Permit C ITY OF TIGARD ELECTRICAL PERMIT
4 PERMIT #: ELC2003 -00322
�
i �1 DEVELOPMENT SERVICES DATE ISSUED: 6/4/03
*`"' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S133AD-02200
SITE ADDRESS: 10820 SW 130TH AVE
ZONING: R -
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (3) branch circuits for tenant improvement to classrooms.
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: 6014-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: 2 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: i�
WESTGATE BAPTIST CHURCH Cam
12930 SW SCHOLLS FERRY RD 2 •
TIGARD, OR 97223 ❑F VE-124igN ^ ` ^07
Phone: Phone: 642 -7937
Reg #: LIE 81518
SUP 3344S
FEES ELE 34 -217C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/4/03 $60.15
[TAX] 8% State Tax 6/4/03 $4 Rough -in
Elect'I Final
Total $64.97
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 952 -S i -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -800- 32 -2344.
Issue rte: �' / r / , I /.1_,./A _ s_ Permit Signature: n ,, - � ' f
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
)4
SIGNATURE OF SUPR. ELEC'N: c )4- %-a7 DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
•
Electrical Permit Application Received . - . FOR OFFICEAUSE ONLY , , ...
i _ - .. Electrical
Date/By: LO 09- Permit No.: EteA03 _
City o f T: igar Planning Approval Sign
d
Date/By:
Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.: 47 - 0 :: ) 527
Phone: 503-639-4171 Fax: 503-598-1960 i 1 • , .k Post-Review Land Use
Internet: www.ci.tigard.or.us Apv tv04(iff
Al p. el 1 Date/By:
Contact No.:
iiip.&:: El See Page 2 for
24-hour Inspection Request: 503-639-4175 "'" ' Name/Method: //a. Supplemental Information.
giN.RMONAWMA1410.0MA:OWN.MatialitaiSM Min:--::4:2WALWRE-Y/ANY.Olaeliill'atratliffMTOPS4M6...V;
0 New construction III Demolition 0 Service over 225 amps- El Health-care facility
commercial 0 Hazardous location
El Addition/alteration/replacement [S1 Other: 0 Service over 320 amps-rating of 1=1 Building over 10,000 square feet,
witml I & 2 family dwellings four or more residential units in
El 1 & 2-Family dwelling NCommercial/Industrial CI System over 600 volts nominal one structure
0 Building over three stories 0 Feeders, 400 amps or more
p Accessory Building El Multi-Family 0 Occupant load over 99 persons 0 Manufactured structures or RV park
Ill Master Builder 111 Other: 0 Egress/lighting plan 0 Other:
gE41)042=4:100.IMEMO~0.8.., 111:14r0:41CATiONMWAV Submit sets of plans with any of the above.
: /0 gAen sm.) Lao '''-',.....- The above are not applicable to temporary construction service.
Job site address
'---IN .-- aZiliiii0mitatamtsoitoommsommanitoia
Suite #: I Bldg./Apt.#: Number of inspections per permit allowed
Project Name: (3 Es-cc, pec ftR•c tS c Description Qty Fee (ea.) Total 1
New residential-single or multi-family per
Cross street/Directions to job site: 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 , I
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map/parcel #: Each manufactured home or modular dwelling
tit,VOWITAR41):E'81:CitiltitWfS10.1KWAORIMIRM,I,L4VP-,711 service and/or feeder 90.90 2
Services or feeders - installation,
—: 0 a—all--( a - -62 , 3 iti.A.,...42, .z_.- alteration or relocation:
200 amps or less 80.30 2
,--,,
— 201 amps to 400 amps 106.85 2
' 401 amps to 600 amps 160.60 2
)7 0) MO 1V-MATEMSM17 601 am M 1000 amps •
, 240.60 2
Over 1000 amps or volts 454.65 2
Name: 1 eS rk ve" CZ) cce cL5: C 44 l.) (Lc 4 Reconnect only 66.85 2
Address: tz.i 3° ;,..- S c rto Lc-5 F-e-z(z Zb : T ti e t i e n r p a r o a n ry o s r e r r e v i i o c c e a s t o o r n feeders - installation,
City/State/Zip: -c- C- i C5 c rs q 7 Z-Z.3 200 amps or less 66.85 1
Phone: SO 3 sz.44 3S Fax: c as- “q q,54,6 201 amps to 400 amps 10030 2
, . • _ ,.. ., 401 to 600 amps 133.75 2
kal NOPLVOIMIntilarni 1 0 410111 FAMEAVINACE Branch circuits - new, alteration, or
Name: E, R i - p c , 1• xt rcb, extension per panel:
A. Fee for branch circuits with purchase of
Address: i 0 "S 5 i‘S L PcK e" CO a. 51 ez.d.b service or feeder fee, each branch circuit 6.65 2
City/State/Zip: LkKr C (I 17035 B. Fee for branch circuits without purchase of / 46.85 az g
service or feeder fee, first branch circuit i to' 2
Phone: s ?t 6,5 --s' IL 0 Fax: Each additional branch circuit A . _
6.65 / 0. a 0 2
E-mail:, Misc.(Service or feeder not included):
pump or irrigation circle
f-nrZ)MagifMMIXNOO"),MCI:01MtaSglt,M1NaNXi Ea . . . . 53.40 2
sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
- alteration, or extension Page 2 2
Business Name: ?RerrttEQ. Cce rtkc AL L-T, Description: •
Address: ?,0 , ? x t_t 3,'4- :
,, ....,...,. Each additional inspection over the allowable in any of the above:
City/State/Zip: t4ek,3 a ecc, ' Per inspection per hour (min. 1 hour) 62.50
i .
Phone: 05-537- gu I Fax: , Investigation fee:
CCB Lic. #: q4,1 ,41., Lic. #: g 6, -79 C Other:
MICSAVIMMIEVWetifrealitWaftWOMIC Xlitat,..04Nii
Supervising electrician ,.. ., • Subtotal $
si! ature re. uired: j, ', , ki . Plan Review (25% of Permit Fee) $
Print Name: 61MMIVINFAIMMINF. - _ State Surcharge (8% of Permit Fee) $ q , 6
Wi o TOTAL PERMIT FEE $ CO V. F
_ 7
Authorized or Notice: This permit application expires if a permit is not obtained within
Signature: ci..., /V ,, iet..,Pate: 6 - z s - 0 1 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
_ .
117)AAP<IQ % toOrrt14■3
(Please print name)
i:\Dsts\Permit Forms\ElcPermitApp.doe 01/03
CITY OF TIGARD 24 -Hour
BUILDING Insprection' Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received �� l Z :35 1/'Requested - 04 AM PM _ BUP
Location -= ` �' , ==r' d 4 e 1 MEC
Contact Person ti,,. 4 Ph ( SD 3) 5 7 2 -?69 2-PLM
Contractor _ Ph ( ) _ SWR
BUILDING Tenant/Owner . /Alt. e
Footing ELC 3 — 0
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Drywall ll Nailing i) 1' b,0) 1 a
Dryll N V�
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer i i
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
UG /Slab
Low Voltage Y- " •
1111 � •ll � arm
�+`� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• RT FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line J J L 4
ADA /
Approach /Sidewalk Date � i r 7 Inspector d " ► fit `' Ext
Other:
Final DO NOT REMOVE this Inspection record tivm the b site.
PASS PART FAIL