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Permit i ` V � CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY � F� DEVELOPMENT r SERVICES � 639 -4171 DATE ISSUED: EO/28/2004 SITE ADDRESS: 09725 SW DURHAM RD PARCEL: 2S111CD -00400 SUBDIVISION: ALDERBROOK FARM ZONING: R -7 BLOCK: LOT: JURISDICTION: TIG Project Description: Limited energy for addition of security alarm. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: • HVAC: PROTECTIVE SIGNAL: X INSTRUMENTATION: OTHER: : TOTAL # OF SYSTEMS: 1 Owner: Contractor: SOUTHWEST CHURCH OF DYNASTY SECURITY CHRIST 8301 SW 135 9725 SW DURHAM ROAD BEAVERTON, OR 97008 TIGARD, OR 97223 Phone: Phone: 503 647 - 6179 Reg #: ELE 34- 5O1CLE LIC 135086 SUP 2227JLE FEES Required Inspections Description Date Amount Low Voltage Inspection [TAX] 8% State Surchart 10/28/2004 $6.00 Elect'I Final [ELPRMT] ELR Permit 10/28/2004 $75.00 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 for h in OAR 952 - 001 -0010 thr(f AR 9 - 001 -0100. You may obtain copies of these rules or direct questions to� NC at (503) -6699. Iss by � '; l! - ea n ' Permi tte e Si Signature , /,1 c / Y d� L,G�1 9 ic, 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 Electr> , Permit Application FOR OFFICE USE ONLY ' City o f Tigard Datee/Bey PermitNo.: 24A pee .+ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 1 "nn'Nl 'l" Date/B : Other Permit: Inspection Line: 503.639.4175 =-a, ' Date Ready/By: 0 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Tel Supplemental Information M. . sue•= :"''n:. �'.'� '.,�..� = �aursi�,=p ;. 6 +a ; e> =.-..ya "Y:'ffg -./ t =,., r ;s :.:,� -' - ' UI.;, may ..: - ..s+. . ..;r `: �.c� 'k %uY':i'' e7_' .rt .- ° .:.a C: :. �,- �'ra'= :i%'r`u�e -g, . 5 "-'„ " ?e ":zr .. u u w , - N - '�;'" s • ^c=am.€ �"3" ° -� ' a` �" �. � .R.„��.. _.�a� �,�-- �s'- ,��c -�� � ��r��s"�;a� =.,= ,tea. °,.a ;K�c:�.. :�..4si w: �'e"; -_ , , . _ .. __ _._ . -a . .. • . ❑ New construction ' - 4dition/alteration/replacement Please check all that apply: El Demolition ❑ Other: v amps, mm do Service over 225 am s co 1 Hazar us location r - , r r ., K -� - � ,, _ r � y , , , , ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., G #it GORY Q O -. Zt Tk U ° , ab f of 1 -and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwellingCommercial/industrial ❑ Accessory building ESystern over 600 volts nominal units in one structure ❑ Multi - family ❑ Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more Occupant load over 99 persons Manufactured structures or 4, r , � R- ,,�. , r ,� :- .'.; '... 2 11 � 6 I D a teN, N ,SPO - fi O I ' - Vi s t ❑Egress /lightingpl RV park Job no.: Job site address: / 7 ' St.3 boe .�, • �C� ❑Health - care facility ❑Other. Submit 2 sets of plans with any of the above. City/State /ZIP: 'Ty ,__,, The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: , 1- SCHED L "... ;- . :• Description Qty. 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'l 500 sq. ft. or portion 33.40 • 1 Tax map/parcel.no.: Limited energy, residential 75.00 2 _ - -. .w _ i fi ' ,- ,, Limited energy, non - residential 75.00 2 " lA ` � ` � �- pT�� Q .a ' Wty ;, ,x: __ fs { Each manufactured or modular A P2i. / i] S E'G Lt i2 / !/L� dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 t.: ��.,, _ ..'- °° , • r 45gw � Y. Y = 201 amps to 400 a s 106.85 2 - nt i 1 '� �1°�X =bv ,.cfl u ;:x ` zg & V. 3 ?Fn K . -' gfi.a 'N� ,. s - �.. -.� - tea ,. ;•. ms 7 x s a e�� rlrtt@ ra 401 amps to 600 amps 160.60 2 Name: ' u -r Ll u p f t a/4 4 J f p j C � !,. r 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 Phone: ( ) I Fax: ( ) relocation 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I 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 4 `(Q"A$l c7 I , V aI as li C 1Vfi GT E i A. Fee for branch circuits with 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: each branch circuit 46.85 2 Each add'I branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) I Fax:: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - kkYr `; , t,''5;, 1 t `-'a� - e � .n 4040R�40_.::r;:r.' E ,g;'"' �y�,� .,tl,. I r1 energy Panel, alteration, or ',:»z1 ; z 3. e` �.�, si J k� a.l:�'awev- �v° O�u.x�. 4���' �3:)f�"4:.34'Ar.. �' f' ,t' A+ u'F' Wit Ni �-�.�5 ik .3 u.:- � --'��z �.n an 'a � a.� 'A'e� ,.' = c� 't.. �b3.�'$: My:4'�.� T extension. Describe: I Page 2 75700 2 Business name: v y -$ s E tel 'iZ- Address: S. 3 0) s(.t. 0 c 17 "/„. .._ Each additional inspection over allowable in any of the above • Per inspection 62.50 City /State /ZIP: 1/04 4 5' 7er.) Investigation per hour (1 hr min) 62.50 Phone: (g)513 i 5_ C/ 7 Fax ( ) Industrial plant per hour 73.75 n . CCB Lic.: j,3 w , Kb Electrical Lic.:.--5y.. f -GC ; Suprv. Lic.:22 u Subtotal 'f j'a� • Suprv. Electrician signature, required_ - l • Plan review (25% of permit fee) ` .. r Print name: �� JCL z Date: y State surcharge (8% of permit fee) . °C2 ( � � C / V...-7 TOTAL PERMIT FEE / • 4 ' 4' Authorized signature• / p,t, '5 This permit application expires if a permit is not obtained within 180 d days after it has been accepted as complete Print name: J jo✓ / /q �Z Da te/ '-'l "-t �/ * Fee methodology set by Tri- County Building Industry Service Board / ** Number of inspections per permit allowed. i:\ Building \Pernrits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB • Electrical Permit Application - City of Tigard _ Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: • Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\Building\Permits\ELC- PermitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection:Li 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested / AM PM BUP Location Suite MEC Contact Person Ph ( ) V 5- (175"V PLM Contractor Ph ( ) SWR BUILDING' Tenant/Owner 1 4.) 0 ...& A_(�i ELC Footing (� Foundation Access: , ELC 'O 6 - 60 33k Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam 4--et./Y/ 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 Rain Drains Catch Basin i 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 El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SS WART FAIL SITE -. El Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date V ✓ © Inspector M ( - 6- Ext Other: G Final DO NOT REMOVE this inspection record from the jo site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection:Line: -(503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested //— J AM PM BUP Location 7 -3 D Suite 2-1-7s—L/ ite MEC L fi Contact Person /- -44Yl) Ph ( )3/ PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR Oo D 6,5 Crawl Drain Slab Inspection Notes: SIT Post & Beam 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 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 . C LG - -) v I c,04-\ - LG Volta._ E � G l — a 3 10 Fire Alarm Final Reinspection fee of $ required before next inspection: Pay at City Hall, 13125 SW Hall Blvd. Via PART FAIL El Please call for reinspe tion RE: El Unable to inspect – no access . Fire Supply Line ADA / Approach /Sidewalk Date Inspector / .1 /B�' s Ext Other: Final DO NOT REMOVE this inspection roc • rd from t • - job site. PASS PART FAIL