Permit ITY OF TI GARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00285
DEVELOPMENT SERVICES DATE ISSUED: 6/26/02
�= II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S133AD-02200
SITE ADDRESS: 12930 SW SCHOLLS FERRY RD
SUBDIVISION: ZONING: R -7
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 2 temporary services and 3 branch circuits for const. trailer and const power.
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: 2 W /SERVICE OR FEEDER: 3 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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WESTGATE BAPTIST CHURCH NW ELECTRICAL SPECIALTIES
12930 SW SCHOLLS FERRY RD 2110 NW ALOCLEK DR.
TIGARD, OR 97223 SUITE 609
HILLSBORO, OR 97124
Phone: Phone: 503 - 844 -4788
Reg #: ELE 24 -450C
LIC 121328
SUP 4622S
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 6/26/02 $153.65 2720020000( Elect'I Service
Rough -in
5PCT CTR 6/26/02 $12.29 2720020000( Elect'I Final
Total $165.94
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
•
Permit Signature: ' • i ► I Issued By: A
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: � f�
1,„, I- >D J� DATE:
LICENSE NO: to 2 Z--
Call 639 -4175 by 7:00pm for an inspection the next business day
f
Electrical Permit Application .
Datereceived .02- Permit no.;�2Go2Ud2 - Ov SS
,,,...1r j! City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: ByT1S 6 I 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 , ❑ Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction ❑ Addition/alteration /replacement O Other: 0 Partial
JOB SITE INFORMATION
•
Job address: /9-93) SW C/10/ S Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: I Description and location of work on premises: \ 0W5T T/e/¢ /i- 6'
Estimated date of completion/inspection: / �i NJ S 7 " , tit/ /e
._.* i,CONTRA, TO'- APPLISATI ' ; • ._ =i _ . _� `;3::- ,1 kvi':SGIIEQU.F ,. a . , , :...k . ..4.4" --
Job no: Fee Max
r S a a Description Qty. (en.) Total no. map
Business name: NW F
1 e t 1 a l p c i a 1 t 1 s New residential - single or multi- family per
• Address: 2110 NW Aloclek Dr. , Ste 609 dwelling unit. Includes attached garage.
City: H i l l s ho r I State: ORI ZIP: 9 71 7 4 Service included:
1000 sq. ft. or less' 4
Phone: 844. 4 7 8 8 F8 4 4. 9 5 2 E -mail: / per I Each additional 500 sq. ft. or portion thereof
CCB no.: 121328
I Elec. bus. lic. no: 3 4. 4 5 0 C O L imited energy, residential 2
City /metro lic. no.: 004899 Limited energy, non - residential 2
1,0 _I �04' Each manufactured home or modular dwelling
_ Signatur o s NI ng a clan required) Date fp-- Service and/or feeder 2
Sup. elect. name (print): t . . _ License no: Services or feeders — installation,
' • alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): k^f fSTr/1 TF_ $APT/5 T ova A C/f 2 amps to 400 amps 2
g / 2 93 0 SW 500 L F y k/)
401 amps to 600 amps 2 2
Mailing address 601 amps to 1000 amps 2
City: Tl (.:AQ 0 I State: Qg, I ZIP: Over 1000 amps or volts ' 2
Phone: I Fax: I E -mail: Reconnect only
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, or relocation: X33.
ORS 447, 455, 479, 670, 701. 200 amps or less 2 85 70 2
201 amps to 400 amps 2
Owner's signature: Date: 401to600am.s 2
' ENGINEER Branch circuits - new, alteration,
or extension per panel: /9
Name: • A. Fee for branch circuits with purchase of � . ' 9 s 2
Address: service or feeder fee, each branch circuit .
City: I State: I ZIP: B. Fee for branch circuits without purchase •
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit: ,
PLAN REVIEW (Please check all that apply) Misc . (Serviceorfeedernotincluded):
❑ 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 extensions 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 I 1 I
Submit sets of plans with any of the above. ' Investigation fee
' The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ iC k).-S
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ 'el'
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ it
Name of cardholder as shown on credit card Expires accepted as complete. TOTAL $
$
Cardholder signature Amount 440 -4615 (6/00/COM)