Permit S S JTY OF 1 IGARD PERMIT #: ELC2004 -00275
i ' DEVELOPMENT SERVICES DATE ISSUED: 5/19/2004
I
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 25111 CD -00400
SITE ADDRESS: 09725 SW DURHAM RD
SUBDIVISION: ALDERBROOK FARM ZONING: R -
BLOCK: LOT : JURISDICTION: TIG
Project Description: 1 service and 1 feeder (temporary power).
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 2 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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 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 $123.70
[TAX] 8% State Surcharge 5/19/2004 $10.70 Elect'I Service
Rough -in
Total $134.40 Elect'I 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 Oreg• n 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 o •irect questions to OUNC at (503)
246 -6699 or 1 -000 -3 - 344.
Issued 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: DATE:
LICENSE NO: 4 /67
Call 639 -4175 by 7:00pm for an inspection the next business day
•
10 , 0 G% — / e
..,. ..: r . : . ,t -,,,,,•; ' e' e 5 ... - .
Electrical PQrmit Application . k , FOR• USE ONLY r ° ' x z ! -
'City of Tigard Received i �ti o� Permit No • e.V7 —°°?7 ' ■ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598. 1960 ' `; Da /t3 -
Other Permisi
Inspection Line: 503.639.4175 n i l I ' . Date Ready /13v 1 • " /2 0 See Page 2 for
Internet: www.ci.tigard.or.us Noulied /\Method' I le) Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑Addition /alteration /replacement
Please check all that apply:
❑ Demolition 6 Other: / ,•, r ., ` S,•prvr c-e ❑Servlce over 225 amps, eomm'I ❑f lazarduus location
p ❑Servlce over 320 amps - rating ❑ Buildng over 10,000 sq. ii.
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more new residential
❑ I - and 2 family dwelling Commercial /industrial ❑ Accessory building ❑S over 600 volts nominal units in one structure
['Building over three stories ❑Feeders. 400 amps or more
❑ Multi family ❑ Master builder ❑ Other: ❑fvtanufactured structures ❑Occupant load over 99 persons act or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Q ❑H ealth -care facility ❑Other
Job no.: Feet 9S' Job site address: / 7 2 5- S CJ D �ea.o�
Sub 2 sets o plans with any of t he above.
City /State /ZIP: 77 e t e.A The above arc not applicable to temporary construction service
Suite /bldg. /apt. no.: Project name: c FEE* SCHEDULE
^ �* � �Y �O C l.. v t s Description Qtr. I Fee I Total I
Cross street/directions to job site: , gl ■ 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 I
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75 00 2
DESCRIPTION OF WORK Each manufactured or modular
,- r ` dwelling, service and /or feeder 1 )0.90 2
I -r (—I C. Le e f Y‘et 1 ST I(' U I e-c - eot.s A Ot- Services or feeders installation, alteration, and /or relocation
— 1 7 ? - 4N l.ef f- ?o erH r 200 amps or less 80.30 1 I 2
❑ PROPERTY OWNER 201 amps to 400 amps 106.85 2
❑TENANT
401 amps to 600 amps 1 60.60 2
Name: , amps to 1,000 amps 2-10 60
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 7 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with I
A. service or feeder fee, each 6 65 2
Business name: G , 2 r 1 ..p e k. h t c 4 ( , , i, tit 4 . c. ,. , i,‹ branch circuit
/ L B. Fee for branch circuits
Contact name:
A t, U Y v "t without service or feeder fee
46.85
Address: I each branch circuit
2 O't `� f� (,J A ( G 1 Q q t Vf 2 Each add'I branch circuit 6.65 2
City /State /ZIP t 4 t I IS L 0 T 0 o f 97 ( z el Miscellaneous (service or feeder not included)
F ax:: Pump or irrigation circle 53.40 )
Phone: ( 5o3 )
B /0 ( - O�/O (503) 6/y - pc/ 0 Sign or outline lighting 5340 2
I E - mail: 4 I a Ca. Signal circuits) or limited-
CONTRACTOR energy panel, alteration, or
extension Describe Page 2 -'
Business name:
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50 I I
City /State /ZIP: Investigation per hour (I lir min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour I 73.75 I
ELECTRICAL PERMIT FEES*
CCB Lie.: 13 SGO 8 Electrical Lie, 34 c Suprv. Lie.: C 673s Subtotal i 23
Suprv. Electrici n signature, required: Plan review (25% of permit tee)
ice
State surcharge (8%
name: - .-/ i Y ,� e • ate . S 4 O `;4, of permit fee) / '� f 4 � �'i�" �
TOTAL PERMIT FEE r
I Authorized signature' This permit application expires if a permit is not obtained „ithin ISO
days after it has been accepted as complete
Print name: Date: • Fee niethodolo v set by In-County Building Industry Sen ice linaid
" Number of inspections per permit allowed. v /' �
i \Building `. Permits \ELC- PermnApp doe 12.03 440 - 46I /T K
i I Or w ��
(,cal , (07
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:
I Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
TI Instrumentation
Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\ Building \Pern[s \ELC- PetnitApp doc 04/03
•
:.., 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
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INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received l' /(9 Date Requested 5 - 2/ 0cV AM PM BUP
Location 7 2� %ti-- ' I Suite MEC
Contact Person Ph ( ) CO ( el 0 ' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC e? On 2 75
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 `J Rc -1.g36 - Ts . ;) ^,,,� po i4WR-, ANAL cs�M�z` -
Drywall Nailing `J �'�`� l
Firewall
Fire Sprinkler
Fire Alarm ' , iw► -
Susp'd Ceiling = ►�� �� `: `ice �� ` r►� r � , ,
Roof �� 67 '' DI .21 •N
Other: •
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Water
Water
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: •
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough-In
Gas a Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
rm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
A S PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line ( \
ADA
Approach /Sidewalk Date v► �}, Om - Inspector . ' N , ! L Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL