Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00222
DEVELOPMENT SERVICES DATE ISSUED: 7/22/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111CD
SITE ADDRESS: 15750 SW 98TH AVE ADM. BLDG.
SUBDIVISION: ALDERBROOK FARM ZONING: R -
BLOCK: LOT : JURISDICTION: TIG
Project Description: 1 branch circuit.
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 FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
TIGARD CHURCH OF GOD HILLSBORO ELECTRIC
15670 SW 98TH AVENUE 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: Phone: 503 - 439 - 9666
Reg #: ELE 34 -4399C
LTC 134481
FEES SUP 4941S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/30/2004 $46.85
[TAX] 8% State Surcharge 4/30/2004 $3.75 Rough -in
Elect'I Final
Total $50.60
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 set forth in e • R 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 699 or 1 -800 -332- ' •4.
r
Is ed By: , `� Permit Signature . iii �i^ / / / i��,
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, les'e, 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
t :am:HILLSB0R0 ELECTRIC LLC. 5036013680 04/29/2004 12:47 #661 P.003
4 i _
RECE IVED FOR OFFICE Iltih: ONLY Electrical Permit _gip
•
City of Tigard APR 2 9 2004 Received
Date /B ; —.9 i --
13125 SW Hall Blvd„ Tigard, OR 97223 Plan Review , .
Phone: 503,639,4171 Fa.: 503.590 M OF TIGARD 444. � DateBv: Other Pu,,,it; ,�� /! %
i Line: 503,639.4175 i3UILDING DIVISIO *`�^ ' =- Date Ready /By; Juris; SI See Paget for
Internet: wewv.ei.iigard.or.us Notified/Method: Supplemental Information
.. TYPE OF WORK ... .. -
PLAN REVIEW :.. '.. .., •..:., •
❑ New construction4ddition /alteration/replacement , Please check all that apply:
❑ Other: ❑Service over 225 amps, comm'l EHazardous location
11 Demolition ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
' • • TEGORY OF CONSTRtICTiON -•;' i:: :. i,;: • of ••' ...;.•••;:••.. •: :•,.. of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
QMulti- family Master builder 0 Other; DOccupunt load over 99 persons ❑Manufactured structures or
-
JOB SITE IN.FORMA'I'tOi!1',ANb LOCATION .:.,:..,':., •••: ::'::,15'.:•.:'•, ::'::,15'.:•.:'•, • ❑Egress /lighting plan RV park
Job no.: '7 —1 Job site address: 15110 w ; �t , ❑Health -care facility (ve
i I' e Y1 it `�,✓' Submit 2 gets of plans with any of the e a abboove.
City / State/ZIP: ) 417,7.. The above are not applicably to temporary construction service. .
�l (� �-[ .FEE"' :SCNEDVI. .,:" ` "..,i; .::.:. :`
- Suite/bldg. /apt. no.: Project narigq - A (,k'A1 0t 4 .p..tYiPtlon I Q,,,. L Fee_ i T°tal I ••
Cross street/directions to job site: 1 + �`� New residential single- or multi - family dwelling unit.
Includes attached Itarage. _
. 1,000 sq. ft. or less 145.15 4
•
Subdivision: . I Lot no.; Ea. add'l 500 sq. ft or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK' :.:,•;.' : ;.,`:`
:,;:,.*::•
,; . • • .,. ;
• :: Each manufactured or modular
It CO Vat l `li CI v', dwelling, service and/or feeder 90.90 2
(1 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
• PROPERTY :'OWNER:' :•‘,.:::...
,....., ., •. ` "� , N;A1V :: ' : . ; ,:•• "'; .- ''•, Ot amps w 400 amps 106.85 2
° ' 401 amps to 600 amps 160.6 . 2
Name: , • 601 amps to 1,000 amps 240.60 2
Address: 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 l 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
,.. .`• ..•:j )]-AL'PI:IC' NT!: . :•::rs:.:.. ::•::;;ii:;!.:' ❑.' CONTACT PERSON'i:';:h,`•::,
•. .: A Fee for branch circuits w///t
service or feeder fee, each
Business name: branch circuit 6,65
_ • 2
B. Fee for branch circuits
• Contact name: wilhnut service or feeder fee, i 46,85 4 "� . "
each branch circuit
Address: - Bach add•l branch circuit 6.63 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 5140 2
Phone: ( ) Fax:: )
Sign.' or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
:,.... „ CONTRACTOR n,
. ; "._::; ';;•;" energy panel, alteration, or
0
2 2
- extension, Describe: Page
Business name: Hillsboro Electric L.L.C. ,
Address: Each additional Inspection over allowable in any of the above
21185 NW Evergreen ?KU Ste #110 _ Per inspection 6230
City / State/ZIP: Hi 11 sboro r OR . 97124 Investigation per hour(' hr min) 62.50
Phone: (5 0 3) 439-9666 Fax: (503 )6 01- 3 6 8 0 Industrial plant per hour 73,75
ELECTRICAL; :PERMIT FEES".
CCB Lic. :1 3 4 4 81 Electrical i c.:3 4 - 4 9 9 j i Suprv Lic 4 9 41 S Subtotal e. �5- Ar.
Suprv. Electrician signature, required:41 / ' ,� - Plan review (25% of permit fee)
i / State surcharge (8% ofpennit fee) �s
Print name: Joey Vi.tacco G Date:.. j��
"'T TOTAL PERMIT FEE 0 - 19CJ
Authorized signature: • Thi permit application expires ire permit is not obtained within ISO
days after it hits been accepted as complete
Print netne: . Date: * Foe methodology set by '171 Building, Industry Service board
•" N umhcr of inspections per permit allowed.
is\ Build ,nSV'cnnitt \ELC- PcnnItApp•oc I 21(0 44u-0r, OTC nitt >JCOM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection-Lanr (503) 639 -4175
•
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location itZ 9SN ,' - 4 - Suite MEC
Contact Person / S Ph ( ) PLM
Contractor Ph ( ) 43q SWR
BUILDING Tenant/Owner ELC /O 1 1 - 70 �a�•
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT AgrAla
Post & Beam -L_'
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing pp��
Insulation ' l � " ' / J OFF eAs S — D / ,V
Drywall Nailing Jlj
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling 1
Roof
c Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
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
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
�LT El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA / )Cint fL i rg-0 ...� .� Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL