Permit ACITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
PERMIT #: ELC2003 -00382
��' DATE ISSUED: 2/17/04
.�
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: Electrical work for new administration building. 1 200amp service and 30 branch circuits.
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: 1 W /SERVICE OR FEEDER: 30 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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 DELSTAR ELECTRIC INC
15670 SW 98TH AVENUE PO BOX 1371
TIGARD, OR 97223 TUALATIN, OR 97062
Phone: Phone: 692 - 3219
Reg #: L1C 63667
SUP 3214S
FEES ELE 34 -214C •
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/17/04 $279.80
[ELPLCK] ELC Pln Rev 2/17/04 $69.95 Elect'l Service
[TAX] 8% State Tax 2/17/04 $22.39 Rough -in
Elect'l Final
Total $372.14
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 t o OUNC at (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By. 9// �"7 P ermit Signatu Ii,, i�i.�4' _ iii„ / ice.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, I:' e, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: ' c -- / 47 ‘ S
Call 639 -4175 by 7:00pm for an inspection the next business day
a
fr • .
4 Electrical Permit Application FORAFF CE US ONLY .
Received ( ---, Electrical
��® Date/By: �' Iy -03 PermitNo.: CZ 6,Pa03"O 3 g 2
City of Tigard R °CEI Planning Approval Sign
Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 14 2003 Date/By: Permit No.:
F Phone: 503- 639 -4171 Fax -598 -1960 y/ ? Post- Review Land Use
� Date/By: Case No.:
0 �, Internet: www.ci.tigard.or.us � ��� _ 1
'\l A Contact Juris.: ® See Page 2 for
24 -hour Ins ection Re uest: `"
p Q S1Q'� Name/Method: Supplemental Information.
BUILD Quar'v o3 -ao 3 P7 1;4.,,4- '/y /o3
Ngt +>;- W K,F. _ %.,3 iiat,, e�. ar' tiiEtiaka4�s.""�`�:��.'�"�.aar_
E New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑Hazardous location
❑ An /a lteration/replacement ❑Other:
❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
t
J 1 , dditio G, l ung CO Commercial/Industrial ,. >, 1 & 2 famil dwellings four r more residential units in
El 1 & 2- Family dwellin Co mmereial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more ----.)
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
... ,�-;,.�_ I ^- k� =� W-' ° '1 Submit sets of tans with'an of the above.
� �;� ��: ;� The e above are not applicable to temporary construction service.
W
Job site address: - 5 clQ) -fh /`�J� ,._.t ` -, ,A ;..,;lie
Suite #: /S72 ..co Bldg./Apt.#: Number of inspections per permit allowed
Pro Name: T, 4[/A ChvV�� b (/� ce- Description Qty Fee(ea.) Total I �_
`'`��' Cross street/Direc to Ob site: New residential - single or multi - family per i M
l � � dwelling unit. Includes attached garage. W
Mai V �/1rh(A vn Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
i Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
ll umpanw� tototo �'Q, WO t e3 z, `"" service and/or feeder 90.90 2
" a kl�- t O F t _ ,C 11 f,/ , �.r _ ., /(/, } t e +/1 e or ref Services feeders - installation,
ti W C �/�. t.4. -vim V 1 1 1 alteration or relocation:
i � I s !. t yi ei 200 amps or less I 80.30 a 2 •
,\ VL 201 amps to 400 amps 106.85 2
, . 401 amps to 600 amps 160.60 2
;�'" a �, 3 .'' °` 601 amps to 1000 am s 240.60 2
.. =PROP I2 Q ! NT IZ, c .a., i;4.` p p
v Name: 11 aver C ij P &O� Over nett only 66.85 2
amps or volts 454.65 2
' �
{� Reconnect
k Address: ( 1 =2'G/0 5 ki 9 & ii l Alte Temporary services or feeders - installation,
T 9 a O p, a 200 alteration, ps o le relocation:
City/State/Zip: Z Z � 200 amps or less 66.85 1
I Phone: Fax: amps ps 400 amp 100.30 2
4:.d APPLIC R.. T, � Y�, : . A . _ ,,. alteration, or
201 s
401
`` -, `� ' � ��^' � ► /� .�+ � � ,t ; �C' °% � P�'� � B ranch circuits new, a n, o
'.t Name: 7 at.k�( I/V� \ 1'' A h ` � c 1> extension per panel:
Address: , O N V V y r m a h 9 r A. Fee for branch feed r fee, each ranch circuit of 6.65 /4g jj 2
�` service or feeder fee, each branch circuit �
City /State/ 1 p: Po ' a a c CO 2-1 0 B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone:(5j 'Z � ZZ 115 Fax:( O) �� Z"' 1460 Each additional branch circuit 6.65 2
b ., E -mail: .. i Yv1 01 e) Zak k vh 1 1-e r .- ca wi Misc.(Service or feeder not included):
• a ,{ " b aT 4GTQ a „E ,. asla Each pump or irrigation circle 53.40 2
:- Vi i'' . � O - -- _ - --,447-4",-,-------
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: t t , ' • 0 41 V ‘ I / alteration, or extension Page 2 2
Description:
iNi( Address: o r_ r3� % [�z
City/State/Zip: Each additional inspection over the allowable in any of the above:
y 1> T,,y5 ,r, , 0 1 t ,Q ?7&(Z Per inspection per hour (min. 1 hour) 62.50 _
Phone( 0D ( I ii" frt(b' Fax: G r/-- 834 Investigation fee:
CCB Lic. #: Li, . #: 4� _ �, 3 Other:
Supervising electrici g� 11 /0 1 o i ✓ " ' �"
Subtotal $ x' .9e)
signature e re uired: ( � � �� Plan Review (25% of Permit Fee) $ /b rq . '5
Print Nam- : Av� re � � �,ty Li # : 31 4 State Surcharge (8% of Permit Fee) $ ,gc9, , 3`j
/0--! —o y TOTAL PERMIT FEE $ s3-a. /4 d
Authoriz d ' Notice: This permit application expires if a permit is not obtained within
Signature. // / , /L / /if .n. ' •_ °T / 7 / 180 days after it has been accepted as complete. 0 'J
I *Fee methodology set by Tri- County Building Industry Service Board. 1 I� "1
0
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
Burglar Alarm
Garage Door Opener
n Heating, Ventilation and Air Conditioning System
Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
Ti Clock Systems
n Data Telecommunication Installation
0 Fire Alarm Installation
HVAC
n Instrumentation
n Intercom and Paging Systems
Ei Landscape Irrigation Control
0 Medical
n Nurse Calls
I I Outdoor Landscape Lighting
n Protective Signaling .
n Other
•
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lie*: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested _ Zr AM PM BUP
Location / .57, Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant /Owner 0-4/JA .l�- � �t -r�-� / ELC
Footing v
Foundation ELC
Access: % bd
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes:
Post & Beam p ♦ -
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
•
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam /
Under Slab /
Rough -In
Water Service
Sanitary Sewer ‚ 4,
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
e0) Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
• El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date / ® Ins actor Ext
Approach/Sidewalk - p
Other:
Final D . NOT REMOVE this inspection record rom t he b site.
PASS PART FAIL
•