Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00437
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/13/2005
PARCEL: 1S133AD-02200
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE ZONING: R -7
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Phone /data
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WESTGATE BAPTIST CHURCH KELSO ELECTRIC INC
12930 SW SCHOLLS FERRY RD 545 SE 3RD
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: Contact #: FAX 503 648 - 8211
PRI 503- 648 -6360
FEES Reg #: LIC 116254
SUP 4270s
Description Date Amount ELE 34 - 433c
[ELPRMT] ELR Permit 12/13/200f $75.00
[TAX] 8% State Surchaq 12/13/200f $6.00 REQUIRED ITEMS AND REPORTS
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
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 95 You may obtain copies of these rules or direct questions t OUNC at 503 - 246 -6699.
Issued By:. � � � ��/ ` e Permittee Signa -
OWNER INSTALLATION O
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 App i a``tio ft lc �',,- -'" FOR OFFICE USE ONLY
City of Tigard Received
e/ By ---.6 Permit No. gLe v o p q37
13125 SW Hall Blvd., Tigard, OR 97223 DEC 13 200 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /mr,�r fi t I Date/By Other Permit:
Inspection Line: 503.639.4175 CITY OF T1 -.7A S— - •f _, Date Ready/By: Lou H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
' TYPE OF WORK PLAN REVIEW J gr.
construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location
OService over 320 amps — rating ['Bulldog over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION , of I - and 2- family dwellings 4 or more new residential
❑ 1- and 2 family dwelling Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi - family ❑Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION _ ___ ❑Egress/lighting plan RV park
Job no.: Job site address: 10 1.30 sc 1307-14 ❑Health - care facility ❑Other:
•
. v • •— - -- Subm 2 sets of plans with any of the above.
City / State/ZIP: 7i &, qa 0 a The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: LJg- Si-6'A T , 62 . ,7-/1 j — FEE* SCHEDULE
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'( 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential S 75.00 7,S` =' 2
DESCRIPTION OF WORK _ Each manufactured or modular
dwelling, service and/or feeder 90.90 2
p 39O • ef o fr i<'T.•9 • Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
.0 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 • 2
City /State /ZIP: 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 I , ❑ 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: first branch circuit
Each add'l 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
�/ extension. Describe: Page 2 2
Business name: 1/474.,s r �Ef G?72/ c
Address: SVC- ,5::/: 7 rod - Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: i //4 4 s„gziA. cve G! 7/ 22 Investigation per hour (I hr min) 62.50
Phone: (302) CV,e 6g6co Fax: (Sp 3) ‘yc57 vz,/" Industrial plant per hour 73.75 •
ELECTRICAL PERMIT FEES*
CCB Lic.://6Z 4/ Electrical Lic.:39 V37C Suprv. Lic.: *2 70 j . � �
Subtotal
Suprv. Electrician signature, required: �� r Plan review (25% of permit fee)
Print Date: ///31,,,..t--- State surcharge (8% of permit fee)
nt name: O
gL S v TOTAL PERMIT FEE
Authorized signature: 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.
1:\ Building \Permits\ELC - PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
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*
1I Burglar Alarm .
U Garage Door Opener*
❑ sating, Ventilation and Air Conditioning
System
❑ Vacuu 'i Systems*
❑ Other:
I COMMERCIAL WO" ONLY:. .
Fee for each commercia .. $75.00
(SEE OAR 918- 260 -26
Check Type of Work Invo
❑ Audio and Stereo Syst- s
❑ Boiler Controls
❑ Clock Systems
❑ Data Tele is mmunication Installation
❑ Fire A :rm Installation
El HV • C ,
❑ nstrumentation
,❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
III 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 ,, A
BUILDING DIVISION PERMIT #: FLR200,5-00437
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/13/200a
Phone: (503) 639-4171 1441141Alifit\
Inspection Requests (24 Hrs.): (503) 639-4175 441 11...
N
INSPECTION WORKSHEET FOR ' 0 ATE: 1/3/2006 TIME: 7:01AM PAGE: 57
SITE ADDRESS: 10730 SW 130TH AVE Mi) CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WESTG BAPTIST \ •
DESCRIPTION: Phone/data \N,
OWNER: WESTGATE BAPTIST CHURCH, PHONE #:
CONTRACTOR: KELSO ELECTRIC INC PHONE #: 503-648.6360
\
Inspection Request Scheduled For: Date: 1 \ /3/2006
Pour Time:
N
Code # - - • - .= • D esc ri ption Confirm # Contact # Message
\
199 - ctrical final 024277-01 \ 503-572-7392 N
Corrections/Comments/Instructions: \
\
. .
•
PASS n PARTIAL APPROVAL 0 CANCEL El NO ACCESS
n FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: '''.4 0 '' L•41 Date: 11' S' Phone #: (503) 718- 7 -4 41,
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELR200&00437
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/13/2005
Phone: (503) 639-4171 . Ango l t i ts
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 12/1412005 TIME: 7:0101 PAGE: 43
SITE ADDRESS: 10730 SW 130TH AVE MULTI CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WESTGATE BAPTIST
DESCRIPTION: Phone/data
OWNER: WESTGATE BAPTIST CHURCH, PHONE #:
CONTRACTOR: KELSO ELECTRIC INC PHONE #: 603-648-6360
Inspection Request Scheduled For: Date: 12114 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 023446-01 • 503.5724392
Corrections/Comments/Instructions:
‘.\
0 "T L. . he. t„&
t4 cs\ -- • Cv e• • I* CT ( c-LA6afa.tQm. V\
F I
FiZa, PIA!) Q1/k
W; PASS fl PARTIAL APPROVAL fl CANCEL LII NO ACCESS
I FAIL 1 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: '11 \e'll ‘ a--, ON6 L Date: \ 01 Phone #: (503) 718- •