Permit k CITY O TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
Y
,'r,,1I DEVELOPMENT SERVICES PERMIT #: ELR2004 -00318
—"-`'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/14/2004
SITE ADDRESS: 09725 SW DURHAM RD PARCEL: 2S111CD-00400
SUBDIVISION: ALDERBROOK FARM ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
Project Description: Limited energy for fire alarm wiring.
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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SOUTHWEST CHURCH OF POINT MONITOR CORPORATION
CHRIST 4755 SW OLESON ROAD
9725 SW DURHAM ROAD PORTLAND, OR 97225
TIGARD, OR 97223
Phone: Phone: 503 292 - 5533
Reg #: LIC 135901
ELE 34 508CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/14/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 10/14/2004 $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. ATTENTION: Oregon law requires
you to foll les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-?010
throw OAR 95 -401 -0 00. You may obtain copies of these rules or direct questions e • NC at (54 - ').99.
Issu d by i ji . ,,e � Permittee Signature .t L/..«
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:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application • pox OFICEUSE oNr71
Cit of Tlbilyd • Received ' Permit No.: ��
13125 SW Hall Blvd., Tigard, OR 97223 Da : � �,
g Plan n /B Review
Phone: 503.639.4171 Fax: 503.598.1960 t ?'� 1pgi l Date /B : Other Permit:
Inspection Line: 503.639.4175 �' `` I Date Ready /By: Juris: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
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❑ New construction J Addition /alteration /replacement Please 'check all that apply: :_,
❑ Demolition ❑Other: ❑ Service over 225 amps, comm'l ❑Hazardous location
k , •t. , 0 , , .,, ,_: _ i £ .._- , ,, Service over 320 amps rating Buildn over l 0,000 sq. ft.,
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�,�'ik d -, __ ,, ,,,.,�,,;,,'�_,- .. ,.,- �z� ^:�,: „gi n: ,,�,,,,.,,� h „�, , .�5�. �r:�x�,e,ca �;• � , o f 1 -and 2-family dwellings 4 or more new residential
❑ I- and 2- family dwelling XI Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories Feeders, 400 amps or more
❑ Multi- family ❑ Master builder ❑ Other: ❑
p rsons
, . ; ,,, a:>:. e�;.,>.:.,..,.: ga, k_.;:, �^,,,; e:.. �;,, a,,;.:,,., p, �, A`., a: ...- �.r.N :..,at:;.;,::;;,a:..7 DOccupant t load over 99 e M anufactu red structures or
1 .. �t .•; i '..•ii'::y i ^A�• tg �il.
:s €< 7OB'; SITE; >7NPORIVPA�I.ON: AIV3?' I OC?:I?IONi:.,y= _ r Egress/lighting RV park
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❑Health -care facility ❑Other:
'a y_; .. � .,.. � -.- ,: ., = �:'.'. �,. .: _;'t .r ,,:�.. E ress/h htin plan P
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Job no.: Job site address:9 .2 ' 5 SW 0 vrho n. f Submit 2 sets of plans with any of the above.
City /State /ZIP: ''7�� ( ' \ The above are not applicable to temporary construction service.
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suite/bldg./apt. no.: Project name: ' � •- �' X ..�..,- u, F l �.,'
( Descri Qty. Fee. Total
Cross street/directions to job site: DtA r ‘, 0,41v .. \ ek 61 d 140 ( 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. It or portion • 33.40 1
Tax map parcel no.: Limited energy, residential • 75.00 2
. Limited energy, non - residential 75.00 2
z : �v,'( 7n ` . }tr \ ;:`t , DESCRIPTION OFt WORI{, ` i aMt E- '' t. AO Each manufactured or modular
re_ a f rrv1 i A s - i a. ((� ,. OYO dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
i:'S1;sF�;: , z'e£ry .Mr e'«�.eFi' - iF "-i#^'..; - .G'4, - Y.'�9Fu. ..,.5 w G'-: ';'i.:',
ai'��� �-, r - E ,;rr *� ,.. „ t��} 201 amps to 400 am s 106.85 2
dam' - i�!�: t- - `ry'::s" �;,�.` - " -w `
,;�;:, !�;x °„ _ ;�:I?ROPER�:I,.OWN)y ,;t '��::F,. ,r� P , ,�' � i.
_:. :. . ��4�..`�a. ^w � ��.•. ��, t t�';=�•r � . i� �,1.: r � Y� «'1wEN.411'�: �u;r'� . � .�
" I L r 401 amps to 600 amps 160.60 2
Name: S La t((1) � Ch t 1 - •1 601 amps to 1,000 amps 240.60 • 2
Address: ( 7 '7 S 5 (,t1 Our-ha d'Y - Over 1,000 amps or volts 454.65 2
Reconnect only 66,85 2
City /State /ZIP: -- -- a rd (4.. 0 Temporary services or feeders installation, alteration, and /or
• Phone: ( ) ✓ / Fax: relocation
( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 20] 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
"3: : "si ":; „3 i•2;`.t: ;�'.i':i,- •`. ^ - - : 02;` . ^tki -r ':�k•T, r:n it �iA"ia "';:k:1'c,u srs�xh.;,4. . ":C,+' -._
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:.,,,* ` « . - :;, , ' ; r. „1µ A, Fee for branch circuits with
-;t, :A [?PI:;TCANT,..�',� ,<. <a, - .,GrOI�TEL- AGT�.�PD 'SOPi',�:::es<�;�: r:
;;yt ?��:� =r. .,.. - ,,, - '.R�,: -..s:- ..,,. .N•w,.;..�..,.,b.:..� r,;tw' ti'o" ...'�z�?�:�'�'!%`.,...'r +.. •+�,,. }� Z � .,..ti .
D � ^ service or feeder fee, each
Business name: 1 , I ttii`JJ � 1-171 (- C Z ( fC �- a -f - branch circuit 6.65 2
/� 1 A .. B: Fee for branch circuits
Contact name:
, " IQ/ 1`1• te-3 g /l3 without service or feeder fee, 46.85 2
C.,•3 ,�}� 4 each branch circuit
-
Address: L 5 S o( g�'1 E� •
Each add'I branch circuit 6.65 2
City/State /ZIP: `\ ,N \ ,,,d 2 l -0_, Miscellaneous (service or feeder not included)
Phone: (�3 ?92- 5--g---3 3 / Fax: : ( b3) 2R 2 SS( Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
, (
E -mail: / t(1.1 9 Asill f 6 � 3 � � o ^'a '1'1`t¢IIIJovtI Ta C5Y - Signal circuit(s) or limited-
:., 's energy anel alteration or
Business name: •�C ( �.�- n - �� 1-471e--- r a b extension. Describe: Page 2 �' 2
Address: y - 5 (. 0 ( may S �,,Q " (b � t•` t MN. Each additional inspection over allowable in any of the above
l / /� � / � � (it Q Per inspection 62.50
City/State /ZIP: V 1
Pb ( 4- (a. in d f 0 (? l -7 Z•Z s- Investigation per hour (] hr min) 62.50
Phone: (93) „Z 2 _ -3 .3 Fax: ( 3) ? 2 -3S (Z Industrial plant per hour 73.75
g t .; i''Fs13ErC ':R7004,F, ']Vll F3TvES* yy . <.igfi -' , I
CCB Lic.: 3. go 1 .Electrical Lie.: 3 y -5 re L 4 . Suprv. Lie.: Subtotal �
°
Suprv. ETt ? triC�dfi Qilature, required: 7(/ /O
Print name: Mal- 6 T'l ` 19 11.5 Date: / 0 State surcharge (8% of permit fee) (0 ,(5.O
/` TOTAL PERMIT FEE '
Authorized signature k
This permit application expires if a permit is not obtained within 180
( 6
• / I/ days after it has been accepted as complete 01
Print -name: Ma --, -(I .e v (A, $ Date: ( (� if (/ v * Fee methodology set by Tri- County Building Industry Sery srd
.e i f " Number of inspections per permit allowed.
is \Building.\Permits \ELC- PermitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION — Business Line: (503)' 639 -4171
BUP
Received Date Requested l AM PM BUP
Location Suite MEC
Contact Person ' 4J -t -rte Ph ( ) e �7 - 5 8 PLM •
Contractor - Ph ( ) SWR
64) _L
BUILDING Tenant/Owner 5 CLutzik- ELC
Footing ELC
Foundation Access: r ` r '
Ftg Drain ELR G�� 7 �d .3� 0
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation •
Drywall Nailing ,�` C
Firewall \ !, 1 Q t`� c _�,1 ►' v
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: '
Final
PASS PART FAIL
PLUMBING V (�
Post & Beam
Under Slab ra
Rough -In
Water Service
Sanitary Sewer
Rain Drains •
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final —� 3 7 ° I — / / � , f2 -- / $$
PASS PART FAIL
ELECTRICAL L'L rto — ,c}o 33G° - ✓ `° . 144RQ, j''
Service
Rough -In LC �Z ` 15 ' > 14 '/2 se-g r
UG /Slab
Low Voltage 1�� C v � /8 / r / . , iv
Fire Alarm
t • Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
P PART FAIL
SI 0 Please call for reinspection RE: El 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 site.
PASS PART FAIL
•
CITY OF TIGARD . 24 -Hour
BUILDING InspectionrLine : (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested (Q , 0 / AM PM BUP
Location q.7 S , 1 Suite MEC
Contact Person A J24 Ph ( )'g/ — 7;-3Y PLM
Contractor Ph ( ) � SWR
BUILDING Tenant/Owner 5 0 /
- ` 1 Al ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
7 \ [ 411j
PLUMBING
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
Post & Beam
Rough -In •
Gas Line
Smoke Dampers
Final
- - FAIL
RICAL
Rough -In
UG/Slab
Low V, - . e
Fin I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspe tion RE: ❑ Unable to inspect — no access
Fire Supply Line •
Approach/Sidewalk Date Inspector / - ' Ext
PP
Other:
Final DO NOT REMOVE this inspection record rom the Jo site.
PASS PART FAIL
•