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Permit ` � ' CITY O F TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY y, DEVELOPMENT SERVICES PERMIT #: ELR2003 -00173 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/17/03 SITE ADDRESS: 11305 SW BULL MOUNTAIN RD PARCEL: 2S110AC 01700 SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG Project Description: Installation of data telecommunications system. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: • HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: CHRIST THE KING GG TELECOMMUNICATION CO LUTHERAN CHURCH 121 SW SALMON ST STE P1 11305 SW BULL MTN RD PORTLAND, OR 97204 TIGARD, OR 97224 Phone: Phone: 503 295 - 2922 Reg #: LIC 59692 ELE 34- 248CEA FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 6/17/03 $75.00 Elea! Final [TAX] 8% State Tax 6/17/03 $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 to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc �N , 1 � ✓ / � / 7 I sued by • , j;.�® 1_, .I_/ __ �_ Permittee Signature r I �� 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 • Received / RR Electrical t ,,�,,,o, 4 " Date/By: L / 7 Q J Permit No.: c -�cpw -Gt,f73 • Cit of Ti and Planning Approval Sign y g Date/By: Sign No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: - Phone: 503- 639 -4171 Fax: 503 -598 -1960 Date /B eview Awl Land Use idlip����' � �� Date/By: Case No.: Internet: www.ci.tigard.or.us .� Contact Juri ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 '�"" Name /Method: i7 p ' Supplemental Information. r„PP t 5 a '` e : t ? 14:',„ ,a te Pin A art 1 w' lease r. r , k ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location ire Addition/alteration/re • lacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, VY xEMAlp]S[� UM I0 4' - , -'': ;; 1 & 2 family dwellings four or more residential units in il 1 & 2- Family dwelling commercial/Industrial ❑ System over 600 volts nominal structure ❑ Building over three stories ❑ one Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park • Master Builder ❑ Other: El Egress/lighting plan ❑ Other: 1 ¢ tl i O � Submit sets of plans with any of the above. g The above are not a . � hcable to tem t orar construction service. Job site address: 0,95 Sk1 ,c . tzf,n .P ..� ''' .. ' 14 Suite #: Bldg. /Apt. #: °,. , t Number of inspections per permit allowed Project Name: Cog 'The 141,14 Iimiee �k(P44 Description New rn de Qty Fee (ea.) Total 1 Cross street/Directions to LO b . Includes attached garage. multi-family per wr 99 4- t 11, Sit �trt � � TA O * dwelling unit. a 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 Subdivision: I Lot #: Limited energy, non residential 75.00 2 Tax ma . / • arcel #: Each manufactured home or modular dwelling service and/or feeder 90.90 2 a / Q Services or feeders - installation, C .L ADD b •1! Does GTwo ( I QdMCtt) ti 9'10 alteration or relocation: 200 amps or less 80.30 2 13 ez es 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 : 601 am s to 1000 amps 240.60 2 Over 1000 amp or volts 454.65 2 Name: Reconnect only 66.85 2 Address: Temporary services or feeders - installation, alteration, or relocation: Ci ty /State /Zip: 200 amps or less 66.85 1 Phone: Fax: 201 amps to 400 amps 100.30 2 401 to 600 amps 133.75 2 : * ,._ �' i, . s t,, 4;t ..�. d� • x� % -_- Branch circuits -new, alteration, or Name: 3TEve Cog PA-8 extension per panel: of Address: 1(305 SW BULL M M- i tL A. Fee ice branch feeder r eeach chh branch circuit 1� � A. service or feeder fee, each branch circuit 6.65 2 City /State /Zip: 116A Q. ,7 B. Fee for branch circuits without purchase of d service or feeder fee, first branch circuit 46.85 2 Phone:5 639- $'4'0+ / I Fax: Each additional branch circuit 6.65 2 E-mail: Misc.(Service or feeder not included): k :' r � f i ` { Each p ump or irrigation circle 53.40 2 ' *= 9 ' Each sign or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, /� Business Name: GG TEl,.6co mmvwt eA O4 Oz , alteration, or extension Page 2. ( 2 T1 Description: Address: rzi 5& SA(J wM ST 'SQ % t. Pi CltCity/ State/Zip: Each additional inspection over the allowable in any of the above: y p PO P--reA I4i 0 r © R- 9 710 T Per inspection per hour (min. 1 hour) 62.50 Phone: 5b3 2.95 -19ZZ Fax: 503 - 295 - 0886�t Investigation fee: CCB Lic. #: 606949590Z. Lic. #: 34••24 di-A- Other - Supervising electrician - Subtotal $ ' signature re uired: Plan Review (25% of Permit Fee) $ Print Name: BC-R� I r Lic. : 7-5422 LEA _ State Surcharge (8% of Permit Fee) $ f' vO TOTAL PERMIT FEE $ 8 J . Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) is \Dsts\Permit Forms \ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information • , 4 LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems Burglar Alarm 0 Garage Door Opener D Heating, Ventilation and Air Conditioning System D Vacuum Systems* • 0 Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: 0 Audio and Stereo Systems n Boiler Controls Clock Systems lg Data Telecommunication Installation D Fire Alarm Installation HVAC PI Instrumentation El Intercom and Paging Systems • Landscape Irrigation Control* • • E Medical . Nurse Calls n Outdoor Landscape Lighting 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 Line: (503) 639 -4175 MST INSPECTION DIVISION Business tLirie: (503) 639 -4171 BUP Received Date Requested g- • AM PM BUP Location t � 34 .- ��- {-c-e— / d T • Suite MEC Contact Person Ph ( ) 39 PLM Contractor ( ) SWR BUILDING Tenant/Owner L / ��t Footing Foundation ELC Ftg Drain Access: ELR - D ` 3 Crawl Drain Slab Inspection Note _ _ SIT 10 a Post &Beam - � Shear Anchors r ; . 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 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 Low Voltage Ire Alarm Fi PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 6 7 © 3 Inspector `i 1 4 & Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL