Ext
Other: l �
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL