Permit CITY OF TIGARD
/,,rmt et, DEVELOPMENT SERVICES ELECTRICAL PERMIT —
A- e'h! 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 -4171 RESTRICTED ENERGY
PERMIT #: ELR99 -0063
DATE ISSUED: 03/22/99
PARCEL: 1S133AD -02200
SITE ADDRESS...:12930 SW SCHOLLS FERRY RD
SUBDIVISION • ZONING:R -7
BLOCK • LOT • JURISDICTN: TIG
Project Description: Audio /visual system
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..:
INSTRUMENTATION.: OTHER..:AUDIO /VISU::X
TOTAL # OF SYSTEMS: 1
Owner: FEES
WESTGATE BAPTIST CHURCH type amount by date recpt
12930 SW SCHOLLS FERRY ROAD PRMT $ 40.00 B 03/22/99 99- 313886
TIGARD OR 97223 5PCT $ 2.00 B 03/22/99 99- 313886
Phone #: 644 -2505
Contractor:
RICHFIELD TECHNICAL SERVICES $ 42.00 TOTAL
BRAD RICHFIELD
19570 SW NEUGEBAUER RD REQUIRED INSPECTIONS
HILLSBORO OR 97 123 Ceiling Cover Low Voltage Insp
Phone #: 628 -8324 Wall Cover Elect'1 Final
Reg #..: 88797
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952401 -0010 through OAR 952 - 001-0080. You may obtain copies of
these rules or dire t questions to OUNC at (503)246 -1987.
Issued by t Permittee Signatur
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: Pr DATE:
LICENSE NO:
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
li
CITY OF TIGARD Electrical Permit Application Plan Chec ,: . i
13125 SW HALL BLVD. Rec'd By n /'
TIGARD OR 97223 Date Recd - 2 -
Phone (503) 639-4171, Date to P.E.
( ) 639 -41, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # l =L (Z`�� - Dot[ 3
Fax (503) 684 -7297 ��'�S Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) U)e - „ - 139p7:r7 C-4Leecil Service included: Items Cost Sum
I
Address / 2,3' S (v ,Sc.(iO/i $ Fe ✓t y Roca/ 4a. Residential - per unit
9 7 z Z 3 l000 sq. ft. or less $110.00 4
City /State /Zip 9c 0� Each additional 500 sq. ft. or
Commercial ® Residential El Limited thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of a I current licenses) 4b. Services or Feeders
Electrical Contractor / ic.1 elc/ e.c.4 ti'ccr/ Seev.isc.eS Installation, alteration, or relocation
.-70 Se> At ,(emu �^ 200 amps or less $60.00 2
Address 19
C am' R � 201 amps to 400 amps $80.00 2
City /P: / /s/,:9ro State aR Zip 9 7/ z 3 401 amps to 600 amps $120.00 2
Phone No. 6 2e - 8 32.4 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. Sy_ 4/93ccd Exp.Date Pi/99 Reconnect only $50.00 2
OR State CCB Reg. No. e8 797 Exp.Date �// 2 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n 201 amps to 400 amps $75.00 2 -
-
401 amps to 600 amps $100.00 2
-
Over 600 amps to 1000 volts,
License No. / 67 TLE Exp.Date /D//9 ? see "b" above.
Phone No. 6 28 - e 324/
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circ $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy 1 $40.00 " l D • 0 V ;1 2
panel, alteration or extension
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
•
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: �o
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ 402_ d
NOTICE • Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $
I:\DSTS \ELC96.APP Rev 9/96
8/30/99 Activities for Case #: ELR99 -00063
4:26:14 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 Application Received 3/22/99 B RECD BON 3/22/99
ELRC003 Permit Created 3/22/99 B DONE BON 3/22/99
ELRC700 Ceiling Cover BON 3/22/99
ELRC720 Wall Cover - BON 3/22/99
ELRC725 Low Voltage Inspection BON 3/22/99
ELRC799 Elect'I Final • 8/18/99 CD PASS AKJ 8/18/99
ELRC500 (F) Issue permit 3/22/99 B PASS BON 3/22/99
ELRC800 Case finaled 8/18/99 AKJ DONE No Hold AKJ 8/18/99
•
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
o -I-99 BUP
Date Requested I �s AM PM BLD
Location q 9 7D _ l. S ..j L.A.J. Suite MEC
Contact Person - e:-C-- , - A5 Ph SZ /' 3ScO PLM
Contractor Ph /" SWR
BUILDING Tenant/Owner I�0 'c4 611, ICI"\ - ELC Q��
Retaining Wall v ELR -/ / -- oo l /
p a
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 (.l ix:e
Firewall VV
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING 00
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
P RT FAIL
ECTRIC L
Service
Rough In
UG /Slab
Low Voltage
Fire ' rm
FiT
PART FAIL 0
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL D NOT REMOVE this inspection record from the job site.