Permit • V `�
CITY OF TIGARD
COMMUNITY DEVELOPMENT ELECTRICAL PERMIT
lig ° PERMIT #: ELC2008 -00683
D ATE ISSUED: 12/23/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 133AD -02200
SITE ADDRESS: 12930 SW SCHOLLS FERRY RD ZONING: R -
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: WESTGATE BAPTIST
Project Description: (5) branch circuits.
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: 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: 4 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 NORTH LAKE CONTRACTORS
12930 SW SCHOLLS FERRY RD 12900 NW LOVEJOY CT
TIGARD, OR 97223 PORTLAND, OR 97229
Phone: Contact #: PRI 503 - 709 - 0985
FAX 503 - 641 -3168
FEES
Description Date Amount Reg #: ELE CI3
[ELPRMT] ELC Permit 12/23/2001 $73.45 LIC 154178
[TAX] 12% State Surchar 12/23/2001 $8.81 SUP 4891 S
Total $82.26 REQUIRED ITEMS AND REPORTS
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 -0100. You may obtain copies of these rules or direct questions t NC at 503.246.6699 o 1.800. 2.2344.
Issued By: 4Dak (p 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit ApplicationRE FIVE — FOR OFFICE USE ONLY
City �'1 V eceived PePenult No.
U PI
° 131 of Tigard SW Hal Blvd., Tigard, OR 97223 Pla Rev w 2 n8 �� V 008 • 00 (
� ` L 2Q!,,;� Plan Review Other Permit:
2 ' Phone: 503.639.4171 Fax: 503 DEC 3 Date/By:
T I G A R D Inspection Line: 503.639.4175 . Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard -or.gov ARMING A OF TIGARD Notified/Method: T t (2� , Supplemental Information
TYPE OF % WH. SING DIVISION PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling yr ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: Job site address: 1 F I OOHP or more. occupancy.
1 � 3- •� �446U-`s 1 612/!1 QO ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: �'• tG ��� �'� Z 1 d 3 Ell Health-care facilities. ❑ Supply voltage for more than
4 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 1 1' ..c- ‘ 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 5C,atol,ts F t tza.y , kl0k1, Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
r! Limited energy, multi- family
(0 , (lk ( (� ) qtA.) 14 4t' — ec4 ill 1 1 (Z) Er` R-t L residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
F4 ANA / I' etc 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 113 es Tc, Art Z erPns , - C rt0ac 1-1 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 1 2A 3O s tI SG NdU.S . y R D Over 1,000 amps or volts 454.65 2
City/ State/ZIP: � �� q7 ZZ� Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( sea) s L i4 / I Fax: (50 3) 5 z y 454 6 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ A$PLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
Business name: each branch circuit
i b
U Tl'a IV 1g erne) n t L 1 t•.14 B. Fee for branch circuits
Contact name: •
without service or feeder fee, 46.85 2
t � N u ja first branch circuit '
Address: Each add', branch circuit 4 6.65 2
I b r 7 3 S I� L it t`gS FoReser ` a 1_ V Miscellaneous (service or feeder not included)
City/State/ZIP: l.,„„..K ? St) t?4 O Oa e c 7a 3 S Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503 ) . n a 735 L Fax: : ( ) Reconnect only 66.85 2
• E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
r U Signal circuit(s) or limited -
Business name:
N 0 its T qt. �K reIU i U. energy panel, alteration, or
Address: + Z C 1 Ob N tJ LA0vcrOV CTI extension. Describe: Page 2 2
C ity/State/ZIP: pd to- LKoIN 0 kO cjj r- Z.2 1 Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: ( ) q - Fax: ( )
7� 1 � Investigation per hour (I hr min) 62.50
CCB Lic.: 154 I �) g Electrical Lic.: C 13 Suprv. Lic.: y $ei i -3 Industrial plant per hour 73.75
--1' 1 l\ 1 O • .�10 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: S � Subtotal: 7,3 .4 > ti
Print name: ,, r t 1� Plan review (25 % of permit fee):
a i, 1 1 1 i f Date:) 2� ( 8 l� g
State surcharge (12% of permit fee): S' , C 1
O
. Authorized signature: TOTAL PERMIT FEE: R 2 • 2
Print name: Date: This permit application expires if a permit is not obtained within 1 0
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \Building \Permits \ELC- PermitApp.doc 05/23/06 440-46I5T(II /05 /COM/WEB
E lectrical Pernut Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 - 0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
p Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: •
4 No licenses are required. Licenses are required
for all other installations
t:\ Building \Pennits\ELC- PermitApp.doc 03/23/06 — —
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: ELC2008.006t33
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/230008
Phone: (503) 639 -4171 i 111
Inspection Requests (24 Hrs.): (503) 639 -4175 " :_
INSPECTION WORKSHEET FOR DATE: 3/2/009 TIME: 7:00AM PAGE: 9
SITE ADDRESS: 12930 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WE.STGAl E BAPTIST
DESCRIPTION: (5) branch circuits.
OWNER: VVE.STGA E BAPTIST CHURCH, PHONE #:
CONTRACTOR: NORTH LAKE CONTRACTORS PHONE #: 503 - 709.0985
Inspection Request Scheduled For: Date: 3/2/2009 Pour Time:
Code # Inspection Description C z ofirm -# Contact # Message
12U Electrical rough -in t 80946 -04 503- 672 -7392 N
Corrections /Comments /Instructions:
C.0 N F- i S b 5 Cte* l) 6E t> i II)
k_., Pic;` A A(et -\,n k) J (c
❑ PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
?:I FAIL y] CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
J " ,,,,'' llII II i
Inspector: G--._ N_� Date: 3-2--, Phone #: (503) 718- 2i'T
CITY OF TIGARD i
BUILDING DIVISION PERMIT #: EI_C200l O0683
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/23/2008
Phone: (503) 639 -4171 Ars I "'' ` l
Inspection Requests (24 Hrs.): (503) 639 -4175 IL.
INSPECTION WORKSHEET FOR DATE: 3/2/2009 TIME: 7:OOAM PAGE: 6
SITE ADDRESS: 12930 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WESTGA1 E BAPTIST
DESCRIPTION: (5) branch circuits.
OWNER: VV STGATE BAPTIST CHURCH, PHONE #:
CONTRACTOR: NORTH LAKE CONTRACTORS PHONE #: 503
Inspection Request Scheduled For: Date: 3/2J2O09 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical finial N080946-05 603.572 -7392 N
Corrections /Comments /Instructions:
Co N)c Li £'r; 6 -- ga4mN fe 5
N c��® t..yrt G e � . fkdq- ii (e3
11b1(11/4
n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1; FAIL 71 FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • 1\) 0 e L Date: 3. 21 Phone #: (503) 718- VP IL
L