Permit :CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00406
�l� DEVELOPMENT SERVICES DATE ISSUED: 7/7/03
^. '`--' 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25101 AD -02400
SITE ADDRESS: 12753 SW 68TH AVE. ifff
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT : 032 JURISDICTION: TIG
Project Description: Installation of (11) branch circuits and low voltage for data & fire alarm systems.
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: 2
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: 10 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:
WESTERN EVANGELICAL SEMINARY GEORGE FOX UNIVERSITY
PO BOX 23939 1101 VILLA ROAD
PORTLAND, OR 97281 NEWBERG, OR 97 132 -1 21 8
Phone: Phone: 503 - 554 -2014
Reg #: ELE 36 -75C
SUP 923S
FEES
Description Date Amount
Required Inspections
[TAX] 8% State Tax 7/7/03 $21.06
[ELPRMT] ELC Permit 7/7/03 $263.75 Low Voltage Inspection
Rough -in
Total $284.81 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 i 952 -00 -: e 0 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -8 332 -2344.
/
Is /
1,i (,
e d By: r,A A ., / 10 •7 i j Permit Signature: x
' OWNER INSTALLATION ONLY 1`
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: .5773 S
Call 639 -4175 by 7:OOpm for an inspection the next business day
FOR OFFICE USE ONLY
Electrical Permit Application FOR
A ..
DDate/By: � , o .� � �j Permit No.: va:U —
City of Tigard Planning Approval Sign
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 an Post - Review Land Use
r`i��,k I t�
Internet: www.ci.tigard.or.us .. o, 6! I Date/By: Case No.:
Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 - 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
® Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling jX1 Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant Toad over 99 persons ❑ Manufactured structures or RV park
p Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
6 S The above are not applicable to temporary construction service.
Job site address: I 2.75 3 ...C&,- 69 SCHEDULE
Suite #: 1 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: ?or-} Kw+veLL Description Qty Fee(ea.) Total 1
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
7'Z ‘` ° t 1 / S,� N to 4 r p `' ^ d 68 It, , Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: 1U5' Pot + IG-✓/ /t 'S 4 f.5 1 L #: i Z Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Zs - /- /4 P " Z t/b 0 Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
( Services or feeders - installation,
W oe , 9l -7 - -) vc ,- -e,..t _/ alteration or relocation:
app ( X L i 1e0 SQ < "/ 200 amps or less 80.30 2
((!! ,// ,, ww ,�// 201 amps to 400 amps 106.85 2
re to r u L /I L s � s ides Y' s O ✓ T t-eT,S yliOHQS 401 amps to 600 amps 160.60 2
PROPERTY OWNER 1 fa TENANT 601 amps to 1000 amps 240.60 2
v Over 1000 amps or volts 454.65 2
Name: (7e orb Ale Vn 1 tit ff $ ( Reconnect only 66.85 2
Address: y l N N. N1ow(Ja4 ..S. Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: ARAI k)-V- OR .17/3 Z 200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Phone: Fax: 401 to 600 amps 133.75 2
® APPLICANT ® CONTACT PERSON Branch circuits - new, alteration, or
Name: D4,1 S c 4 ,,/,...v- extension per panel:
�
A. Fee for branch circuits with purchase of
Address: CQ t ito 4 *--er 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 48 b S 2
Phone: 3 - 3 L Z o / y 1 Fax: S : .QE/ ZOO °/ Each additional branch circuit /o x 6.65 a • SG 2 -
E -mail: d •c c , 4 1 --Qi' d" p, O`�" fC( ' ea/LA Misc.(Service or feeder not included):
x
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel, rr��
,/' c alteration, or extension p' Page 2 / 5°M0 2
Business Name: 6,,,,-,.. 4
.Q , tf�tdfi Description: v a cIa ✓q
Address: 1 - / / Al. A l i p ; o ' S - L , r4p A IcM sys •- -
Each additional inspection over the allowable in any of the above:
City /State /Zip: A c OR * Per inspection per hour (min. 1 hour) 62.50
Phone: 5 3 S� ?0w(/ Fax: 3 Ssy zoo Investigation fee:
CCB Lic. # icc.�. #: 3 7s Other: -
Electrical Permit Fees*
Supervising electriciat>� Subtotal $ Z6 3. 3S
signature required: (Cl Plan Review (25% of Permit Fee) $
Print Name: P. Co r h t4 4 1rycl 1 Lic_ #: 34,73 State Surcharge (8% of Permit Fee) $ Z 1.
TOTAL PERMIT FEE $ -'
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set. by Tri- County Building Industry Service Board. ,/,
iagi
(Please print name)
i:\Dsts \Permit Fotms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
•
Check Type of Work Involved:
• Audio and Stereo Systems
0 Burglar Alarm
Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls
0 Clock Systems
® Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
0 Intercom and Paging Systems
0 Landscape Irrigation Control
❑ Medical
0 Nurse Calls
El Outdoor Landscape Lighting
0 Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
C� BUP
Received Date Requested ( AM PM BUP
-
Location / a 7 5 3 ir W- 4-0-e_ Suite Z ' ea MEC
Contact Person Ph ( ) 176 r q PLM
Contractor Ph ( ) 5 -0-6 SWR
(..0 BUILDING Tenant/Owner - "FOC Lt-v --) do 3 - 0 0(p
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ee / SIT
Post & Beam � - d
Shear Anchors (� .[,, �`
Ext Sheath/Shear _ �-�'X �.t XX� `Yri �-' -
Int Sheath/Shear
Framing
Insulation
7,..-7,„,,,0644,
\
Drywall Nailing
Firewall C 2 • s 200 -
Fire Sprinkler • • � 7
Fire Alarm
Susp'd Ceiling
Roof _ - ` S '
Other:
Final
PASS PART FAIL J `,
PLUMBING . 0 0 2 k$ r D, 1) m
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 !, 1
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service Cfr
Rough -In ( O p
UG/Slab
ow Voltag� p lf,�✓
ire : arm I
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
i PART FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line /
ADA - -
Approach/Sidewalk Date Inspector ! Ext
Other:
Final DO NOT REMOVE this inspection record from the job ite.
PASS PART FAIL
•
. _~
This is your license.
. _ - - _-
ELECTRICAL SECTION
uu./Ro as: No.: 36
ELECTRICAL CONTRACTOR
DB A
•
GEORGE FOX UNIVERSITy
1101 N VILLA
NEWBERG OR 97132
ISSUED 09/ 25/01 EXPIRES 10i01/02
•
•