Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00136
„y4,” DEVELOPMENT SERVICES DATE ISSUED: 3/8/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102CC -01200
SITE ADDRESS: 13720 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of branch circuit for new sign.
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: 0
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 FOURSQUARE CHURCH OWNER
16260 SW 108TH AVE
TIGARD, OR 97224
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Phone: 503 - 624 -8021 Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Underground Cover
PRMT CTR 3/8/01 $46.85 2720010000( Elect'l Final
5PCT CTR 3/8/01 $3.75 2720010000(
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 are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATUR , i i � / • $ ' ISSUED BY: . ..,(aMir- gc.7 ... j _ ez ___
OWNER STALLATION 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
Electrical Permit Application
Date received:3 /r /0 / Permit no.: g j - # jr a 4
4.x1`i 1,,,,
I,L , City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By;lj Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family A 0 Tenant improvement
0 New construction 0 Addition /alteration/replacement 0 Wither: •& 0 P ial
yz: r 1•Q: L'r
JOB SITE INFORMATION
Job address: L3 702 0 30 a 6c----, N w . Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: - S/O • —O 2.
Project name:'r' gqn.A 1. ,( ,,r4. I Description and location of work on premises: /i /-77t h -F0 r 5 / ' r7
Estimated date of dompletion/ins ction: 3 7,3/0 /
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address: dwelling unit. Includes attached garage.
City: I State: I ZIP: Service included:
Phone: I Fax: I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: I Elec. bus. lic. no: Limited energy, residential 2 .
City/metro lic. no.: Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services orfeeders - installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
/ 201 amps to 400 amps 2
q
Name (printrr Ar Sv,rSiu arse 0 t.„ it
f 401 amps to 600 amps 2
Mailing address: / (, 2 G 0 S / O8" 601 amps to 1000 amps 2
City:
T; la 4 `" IState:O k ZIP? 7,2 Over 1000 amps or volts 2
Phono e', ..c 39 -9x I F�6-b3-C39 -9.10I E- mail:5wo•r - Reconnect only
Owner installation: The installation is being made on proper{y I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
a7 1. � , 200 amps or less 2
ORS 447, 455, 47r
201 amps to 400 amps 2
Owner's signature. ate: 3 / r /d / 401 to 600 amps 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase /�
of service or feeder fee, first branch circuit: 1 y 4Y 4 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not lncluded):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* . 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park ' Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other V6, ' g
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 3 7 7
Expires accepted as complete. TOTAL $ SO . (06
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440.4615 (6/00/COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total `i' Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 Systems 201 amps to 400 amps $106.85 _ 2
401 amps to 600 amps $160.60 2 Other
601 amps to 1000 amps $240.60 2
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 _ 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918-260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
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Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems
Branch Circuits El Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or L Clock Systems
feeder fee. 1 �I
Each branch circuit $6.65 2 I Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service O Fire Alarm Installation
or feeder fee.
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First branch circuit
additional branch circuit •
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 Intercom and Paging Systems •
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy Landscape Irrigation Control
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over
•
the allowable in any of the above Nurse Calls
Per inspection $62.50 El
Per hour $62.50 ❑
In Plant $73.75 Outdoor Landscape Lighting
Fees: /,, � 5 / 0 Protective Signaling
Enter total of above fees $ `� / r7 Other
8% State Surcharge $ c J Number of Systems
25% Plan Review Fee
* No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application.
Fees:
Total Balance Due $ 5
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts \ forms \elc- fees.doc 10/09/00
3,s7y
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 - .
BUP
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Date Requested 3 .2p AM PM BLD
Location /371 11✓ / C r f t A-7 Suite MEC
Contact Person Ph .1 G 39 Z a 3 PLM
Contractor dIP SWR
BUILDING Tenan Owner ,/ Lc (, �,7 / ,./ ` ELC
Retaining Wall '3 Lee, C, ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling —
Roof
Misc: �5
Final /
PASS PART FAIL / � Jam' 11
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer _
•
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
` Service c --; 71
Rough In
UG /Slab
Low Voltage
Fire Alarm
a
PASS P RT FAIL
SITE
ackfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required befor e xt in pection. P "y "t City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: - "r ] Unable to inspect - no access
ADA
Approach /Sidewalk \ . �
Other Date Inspector ?�Z� �Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.