Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00178
'l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/5/2005
PARCEL: 1S133AD-02200
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE ZONING: R -7
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: T -stat.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WESTGATE BAPTIST CHURCH INTERIOR COMFORT SYSTEMS
12930 SW SCHOLLS FERRY RD 17200 SE HEMRICK RD
TIGARD, OR 97223 BORING, OR 97009
Phone: Phone: 503 - 558 - 9224
Reg #: ELE 2614LEP
LIC 135118
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/5/2005 $75.00
[TAX] 8% State Surchart 7/5/2005 $6.00
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. A ' TENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are -t forth in OAR 952 - 001 -0010
through OAR 9 - 001 -0100. You .ay obtain copies of these rules or direct uestkn : to OUNC at 503 - 246 -6699.
Issued By: _ ,: �� : ; Permittee Signature: ®A 0 ‘S tic..P-a- / �
i
OWNER INSTALLATION ONL
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.
M E� 3 -oo 5 -00 4 /0 . /
Elec Permit Applicat oltFC E l V ® I OR OFF
ICE, usG O \i Y= .
City of Tigard oate/B s U 5 • Permit No.-0 y� -00 /7V
• 13125 SW Hall Blvd., Tigard, OR 97223 ����� ✓ Plan Review z
Phone: 503.639.4171 Fax: 503.598.1960 O �'�I wy}i' i'' D��g . Other Permi • G .� l 4
Inspection Line: 503.639.4175 CITY p oi- , ! I ' Date Ready/By: 7 t"n ' El See Pa. e2 for
Internet: www.ci.tigard.or.us BUILDING ®I1�I Eft I Notified/Method: 1 ��I Sup Information
• TYPE OF WORK PLAN REVIEW
111-Ke construction ❑ Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location
• ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF. CONSTRUCTION of 1 - and 2 family dwellings 4 or more new residential
❑ 1- and 2 family dwelling ommercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION I • ❑Egress/lighting plan RV park
/� 93 J 0 sj / (� 4". � care facility ❑Other:
Job no.: Job site address: ] 0 �l
c 0 , J n 2 sets of plans with any of the above.
City /State /ZIP: ( i, G r0 4 0 c' 7222- The above are not applicable to temporary construction service.
J r FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name:
Description I Qty, I Fee. I Total I ""
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
• 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75. 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF ` WORK I � Each manufactured or modular ---��_
dwelling, service and/or feeder 90.90 2
L, o d...11 d...11 u o ` P 6,r �yt D 1 w T SyJ �' Services or feeders installation, alteration, and /or relocation
/1-4-7/L- / J U ` Nor- / e � /� 200 amps or less 80.30 2
. ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
7
f 401 amps to 600 amps 160.60 2
Name: I ,�� t'..) 1.3 4!L � 4' � 7 N Q d 6 01 amps to 1,000 amps 240.60 2
Address: V ` 2 , V S'' A dl � � ,, R Over 1 am ps or volts 454.65 2
/ Reconnect only 66.85 2
City /State/ZIP: 7� 1', s 4 O f , Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 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 600 amps 133.75 2
Owner signature: • Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
• City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
- - CONTRACTOR - - energy panel, alteration, or
� j , extension. Describe: Page 2 2
Business name: -- t _
Address: ) 7 2 0 U J -C Each additional inspection over allowable in any of the above
) ( wt /`t C r 1l Per inspection 62.50
City/State/ZIP: / O �' Q t- - 9700 r Investigation per hour (I hr min) 62.50
Phone: Ls ) (S 2 4f Fax: (j7,3 ) Tr e)— y/ 2 1 Industrial plant per hour 73.75
Electrical Lic.:? ELECTRICAL PERMIT FEES*
CCB Lic.:
Al � 7 , y(Rr1 Sup rv. Lic .: Subtotal 7s" -
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Apr , as 11
,^ to f —T7 Date: J� I` State surcharge (8% of permit fee)
J� `/ D J TOTAL PERMIT FEE c61 00
�
Authorized signature: / aa.....„, ..---/ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
• ** Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PertnitApp.doe 12/03 440-4615T(I0 /02/COM/WE
Sa 3.31 • -
Electrical Permit 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 system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
•
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
•
❑ Outdoor Landscape Lighting* •
• ❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC- PennitApp.doc 04/03
CITY OF TIGARD _
BUILDING DIVISION PERMIT #: ELR2005-00178
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/92006
Phone: (503) 639-4171 4,0411,11,
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11312006 TIME: 7:01AM PAGE: 59
SITE ADDRESS: 10730 SW 130TH AVE MULTI CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WESTGATE BAPTIST CHURCH
DESCRIPTION: T
OWNER: WESTGATI BAPTIST CHURCH, PHONE #:
CONTRACTOR: INTERIOR VFORT SYSTEMS PHONE #: 603-553-9224
•
Inspection Request Scheduled For: \., Date: 1/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Eloctiicel final N 024276 503
Corrections/Comments/Instructions:
PASS I I PARTIAL APPROVAL Li CANCEL fl NO ACCESS
I I. FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G" Nt L Date: 1 3 - CA Phone #: (503) 718-1--16%
CITY OF TIGARD - . -
BUILDING DIVISION PERMIT #: ELRoo oo1ae
, 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 71!2005
Phone: (503) 639 -4171 , N'4P�� y pipi i
Inspection Requests (24 Hrs.): (503) 639 -4175 ,
INSPECTION WORKSHEET FOR DATE: ���� TIME: 7:05AM PAGE: 30
SITE ADDRESS: 10 SW 130 AVE Iv1ULTI PURPOSE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE
PROJECT NAME: VVESTGATE BAPTIST CHURCH
DESCRIPTION:
T
OWNER: PHONE #:
CONTRACTOR: WESTGATE BAPTIST CHURCH PHONE #:
INTERIOR COMFORT SYSTEMS 503-558-9224
Inspection Request Scheduled For: Date: 9/3012005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 017122 -01 503- 572 -7392 N
Corrections /Comments /Instructions:
r
V/
PASS I I PARTIAL APPROVAL n CANCEL n NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
.✓
Inspector: A.--.----1.x.e ( J � Date: .. c� Phone #: (503) 718 -
r'