Permit A. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00413
�4 DEVELOPMENT SERVICES DATE ISSUED: 7/8/2004
I
MA' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S104AB -04700
SITE ADDRESS: 13401 SW BENISH ST
SUBDIVISION: ZONING: R
BLOCK: LOT : JURISDICTION: TIG
Project Description: Job No 11548 Install electrical per plans & specs for the elevator
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: 1
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: 6 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:
OUR REDEEMER LUTHERAN CHURCH ATLAS ELECTRICAL CONTRACTORS
12256 SW 135TH AVE 4403 SE ROETHE RD
TIGARD, OR 97223 MILWAUKIE, OR 97267
Phone: Phone: F - 659 - 4944
Reg #: 'r'9 - 2212 2581S
LIC 1532
FEES ELE 3 -2C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/8/2004 $140.15
[TAX] 8% State Surcharge 7/8/2004 $11.21 Ceiling Cover
Wall Cover
Total $151.36 Elect'I 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: if AL �- !
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
Electri Permit Application I FOR OFFICE USE ONLY
City of Tigard 200 I Received Permit No ��� 9
13125 SW Hall Blvd., Tigard, OR 9722 ' P Plan Review
P 503.639.4171 Fax: 503.59LI19601 OF Ti AF O DDate/By: Other Permit:
m
Inspection Line: 503.639.4175 p ( �pppp ( � (�ep ( � • �. j. a' I � Date Ready /By: lurk: El See Page 2 for
Internet: www.ci.tigard.or.us L-` LiMONS 1 IVEti -- Notified/Method. Supplemental Information
sates' ..� - 's:713,; ,..1 ,Sn'i- `,'u_ :`laa ;dAy' r';;'F:t t` "x'` : «.'� +"
a � ,s,.� ..T:YPE - OF,��VORK � =?' °` PLAN REYIEW;��i
s ..,. :s ��;` � •r�.�..? - tr.. _ -.< . : ' ;aes ro �
❑ New construction ® Addition /alteration /replacement Please check all that apply:
❑ Demolition ID Other:
Service over 225 amps, comm'l Hazardous location
: , R � ,�.�, , ,._ ,,, - . ❑Service over 320 amps rating ❑ Buildng over 10,000 sq. ft.,
E(; i``' �4r y CATEGORY '.OF.CONSTRUCTION:xp -a.. :<<:�''1'° y dwellings more � -�� ��: -_ :,- .- .- �rrrs��: : , ...,.,o ...: . ........z- �x _a�:..n�a:<�: °,.?.•,.n;.l.. -x.. of 1 and 2 amt we n s 4ormor new residential
❑ 1- and 2- family dwelling S Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder El Other: ['Building over three stories ❑Feeders, 400 amps or more
['Occupant red structures or
0 t load over 99 persons
JOB SITE INEORVIA 191 iAND LOCATION�i :?,:d E /li htin plan RV park
. �:W �:�. � -.< -- ��" � -o -: : , -.�.• � �ti a . � _ �� � ❑ g g g p
❑Health -care facility ['Other: Job n Job site address: 13401 SW BF;N T SH STREET Submit 2 sets of plans with any of the above.
City /State /ZIP: . T I GA RD , OR 97223 The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: OUR REDEEMER LUTHERAN ' aF ' - -- FEE *SCHEDULE # ' " ">a " ;,,
UTHERAN D escription Qty. I Fee. Total
Cross street/directions to job site: 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'( 500 sq. ft. or portion 33.40 1
Limited energy, esidential 75.00 2
Tax map /parcel no.: �
Limited energy, non - residential 75.00 2
6 ` D, .SCR1PTION F- WORK' k ', am
r ...
. .�. � .. ,.. r _ . - ..., O , . � � -r a �, �� °`E`.` ° ������- , Each manufactured or modular
dwelling, service and /or feeder 90.90 2
FURNISH AND INSTALL ELECTRICAL PER PLANS AND
Services or feeders installation, alteration, and /or relocation
SPECIFICATIONS FOR THE ELEVATOR 200 amps or less 80.30 2
4 ' is s ',.,,,J; i ;flat; :; ,;,[s': 1 amps to 4 amps 106.85 2
PROPER ... ()V1'NER TENANT `'" , ' °i ,a`,t
:.
,. �3 „ - � i _�.. y. -._._ .,.»,r,� ..,�.: _ _.. " _ :.. . - r .. ,. �., a . . _ _- » •�.,�-- „.::E � ,aa.n. ,,. 401 amps to 600 amps 160.60 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 1 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
' '” C a ` `" t A. Fee for branch circuits with
� ' ®' +'ARPIICANT �' ®CONTACT PEKSON ;I
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
Address: r �� w W
each branch circuit 46.85 �19:'J 2
Each add'I branch circuit 6.65 . ,,C Q, 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle d 53.40 j1.,4Q 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
;, ,,
� _ l _ , ,
_ -� CONTRACTOR` � , - ,� y : - energy panel, alteration, or
�� extension. Describe: Page 2 2
Business name: ATLAS ELECTRICAL CONTRACTORS . INC -
Address: 4403 SE ROETHE ROAD Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: M I L WAUK I E, OR 97267 investigation per hour (I hr min) 62.50
Phone: t 50 659 - 2212 Fax: 150 3) 659 - 4944 Industrial plant per hour 73.75
.-." P;; „.. ELECTRIC- 80PERMIT FEES* - : :.: '- ;: =- r; ",
CCB Lie.: 1532 Electrical�hic.: r . Suprv. Lie.: 5009S Subtotal t1 ‘,\5
Suprv. Electrician signature, required: Plan review (25% of permit fee)
� h 3hep�rSk ) Date: - 7 I � o 014 State surcharge ( 8 % permit fee) `P1 . ,`
Print name:
lI �t TOTAL PERMIT FEE IA Ell , �.0'
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
1:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 46t5T(I0/02 /COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line .45031639 -4175
INSPECTION DIVISION Businesstl_ine: (503) 639 -4171 MST
BUP
Received / �/ Date Re uested — ` AM PM BUP
Location / 7 0 ( Suite MEC
Contact Person Ph ( ) 9) 3 6 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: _ w _ __)_ f SIT
Post & Beam {�� � �- -��L/�
Shear Anchors
Ext Sheath/Shear (p7)31
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
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
e' ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS -- PART FAIL
SIT ❑ Please call for reinspection RE: 0 Unable to inspect— no access
Fire Supply Line
ADA
Approach /Sidewalk Date - ` C / V Inspector — - Ext
Other:
Final DO NOT REMOVE this inspection record fr a m the Jo a site.
PASS PART FAIL
•