Permit R ,
A, ELECTRICAL PERMIT
CITY OF TIGARD
PE RMIT #: ELC2005 -00176
DEVELOPMENT SERVICES DATE ISSUED: 3/23/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 25101 DB -01000
SITE ADDRESS: 07080 SW FIR LP 100 ZONING: C -P
SUBDIVISION: 72ND BUSINESS CTR -VARNS PARK LOT : 012 JURISDICTION: TIG
Project Description: 4 branch circuits.
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 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:
LDS FAMILY SERVICES SAFE ELECTRIC
7080 SW FIR LOOP PO BOX 1677
TIGARD, OR 97223 GRESHAM, OR 97030
Phone: 503 - 620 -1191 Phone: 503 - 998 -8832
FEES Reg #: ELE 26 -984C
LIC 127541
Description Date Amount SUP 4384S
CITY OF TIGARD MENU 3/23/2005 $66.80
[TAX] 8% State Surcharge 3/23/2005 $5.34 REQUIRED ITEMS AND REPORTS
Total $72.14
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 or 1-yi-332- 344.
Issued By: ,� - �_ _ -AL.AL Permittee Signature: ,)c._
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
( +. .` A , � } ` ! ,� J i y s .,
Electri Permi • ECED r a ,./ 3:1:: , ' ; z rFORtOFFICE USE ONLY . { %,ti l' •
City Of w ar d Received ` , 2 e i e % � 7�
Date /By Permit No � 00
13125 SW Hall Blvd , Tigard, OR 9—MAR 23 2005 Plan Revie
Phone 503.639.4171 Fax 503 598 1960 " ; Date /By Other Permit
Line. Ins ection Lin 503 639 417 5 ,
CITY OF TI ''
t' e Date Read /B Juns See Page? for
Inter
net ww hoard or us � rl-'a3 � "'� Nohfied/Method / / Cit Supplemental Information
BUIL C i,- 71 r ' ' • E OF WORK PLAN REVIEW
❑ New construction ❑ Addttion/alterattonlreplacement Please check all that apply
❑Service over 225 amps, comm'l ['Hazardous location
❑ Demolition ❑ Other: ['Service over 320 amps - rating ❑ Buildng over 10,000 sq ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial /industrial 1:1 Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi- family El Master builder ❑ Other ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
73-0 ?d S (7`% f —i2 Lvci� ❑Health -care facility ❑Other
Job no Job site address
Submit 2 sets of plans with any of the above.
City/State /ZIP: 77 0 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite /bldg /apt. no.: Project name. (....1 j 5 ox-C r/ + _.
D escr i ption 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 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
/ e ! dwelling, service and/or feeder 90 90 2
2� e Jell i v p C 7 S W� / y ( S Services or feeders installation, alteration, and /or relocation
(frJlC f(- J// : I�/Tr / c:x C. - t)! r s 200 amps or less 8030 2
201 amps to 400 amps 106.85 2 -
El PROPERTY OWNER ❑ TENANT 401 amps to 600 amps 160.60 2
Name: 601 amps to 1.000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
Address:
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 I
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
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name branch circuit
B. Fee for branch circuits
Contact name' without service or feeder fee, 46 85 �� + L
each branch circuit O S 2
Address Each add'I branch circuit -3 6 65 / % C 2
City /State /ZIP. Miscellaneous (service or feeder not included)
Pump or irrigation circle 53 40 2
Phone ( ) Fax. ( )
Sign or outline lighting 53.40
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe Page 2 2
Business name '1f -- ii. LL, C T Ac -
Address v Each additional inspection over allowable in any of the above
�' 3 Ux l� l l Per inspection 62 50
City/State /ZIP , 4, s�',ly- �/4 ' ? ?- e' U Investigation per hour (I hr min) 62 50
Phone ?q Fax. c� Industrial pla per hour 73 75
(5 U}) / ( � — 3 2 (5 3 ) (O �� Z 2 a. ELECTRICAL PERMIT FEES*
CCB Lic.. / 2_ } 5 Electrical Lie: 26_ S ;¢ L Suprv. Lic 4_ 3 ?¢ S Subtotal 6,(O , as
Supry Electrician signature. required: 6/t - Plan review (25% of permit fee)
Print name b./ 60 Date:
3 - J 5 State surcharge (8% of permit fee) 5 3 X
�� ✓� - TOTAL PERMIT FEE 7P• Pi
Authorized signature' -- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: /Lj,)j j./ ,3 u IV /t&/ 6.4 Date 3 — 2 3 - 05- * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i ABs, ldmeVPt.rmitsVELC- I'emiit App doe 12 440 -4615T( 10/02/COM/55 EB
•
Electrical Permit Application - City of Tigard ,411.
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
Garage Door Opener*
n H eating, Ventilation and Air Conditioning
System*
n Vacuum Systems*
Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
I I Audio and Stereo Systems
I I Boiler Controls
TI C lock Systems
I Data Telecommunication Installation
n F ire Alarm Installation
I I HVAC
I I Instrumentation
I I Intercom and Paging Systems
Landscape Irrigation Control*
Medical
n Nurse Calls
Outdoor Landscape Lighting*
n Protective Signaling
Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 /0 ddmgVPcrmits,ELC- PcrnutApp doc 04/03
CITY OF TIGARD , , . --
,_
BUILDING DIVISION PERMIT #: ELC200S-00176
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/23/2005
Phone: (503) 639-4171 4 41A 1 1 i'\
Inspection Requests (24 Hrs.): (503) 639-4175 k IL
INSPECTION WORKSHEET FOR DATE: 4/15/2005 TIME: 7:08AM PAGE: 82
SITE ADDRESS: 07080 SW FIR LP 100 CLASS OF WORK: i.
SUBDIVISION: 72ND BUSINESS GTR PARK LOT #: 012 TYPE OF USE:
PROJECT NAME: LDS CHURCH
DESCRIPTION: 4 branch circuits.
OWNER: LDS FAMILY SERVICES, PHONE #: 503-620-1191
CONTRACTOR: SAFE ELECTRIC PHONE #: 503-998-8832
Inspection Request Scheduled For: Date: 4/15/2005 Pour Time:
t.. -
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 004583-01 503-515-6478 N
Corrections /Comments/ Instructions:
-----
( 0 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
/ ,
L _1 FAIL 0 CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: C Date: y - z5 0.5 Phone #: (503) 718-