Permit yY
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
.4'4P DEV W H Hall Tigard. ERV I 639 -4171 DATE ISSUED: 2/2/2005 -00022 OR
SITE ADDRESS: 09725 SW DURHAM RD PARCEL: 2S111CD -00400
SUBDIVISION: ALDERBROOK FARM ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Low voltage for fire alarm.
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 DYNASTY SECURITY
CHRIST 8301 SW 135
9725 SW DURHAM ROAD BEAVERTON, OR 97008
TIGARD, OR 97223
Phone: Phone: 503 319 - 4754
Reg #: ELE 34- 501CLE
LIC 135086
SUP 2227JLE
FEES Required Inspections
Description Date Amount Low voltage
[ELPRMT] ELR Permit 2/2/2005 $75.00 Electrical final
[TAX] 8% State Surchart 2/2/2005 $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 1.80 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, tJNC at (503) 246- 699.
Issued by 3�, 'ter h / ,' /� Permittee Signature 2n
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 Per, it A I I • tior D - ; r ' F OR OFFICE` ONLY ,f ' .: ' •
CityOf TIgaI CI .. ''.. ' _ Received _ — 0'S P ermitNo.:� �� - 00 IJ 1 66 DateBy:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.196 / a'e'),'G ('r p. Date/B : Other Permit:
Inspection Line: 503.639.4175 FEB 0 2 2005 '• Date Ready/By: 7uris: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
, _ >, . ' (I 'IN =i rg- r i t cr ", » . r r PLAN IEW
.„ �,'�' ., � v`:%°'.�,,s�t' -, .. � x :," .,..�c,.:= ,�- , ..,Itir�;i,�''��` "�v''S."�z fiu�s.0 .'�,r �,w� �t;�....a,_ .. ....,�.. . . .. .� . ._. .�� -�.. -
❑ New constructionBTTL i jllr . i, i i lilk ,S �lacement Please check all that apply:
❑ Demolition I � ❑ Ot er:
EService over 225 amps, comm'I ['Hazardous location
, f , ^ r4E4 w y ;, i R � Y „ F <Y F e h . r „ y . ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
r o ,if ., i ;' '`` R': of Gri ®
*I('-`'eagf, TIefft5 ° %' =�'t otpiv-L= 'i. =.. =' oft- 2 famil dwellings 4 or more new residential
* m..,.ei ',taw: : m,s a r ,n«,42,. ,,,..s -s,., ,.,- :z :.,..cs. . tfi i v 5ax..t. gia°",.'„ Y g
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stones (=Feeders, 400 amps or more
El Multi - family El Master builder
❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or
s 'X:2 ` + X7.+ ,'.; m ;, =a4, -, ; . :s 4 -ei ;ia a a:z ��^ ;.:s 7,,,r47.5,;.4,94.1..; 3 v
'lr' z 12, 6"41 RALVVI ®,Nay .J_O, :;MAI A ,It ❑E gress /l ighting plan RV. park
R
P
Job no.: Gl) 67///1"1/1/Job site address: • ] s (�L(� W 4' ( /2/� ❑ Health -care facility ❑Other:
/ S Submit 2 sets of plans with any of the above.
City/State /ZIP: 77 G / tie e+ 7 2 2_ y The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name :S - C /� /eC ✓ � //! /S / — Y� ,:. : ' i ": 1h D'''T�Ex _ 4 = <
Description Qty. Fee. Total
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.: .
kTM l xg s , , M 9 Limited energy, non - residential 75.00 2
: - :-yc , lv 4 ,, Z Z ` t A ti GI P° - . , . O. : O RI g =E . t;. rv1F °I ;a. ;
,*, A s�t��.�'�,a1, �= 3, „.��.���,_��,;,�.,,, s.��,.. �...,..:..�,5e ":- ;r,�cba Each manufactured or modular
dwelling, service and /or feeder _ 90.90 2
/ - /t2 £ n L44/ /14 Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
t , i . ', ,.�,. . ;d; :�. R: , ; KW014. t c i.l: is "'&574,14 201 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
' ; -i t fi.M _ .-,, rie e _ ria4 ' .K � �r r a , a > y - -gi A. Fee for branch circuits with
; y ;. . = APP ICAI`Tt ,, = ,, 'i,• �yk V �e 1'T`,CT� . oam ,,, , u tet t
�� � "��� , �'�°'��°� °� ' °� �` �'�'�'�'"� � `"�`�'� service or feeder fee, each
Business name: �y� S � S � c u � branch circuit 6.65 2
� j
Contact name: / B. Fee for branch circuits
without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'I branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
>_, "' ”' ` *' _ "11 s - r ` ;° r°i energy � k,ir' , � t:.����`� �O s O�Z �t +� > . z ��,�k>£' °- : gYP
anel, alteration, or
z a:� :u' . > . } . "ts a��; w.. .. extension. Describe: Page 2 2
Business name: T y/ dj e $ ,5 s-e / /�
Address: ' 30 S /-C-' Each additional inspection over allowable in any of the above
/77/../',. Per inspection 62.50
City /State'ZIP: To py� �7 0 Q Investigation per hour (1 hr min) 62.50
Phone: (c-(73) 37 5'_ y 7 5-77/ / Fax: ( ) Industrial plant per hour 73.75
I .9.11 ECT P R YIIWE M; :..s .:: ...-
CCB Lic.: /3 S 8', Electrical Lic.3V-SO /C . Suprv. Lic.: 22774E/4 - Subtotal 1
Suprv. Electrician signature, required: / , Plan review (25% of permit fee)
/ — State surcharge (8% of permit fee)
Print name: . of, A) K/ � .--
TOTAL PERMIT FEE t
Authorized signature. f . 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 pf inspections per permit allowed.
i\ Building \ Permits \ELC- PermitApp.doc 12/03 440- 4615T(t0 /02 /COM/WEB X 1 / " 15 / D ^ ) 1 ` 0 "
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
.:.st: . � a � �. s; � a .^ �':aw . .wr- r a�.� -3••a ,.a " - ,'s - � 3;^=i F ::: � � ;�'r '!.-" y s:..
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*
❑ Other:
.� ��. -�� >�_.�. �.,�. � a �,��.. �� - °� -.�,.
: 'rt2 *.. r.... `cbaPdS ¢r'. "t- "Sk%'b`�i��7S
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
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
( Other / ` • IZ
Total number of commercial systems:
•
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200S 0002 2
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 2/2/2005
Phone: (503) 639 -4171 .� a��°Ou!�m
Inspection Requests (24 Hrs.): (503) 639 -4175 ...._-_,W `
INSPECTION WORKSHEET FOR DATE: 4/6/2005 TIME: 7:09AM PAGE: 613
SITE ADDRESS: 09725 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: ALDERBROOK FARM LOT #: TYPE OF USE:
PROJECT NAME: SOUTHWEST CHURCH OF GOD
DESCRIPTION: Low voltage for fire alarm. ,
OWNER: SOUTHWEST CHURCH OF, PHONE #:
CONTRACTOR: DYNASTY SECURITY PHONE #: 503 - 319.4754
Inspection Request Scheduled For: Date: 4/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 003697-01 603. 319.4754 Y
Corrections /Comments /Instructions:
C
k\
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I F IL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: m ;,, / `� -„ Date: Y --, 5 -- 45 ----
",5 - (5 Phone #: (503) 718-
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lam: `(5o3) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 - 4171
q BUP
Received Date Requested o / AM PM BUP
Location '7 UJl .d i2) Suite MEC
Contact Person / Ph ( ) — Z ' 1 S3PLM
Contractor //�� Ph ( ) 0-90- g (fo ` c, SWR
BUILDING G Tenant/Owner S� (44 -1.1/1 ELC
Footing U
Foundation ELC
Access:
Ftg Drain � � � � � � � ELR 6.6<c` 000
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
PLUMBING
Post & Beam
Under Slab
Rough -In l,' V - ∎ue
Water Service f �
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
PASS PART FAIL
ELECTRICAL
Servic-
°oug n
U a.
Low Voltage
Fire Alarm
Fi ' " Reinspection fee of $ required before next inspection. Pay at, City Hall, 13125 SW Hall Blvd.
'ART FAIL
S ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
\ ADA l , Ext
Approach/Sidewalk Date Inspector 7V
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL