Permit JTY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00186
, t DEVELOPMENT SERVICES DATE ISSUED: 6/9/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111 CD 00400
SITE ADDRESS: 09725 SW DURHAM RD
SUBDIVISION: ALDERBROOK FARM ZONING: R -7
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical work for auditorium addition and restroom /kitchen upgrade.
Job No. PO4C0104
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: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 40 PER INSPECTION:
201 - 400 amp: 1 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
SOUTHWEST CHURCH OF LORENZ ELECTRICAL CONSTRUCTION INC
CHRIST 2074 NW ALOCLEK DRIVE SUITE 41
9725 SW DURHAM ROAD HILLSBORO, OR 97124
TIGARD, OR 97223
Phone: Phone: 503 - 614 - 0400
Reg #: LIC 138608
ELE 34 -516C
FEES SUP 4673S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/19/2004 $453.15
[ELPLCK] ELC Pln Rev 5/19/2004 $113.29 Ceiling Cover
[TAX] 8% State Surcharge 5/19/2004 $36.25 Ceiling Cover
Wall Cover
Total $602.69 Underground Cover
Elect'I Service
Rough -in
Etet,i t Final
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 f .1 • .• OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -669' • r 1 -800 -33 -2,344.
9 ) , 01zet ,
Issue • By: _ Permit 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: C 4 / =PJ`'( 10 DATE:
LICENSE NO: ®' 7
Call 639 -4175 by 7:00pm for an inspection the next business day
0 tt,P,
Electrical Permit Application , FOR OFFICE USE ONLY
Pep
nit
of Tigard ECEIIVErit Received / e y
Date/By V . C4 PermitNoji
13125 SW Hall Blvd., Tigard, OR 97 2 ' Plan Review a . A A \,,,i,.
Phone: 503.639.4171 Fax: 503.598.1960 4 * 0 47140'd =' Date/By: - Tilizt[ u tri. 849 Other Per F .:249,4 7 _ 0 _ 6 ), 6
Inspection Line: 503.639.4175 Date Ready/By. di i - Juris: la See Page 2 for
Internet: www.ci.tigard.or.us APR 1 3 200 -.-4.4- 11.1
Notified/Method: %ITN Supplemental Information
"- '; .': -',-;;- .v ;' - - - f . : ' ' • : .. :1 - ..'. 4 ' ° '''. ''''.. ' — : , ,-, , - --' = -',',' ", , , ,,.:-, "-, — :' 4, ' PLAN REVIEW
O New construction El klilakicerkibiORP tement Please check all that apply: . . ..
,DService over 225 amps, conun'l 0 Hazardous location
0 Demolition 0 Other:
['Service over 320 amps - rating 0Buildng over 10,000 sq. ft.,
C.ATEGORY .', : ': . '2., -, .7, ,, . of 1- and 2-family dwellings 4 or more new residential
El 1 and 2 dwelling E3 Commercial/industrial 0 Accessory building 0S over 600 volts nominal units in one structure
0Buildin over three stories ['Feeders, 400 amps or more
O Multi 0 Master builder 0 Other: Occupant load over 99 persons ['Manufactured structures or
-'..::,,,, JOB SITE INFORMATION AND LOCATION 4 „ '' '= .' ' El Egress/lighting plan RV park
Job no.: PO4C0104 Job site address: 9725 SW Durham Road 0Health facility 0 Other:
Submit 2 sets of plans with any of the above. .
City/State/ZIP: Tigard, Oregon 97223 The above are not applicable to temporary construction service.
. e t',. l'' :-Etigt:.'., i .
Suite/bldg./apt. no.: Project name: SW Church of Christ ' , ": ;' :: $0 " T
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'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.: Limited energy, non-residential 75.00 2
( ' .1° ‘,,.. •;',., - • ' ,,,DSCRITTION: OF:yvwc • : , ' .‘ . :, , ,;:,: - ,- Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Auditorium Addition and rest room/kitchen upgrade
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 150,30 2
'7';'• '' iiio O
pkinii:wi■iiii '- 4 .- '' - ::=' '': ';- ' . : .4611674 . ," ' ''..," ‘' ' 201 amps to 400 amps f ;. 106.85 /04,,9 2
.. „, .... , . '. ....... _ , 2 .2 ' -'' " - ., - ' "'" N " ' - ' ' " '' -; -''' ' 401 amps to 600 amps 160.60 2
Name: SWCC 601 amps to 1,000 amps 240.60 2
Address: 9725 SW Durham Road Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Tigard, Oregon 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) i 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
1:14kiCASif f- ' ' r: . ' ' tf - CONTACT tia ' ' • :-.,:: .. A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit go 6.65 ; 4,6, 04 , 2
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)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: : ( ) Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
i,COicii* .':''''',!.'-,'1'',f,::,t,:-,:`' energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Lorenz Electrical Construction, Inc.
Address: 2074 NW Aloclek Drive - Suite 412 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Hillsboro, Oregon 97124 Investigation per hour (I hr min) 62.50
Phone: (503) 614-0400 I Fax: (503) 614-0401 Industrial plant per hour 73.75
4I : 34 16C : 4673S ,,, ' , ..." ELEOFItEC PERSitt-F,EES* ';', C'l!
CCB Lie.: 138608 Electrical Lic. "/ Suprv. Lic. i Subtotal 4 , / 5
Suprv. Electrician signature, required: i 0 0 loll 01 Plan review (25% of permit fee) / / 3 , Al
,
Print name: A j r‘ft,,)
S L / I Dat;. 04/13/04 State surcharge (8% of permit fee) 36,, ,2 5"
TOTAL PERMIT FEE ( in bf
e;•
Authorized signature: This permit application expires if a permit is not obtained within 18
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.
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
y .�
° 12E $I]]l:N�'.IALWOItK�ONLY,.Y�i; , °:��fi . }=f,
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*
El Other:
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
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El 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
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2004- 00136
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/$12004
Phone: (503) 639 -4171 �n "a'II iiipyl�"
Inspection Requests (24 Hrs.): (503) 639 - 4175' �...
INSPECTION WORKSHEET FOR DATE: 3/24/2005 TIME: 7:09AM PAGE: 49
SITE ADDRESS: 09725 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: ALDERI3ROOK FARM LOT #: TYPE OF USE:
PROJECT NAME: SOUTHWEST CHURCH OF CHRIST
DESCRIPTION: Job No PO4C0104 - auditorium addition and restroom /kitchen upgrade. 12/29/04 revised to split
occupancy. This permit covers Phase I . and Phase I I
OWNER: SOUTHWEST CHURCH OF, PHONE #:
CONTRACTOR: LORENZ ELECTRICAL CONSTRUCTION INC PHONE #: 503 -614 -0400
I
Inspection Request Scheduled For: Date: 3/24/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 002696.01 603-6140400 N
Corrections /Comments /Instructions:
pz-
. (?..
PASS ❑ PARTIAL APPROVAL ❑ CANCEL 7 NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
�/
Inspect. �s J1 �. / ' Dater pZ j� ` 9� Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: a06 c4--66 ! 0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: • y TIME: PAGE:
SITE ADDRESS: 7 /; 5 J)CL/L_ a-4 1/ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #: (p / 6
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
1_0)11
Corrections /Comments/ Instructions:
PASS tikPARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: X " -et. Nie t' Date: — V CO Phone #: (503) 718- (1.`-
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection L ne:-15G3) 6354175
INSPECTION DIVISION Business Line: (503)'639 -4171 MST
BUP
Received Date Rested } �� AM PM BUP
�v
Location 9'7 .S Suite MEC
Contact Person Ph ( ) `__ ` 7 ( PLM
Contractor
Ph ( ) SWR
BUILDING Tenant/Owner 5 t/3 ti ELC ,Zoo _ 0O(n,
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation A , O �
.r `G
Drywall Nailing " `��'
Firewall fi G 0 V IN
Fire Sprinkler ��` ,�v� \ 1 p f , r _
Fire Alarm `' ,e0 L �W U 1G� T��� ) t4 )ct J f �(� �P
Susp'd Ceiling 111
Roof 3T 1 �
Other:
Final
PASS PART FAIL
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
PART FAIL
Service
• r
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
PASS ART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Date - f_ •
ate l 6 , /
Approach /Sidewalk Inspector . -_ u.& i _ Ext
Other:
Final DO NOT REMOVE this inspection recor from th Job site.
PASS PART FAIL