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Permit CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY All DEVELOPMENT SERVICES PERMIT #: ELR2004 -00199 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/9/2004 SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE PARCEL: 1S133AD -02200 SUBDIVISION: ZONING: R -7 BLOCK: LOT: JURISDICTION: TIG Project Description: Data Telephone, audio, video, lighting control A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: X 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: VIDEO X TOTAL # OF SYSTEMS: 1 Owner: Contractor: WESTGATE BAPTIST CHURCH BROWNELL SOUND + HI -Fl 12930 SW SCHOLLS FERRY RD 12115 SE 82ND AVE TIGARD, OR 97223 PORTLAND, OR 97266 Phone: Phone: 503 652 - 2160 Reg #: LIC 73876 ELE 26- 789CLE SUP 412LEB FEES Required Inspections Description Date Amount Ceiling Cover [TAX] 8% State Surchart 7/9/2004 $6.00 Wall Cover Elect'I Final [ELPRMT] ELR Permit 7/9/2004 $75.00 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. 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 to OUNC at (503) 246 -6699. Issued by T 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: 7/Y /C LICENSE NO: 1 Z _ (-Ed Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day '1 Electrical Permit rAppWatig FOR OFFICE USE ONLY ' g,� L., Ii V Received �Q� City of Tigard Date/By: PermitNo.: Cam! ., © _ 13125 SW Hall Blvd., Tigard, OR 9U3,3 n Plan Review Phone: 503.639.4171 Fax: 503.598 60 ( J 2U0� 49 1 4 1 to DateB : Other Permit: e i w74, ... Inspection Line: 503.639.4175 e I Date Ready /By Juris. Ei See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information 4�a.:t g ; � .�•� ., � . ,.. n =ate �;,.� • �,,: ��:,n .:,,._ ;,,,. < � ; ' 4z.3 t ptr iTI MV "a� ,V. 4, T-0. r e r 4i15 REVIEW ._ a idnom .z au. , wr. arc ..,iiZt.,V.it ` < �a. ru< :i i ta aT. _. ...New construction ❑ Addition/alteration/replacement Please check all that apply: ['Service over 225 amps, comm'l ['Hazardous location ❑ Demolition E Other: } r , -t y , �, *¢ , q _, ,� „ „ vim # , ^r %,, p . y „,, , _, _ , ['Service over 320 amps - rating EBuildng over 10,000 sq. ft., _ �� E=zATEQOR�' (�k�CO�ISTRT9CsTjON� -:��e� �. ��'���� �l� t�. -.�. of 1 -and 2- family dwellings 4 or more new residential �� � ...�':, ^; � .. _; ru:...n�§ix �':;'snu�� -; a��:^.�xr.?a �*� �^:... a�. �: ��!_ �s,^< a; a-,: �a�� :;`s:�^.;.a:���,�,�:ha���.. aW„:= kisa:n . ❑ 1 - and 2- family dwelling Ea Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: ['Building over three stones ❑Feeders, 400 amps or more }, . Tom , , $s_ Master , � art m , _„ , tee j k „}, ['Occupant load over 99 persons ❑Manufactured structures or :,., ''- . ,1a, ,§ SITE OR141 TION�AND LOCATI'O at l- ['Egress/lighting ��ax� °, s �a..� a�r„�.� f� �sa .zr'�c:�zn.r�. �. ,.� � =t�, -ter. �.,�.,ai -,� ��s;�,�tn.s� lan RV park P /� 1 lQ "f;- ❑Health -care facility ❑Other: Job no.: Job site address: l �,�C D Submit 2 sets of plans with any of the above. City/State /ZIP: 7 The above are not applicable to temporary construction service. / r� °'� � � ,�� FEE *'SCHEDULE Suite/bldg. /apt. no.: Project name: l✓ 2� �'f�” ' � • Description Qty. Fee. Total Cross street/directions to job site: Sr ' /C1 i / j j to 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'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: 3 °� -. �l �- � aKsY, 3RR.� � S 9+�' p a, � " h k`% yam. �.. Limited energy, non - residential ( 75.00 Each manufactured or modular 2 .� ' I . '' * �AESGR7PTION OIi" WOT 1 '' +� ..� �.. u.e.�tr+�,�ax ..�., .. .... ;�`s',a Wiz, �.4.-�a.�_,,:....�' t.,.;.,a . ._ - rte- PAZ 2 � r �' "�+� - r vi/ te V t � t .0 Services or feeders installation, alteration, and /or relocation { (- ) A'L . 200 amps or less 80.30 2 ail riti. * .,ate., om. - ,. -.::, ,, a:: �;:ti:w <::,frr4 201 amps to 400 am s 106.85 2 E 5' , , I_ . ® PR(7PE TY«.,OWNER , ` t , , i ,4, r..u:; ° "� ` " " "' "�' ^' j � 401 amps to 600 amps 160.60 2 Name: (,,,t �! s�9 9. l 4''(d`— l� ✓s'tl 601 amps to 1,000 amps 240.60 2 Address: 10 3 © j_� (�0 Over 1,000 amps or volts 454.65 2 7 Reconnect only 66.85 2 City /State /ZIP: t 1 ( 9 — 2 2 Z� Temporary services or feeders installation, alteration, and /or J relocation Phone: (5 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 I • 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 #' 7 '� am ' A. Fee for branch circuits with i. xt ..:: , , 3_APpL`IC T i . ,1° , CON RSON. a, .{ � A , ��.., service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: • Each add'I branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) O Pump or irrigation circle 53.40 2 Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2 E Signal circuit(s) or limited - '\ -- = <",:,; ia� QNtTRACTOR� t : .w - gi' energy panel, alteration, or "d� extension. Describe: Page 2 2 '..- i Business name: Loco*, J Each additional inspection over allowable in any of the above Address: Z S" r�_ y Z -.. Per inspection 62.50 1 N City /State /ZIP: 0��� & r 0 - -9 z G6 Investigation per hour (I hr nun) 62.50 � Phone: ( ) A Z � ` Fax: ( b ) Z-7 Industrial plant per hour 73.75 �� :: :w glit-Q <'RisC ` PERNTITA F—ES -- CCB Lic.: 2 Electrical Lic.: 2(_. prv. Lic.: l'n 7� Ct� Y /Z - 4(6 Subtotal Suprv. Electrician signature, required: - � Plan review (25% of permit fee) Print name: v<� .ge( Date: 7/a1 4 0 [L State surcharge (8% of permit fee) V T 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: lexel Date: 7/ r70,4- * Fee methodology set by Tri County Building Industry Service Board * * Number of inspections per permit allowed. i \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: raSII)MIAL Wriaill:- ,�: / \ Fee for all residential systems combined ... $75.00 / Check Type of Work Involved: \ ❑ Audio and Stereo Systems* // E Burglar Alarm l [ Garage Door Opener* -0 °' ❑ Heating, Ventilation and Air Conditioning , I U l System* '-t ( c • ❑ IP Vacuum Systems* I ❑ Other: '&07.7T, 7 RCIAIJ W:TOW ®NLY N, Fee for each commercial system $75.00 1 . t . /u . (SEE OAR 918- 260 -260) () Check Type of Work Involved: .\/\ b n Audio and Stereo Systems 0 / I ' ❑ Boiler Controls \ V) ❑ Clock Systems jg Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls - ❑ Outdoor Landscape Lighting* . ❑ Protective Signaling i . • ❑ Other Total number of commercial systems: ' *No licenses are required. Licenses are required for all other installations \ is\ Building \Permits\ELC- PemritApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: ' ( 03) 639 -4171 Q BUP Received Date Requested - ( O 7( AM PM BUP Location (07 'S(3 *G ` Suite MEC Contact Person I li Ph (03) 70 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC 2 034--0325- 0- Footing ELC Foundation Ftg Drain Access: ELR e Crawl Drain Slab Inspection Notes: Er P --06 ( • Post & Beam ELR 3 Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation ► / Drywall Nailing Al �� !/ ���3S �� Firewall �1� 77 LU Fire Sprinkler � Fire Alarm Susp'd Ceiling ` -� T- n �� Roof ( £'�1 �. � t � O t ( s 3 iLE7 l i a-S Other: Final -7-?1.4v1 PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service fa e-- Sewer cif v'`- //1(4 Rain Drains � �•J 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 LECTRICAL Rough -In UG /Slab Low Voltage Fire Alarm F� ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL $ El Please call for reinspection RE: Unable to inspect — no access Fire ADASupply Line 17 N..." 0 Approach /Sidewalk Date C r Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL