Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
A. 44 1'1' j DEVELOPMENT H O B MEN � T r S o ER 9 SERVICES 639 -4171 DATE RMII #: ELR200 8/20/02 2 -00158
SITE ADDRESS: 12930 SW SCHOLLS FERRY RD PARCEL: 1S133AD-02200
SUBDIVISION: ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage for fire alarm 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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
•
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WESTGATE BAPTIST CHURCH ALARM TRACKS LLC
12930 SW SCHOLLS FERRY RD 4134 N VANCOUVER AVE #107A
TIGARD, OR 97223 PORTLAND, OR 97201
Phone: Phone: 503 - 490 -5138
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 8/20/02 $75.00 2720020000 Elect'l Final
5PCT CTR 8/20/02 $6.00 2720020000
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 u_ ollow rules adopted by the Oregon Utility Notification Center. Th se les e set fprth in OAR
952 -0 -0010 throag OAR 952 -011 -1180. You may obtain copies of these rule or irec quest s to OUNC at (503)
246- 987.
Issu b y _ 4 ,i Al ■ LA ! 1 ' Permittee 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:
CO TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: / v DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
E
iii, "1Cal Permit Application FOR OFFICE USE ONLY
Received Electrical e .
2/20/ Date/By: /o�0 /A Permit No.: 61 Co 15
City of Tigard P Approval Sign A �' g Test Form Planning lanni Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other Q A ,..) o f
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 r Post - Review Land Use
u"f + f +� y:
Contact Case No.:
Internet: wv✓w.ci.tigard.or.us �,1 �.' I Juris.: ❑ See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 � Contac Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
IQ/Addition/alteration/replacement III Other:
❑ Service over 320 amps - rating of ❑ Building Building over 10 10,,0 000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
111 Accessory Building III Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
I Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: \ZCe.c• t , S�-\ \S ct FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: ) e- < - r G Arc is *F-,„ g.1- C-3„ � Description Qty Fee(ea.) Total
Cross street/Directions to job site: New residential - single or multi - family per T
l dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 _ 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WO K service and/or feeder 90.90 2
Services or feeders - installation,
Ce f..t:e. DA A R.r•.- t AS& i.!,r\ A51-0.0 alteration or relocation:
J 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City/State/Zip: alteration, or relocation:
200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
❑ APPLICANT ❑ CONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Job No: Each sign or outline lighting 53.40 2
Signal circuit(s) or a limited energy panel,
Business Name: 1\a„,,,,- u, alteration, or extension* 75.00 2
Description:
Address: `V43`k L) 00 k 4 14- ay
kia Alit 2M
City /State /Zip: X7 90 ( Each additional inspection over the allowable in any of the above:
�� Per inspection (per hour - min. 1 hour) 62.50
Phone: > -yo,� S Fax: cp3 .eoaq -q 3 33 Investigation fee:
CCB Lic. #: k‘�113 1 ,4-05 Lic. #: a(0-‘02.404 (-LC Other:
Supervising electric r0/1 t1 As Electrical Permit Fees*
Subtotal $ 7 6 • 0 0
signature required: �O .. a .�1. Plan Review (25% of Permit Fee) $
Print Name thee„ 1 K:‘n„I I Lic. #: a l,9S3t State Surcharge (8% of Permit Fee) $ ee , °v
TOTAL PERMIT FEE $ i / , 06
j ,. Authorized (r� Notice: This permit application expires if a permit is not obtained within
Si re: 2 Date: X 180 days after it has been accepted as complete.
� ,,� x 7 vv. *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
CITY OF TIGARD, 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 -
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
G� > BUP
Received Date Requested / / �!� AM PM BUP
Location / 2- � .� MEC
Contact Person c
Ph ( ) / d 7 - I PLM
Contractor Ph ( ) SWR
BUILDING _ Tenant/Owner ELC 2 —3 c 7
Footing
Foundation ELC
Access:
Ftg Drain ELR Od ,s
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
111(
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm `(h r ��� 9���'�(y
Susp'd Ceiling -� 1�'�1111�-
Roof
Other:
Final
PASS PART FAIL %S') � ` 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
Rough -In
L ge
Fire Alarm
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: I=1 Unable to inspect — no access
Fire Supply Line
ADA ..�
Approach/Sidewalk Date ?/ � -- Inspect s. 4 i. = i / Ext
Other:
Final DO NOT REMOVE this inspection record from the Job = ite.
PASS PART FAIL •