Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00207
_,1�I� DEVELOPMENT SERVICES DATE ISSUED: 4/9/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103DD -00900
SITE ADDRESS: 13855 SW PACIFIC HWY
ZONING: C -G
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical work for future kitchen, classroom and 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:
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: 7 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: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
COMMUNITY OF CHRIST CHURCH MICHAEL DUFRESNE ELECTRIC
5321 WINDSOR TERRACE 9240 NE ST JOHNS AVE
WEST LINN, OR 97068 PORTLAND, OR 97203
Phone: Phone: 503 - 481 - 8708
Reg #: LIC 148143
ELE 26- 1096CEP
FEES SUP 4794S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/9/03 $126.85
[TAX] 8% State Tax 4/9/03 $10.14 Elect'I Service
Rough -in
Total $136.99 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 0 52=004- 010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-6699 or
1 -80 2 -2344.
1
Is ued By: � / l e i 41,,,bitlieLe Permit Signature:
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 I STALL¢1TION ONLY
SIGNATURE OF SUPR. ELEC'N: ■ :a am" DATE:
LICENSE NO: 1/ 7 9 /
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Date received: R/ 9 03 Permitno.: .8�px
ra.�f:f11 1 � � �
L . City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: J Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory XCommercial/industrial ❑ Multi- family ❑ Tenant improvement
O New construction ❑ Addition/alteration/replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: '3v geo Qj/ . /yWy Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: S ubdivision:
Project name( a f/,1jrjs * I Description and location of work on premises4 "w _ myL��f •
Estimated date of completion/inspection: ion/inspection: — - - L a : a - Ledo /L ,rte _ % [ -r ezil 1D0/y
.. CONTRACTOR APPLICATION FEE SCHEDULE .
Job no: MD E1e,,-} r i t". Fee Max Qn
Business name: i e n, P fIb � L' 4 I ,G Description _ Qty. (ea.) Total no. insp El
ew residential - single or multi- family per T
Address: /irp" Sr , n S' 4V - dwelling unit. Includes attached garage.
City: ffCriTe y) State:QT ZIP77: ,� Service sq ft. or 4
Phone? 4j - g70 8 I Fax: I E- mail�)1e2 f, 4_, ct'i�!-
CCB no.: /L/ ? / i/ I Elec. bus. lic. no:26 — 7' ,/ a h additional 500 sq. ft. or portion thereof
1 B ° j (1 Limited energy, residential 2
City /metro lic. no.: (4 b tle•(0 9 /p C Limited energy, non- residential 2
�� r 1011 /0.9 Each manufactured home or modular dwelling •
Signature of supervis g leCtrici (required Date /O / / / Service and/or feeder 2
Sup. elect. name (print) #, • - a m - a License no: f _ Services orfeeders — installation,
PROPERTY OWNER alteration or relocation: I go. 50 2
200 amps or less
Name (print):( ,'r ' ehri SI (!hurGj 201 amps to 400 amps 2
Mailing address: 7). D , B t7x 2 3 4/6 2 401 amps to 600 amps 2
_ 601 amps to 1000 amps 1_2_ City: 77 a r 4 I State: 0A I ZIP: 472 r / Over 1000 amps or volts 2
Phonee, 1 7 - 4/4 7 / I Fax per/ 7 I E- mait: r : ofironnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, 671 1 1. 200 amps or less 2
�I of B 201 amps to 400 amps 2
Owner's signature: li i ,„,,,,e' . Date: 4 Gt ? 401 to 600 amps 2
ENGINEER 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 7 �(p 2
City: ' State: J ZIP: B. Fee for branch circuits without purchase
Phone: Fax E-mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ 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,
❑ 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 ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: •
❑ Egress/lightingplan 0 Other: Per inspection I I I .
Submit _ sets of plans with any of the above. Investigation fee w
The above are not applicable to temporary construction service. Other J-16-
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ /O
❑ 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 %) $ c.
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: --
• Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total NI, 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 Manuf'd Home or Modular ❑
Dwelling Service or Feeder $90.90 2 Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System' •
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑
201 amps to 400 amps $106.85 2 Vacuum Systems
401 amps to 600 amps $160.60 2 I �
601 amps to 1000 amps $240.60 2 I 1 Other
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:
Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems .
Branch Circuits �--
New, alteration or extension per panel I I Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ I I Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees A $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms \elc- fees.doc 08/30/01
CITY OF TIGARD 24 -Hour • -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received ¢ Date Requested 7-30 AM PM BUP
Location 13 oss Suite MEC
Contact Person Ph ( ) '(g! - 87 D PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner `M 'r' ELC 3 -o
Footing ELC C) 3 7
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear \�„ ±e -Or"/
Framing Y �°�-
Insulation t
Drywall Nailing
Firewall
Fire Sprinkler ^1 �,, / r
Fire Alarm J `l- VV s f V 1, wf 1 y) S } Vv r%
Susp'd Ceiling , r -
Roof T3 O N
Other:
Final
PASS PART FAIL l
PLUMBING IP r `� � \ �C �� ry \ ' v�
Post Beam
Undder r Slab
Water he
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
Fi - _ larm
41! El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• • SS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA 2 ° o)
Approach/Sidewalk Date d Inspecto Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL