Permit MI CITY OF T' V A R® ELECTRICAL PERMIT
PERMIT #: ELC2008 - 00642
COMMUNITY DEVELOPMENT DATE ISSUED: 11/19/2008
ti": T 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S101BB -01400
SITE ADDRESS: 12176 SW GARDEN PL BLDG 3 ZONING: C -G
SUBDIVISION: PARK 217 LOT : 002 JURISDICTION: TIG
PROJECT: COLOSSAE CHURCH
Project Description: TI
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: 6 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:
SPIEKER PROPERTIES LP RELIANT ELECTRIC LLC
4380 SW MACADAM AVE STE 100 20200 SE OLDENBURG LN
PORTLAND, OR 97201 SANDY, OR 97055
Phone: Contact #: PRI 503 -701 -4562
FAX 503 - 668 -4190
FEES
Description Date Amount Reg #: ELE C59
[ELPRMT] ELC Permit 11/19/2001 $86.75 LIC 162814
[TAX] 12% State Surchar 11/19/2001 $10.41 SUP 5147S
Total $97.16 REQUIRED ITEMS AND REPORTS
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 1.800 332.2344
Issued By: �
`� _ �/ Permittee Signature: Z.4 __j,(
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.
Electrical Permit Application F,OR_OFFICE USE ONLY il ` Received �� City Of Tigard �� Date/By y / ( cie 7 Permit No ��Ci2T__ — �� � 1 _ I n f -° 13125 SW Hall Blvd , Tigard, OR 97 \ktC0 VAD
3 F I Plan Review /
Phone 503 639 4171 Fax 503 598 19600 DateBy• Other Permit
T ' ARD vv Inspection Line 503.639 4175 \\ iG�R , Date Ready /By lures ® See Page 2 for
Internet' ww- tlgard -or gov
1 * Supplemental Information .ca ' , . .: o : , , , TYPE. OF WO AA v A�,4 ., . _; - _ .. ,PLAN REVIEW • " .
❑ New construction `WAddition/alterati n /replacement Please check all that apply (submit 2 sets of plans whtems checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
1 '` ' - CATEGORY'•OF. CONSTRUCTION i , : q t exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ ` Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION' I
ON AND ' LOCATON ❑Emergency system larger separately derived system
" v` ` ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ,
Job no.: Job site address: 1 7 i 1 S,� �w . P L 100HP or more occupancy
1 El or more residential units ❑ Recreational vehicle parks
City /State /ZIP: ' ,-'.- ,d ❑ Health -care facilities ❑ Supply voltage for more than
A v ❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no. pCvt- 1�� CJ � � Project name: c �� �� ❑ Service or feeder 600 amps or more
,�q� �.�lbl/l — . ' ,FEE.'SCHLDULE ,' :,
C ross street/directions to job site: Descript I Qtr. I F ee, I ' T I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145 15 4
Ea add'I 500 sq ft. or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75 00 2
t.:' ` DESCRIPTION 'OF WOR ' ' ' - ' , ' - b (with above sq ft )
Lim ited energy, gy, multi -family 75 00 2
residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation _
200 amps or less 80 30 2
❑' PROPERTY OWNER' ' - _ - , ❑ TENANT. ° , '. 201 amps to 400 amps 106 85 2
Name: 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454 65 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 599 amps 133 75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
-,.:*.4,„;,,: .7 - : APPLICAN ' - ' ,. ` ° ' : ❑' CONTACT PERSON , above service or feeder fee, 6 65 2
t each branch circuit
Business name: Q_A , 0,, 0,)-k Fr 0 B Fee for branch circuits
without service or feeder fee, t
Contact name:
7 1 - aw\, first branch circuit 46 85 1.6
Address: o ('' (k_ .)e� Lt., Each add'l branch circuit 6 65 • e tc; 2
'°'"' , Miscellaneous (service or feeder not included)
City /State /ZIP: L•_ c l, td , s Each manufactured or modular 90 90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53 40 2
„ '•„ .�a," , , , , ,• CONTRACTOR -r- :., , „ . . ,.�r, ''° •,, Sign or outline lighting 53 -40 2
Business name: k �� �'C 1 i <, L LC. Signal circuit(s) or limited -
RQi energy panel, alteration, or
Address: 207:, S'U 0 k ( be'0 4- , n extension Describe Page 2 2
City /State /ZIP• 01Z. CA 7 055 Each additional inspection over allowable in any of the above
�" Per inspection 62 50
Phone: � 21,0 42)4 Fax: ( ) investigation per hour (1 hr min) 62 50
CCB Lic.: l La_ g 1 14 Electrical Lic.: C -5 C Suprv. Lic.: J 141( Industrial plant per hour 73 75
,' 1 i ELECTRICAL' PERMIT FEES,' "" ',: - ,' < 4
Suprv. Electrician signature, required: s _� Subtotal i 5
1
Print name: 'i2 \ � L t f � M is tv Date: Plan review (25% of permit fee)
v ' I t I t t I n State surcharge (12% of permit fee) 1 0 . t-(,
Authorized signature: TOTAL PERMIT FEE G'( 7 t
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit
I \Budding \Permits\ELC - PermitApp doc 05/23/06 440-46 15T( I 1 /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAI`Woitk ONLY:
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*
n Vacuum Systems*
❑ Other:
(_CO AI =WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n A • udio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ H VAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n N • urse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buddmg \Permts'ELC- PermtApp doc 03/23/06
'' '.
CITY., OF ��m u m_�� TIGARD
' '
���UN�8��� DIVISION PERMIT ~°~,"~~~~""~~= ~�.°"~~"~~"° #: 2
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/19/2008
Phone: (503) 639-4171 Al ;
Inspection Requests (24 Hrs.): (503) 030'4175 �����^���
INSPECTION WORKSHEET FOR DATE: 1/23/2009 TIME: 7:00AM PAGE: 4
SITE ADDRESS CLASS 1217G�����DEN WORK:
SUBDIVISION: PARK 217 LOT #: ODZ TYPE OF USE:
PROJECT NAME: C0L(]SSAECHURCFi
DESCRIPTION: TI
OWNER: SP|ENER PROPERTIES LP, PHONE #:
CONTRACTOR: RELIANT PHONE #: �U��7O1~45�2
. b la LE,
Inspection Request Scheduled For: Date: 1/23/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
��
199 Electrical find 079978-01 503-860-4240 Y
Corrections/Comments/Instructions:
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| I PARTIAL APPROVAL �� CANCEL ��NC}AC[}E8S
Inspector: I CALL FOR INSPECTION [l ADD|T|DNALFEE8/\SSESGED
G N 6m �� k -7� ��
CITY „OF TIGARD
BUILDING DIVISION PERMIT #: ��L Ctlfltl Of)
if 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11119/2x108
Phone: (503) 639 -4171 /� 1
Inspection Requests (24 Hrs.): (503) 639 -4175 A- • - �
INSPECTION WORKSHEET FOR DATE: 1/21/2009 TIME: 7:00AMM PAGE: 2
SITE ADDRESS: 12176 SW GARDEN PL. BLDG ti.; CLASS OF WORK:
SUBDIVISION: PARK 217 LOT #: 002 TYPE OF USE:
PROJECT NAME: COLOSSAE CHURCH
DESCRIPTION: TI
OWNER: SPIEKER PROPERTIES LP, PHONE #:
CONTRACTOR: RELIANT ELECTRIC LLC PHONE #: 5037014'562
Inspection Request Scheduled For: Date: 1/21/209 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electlica1 filial 079890 - 01 - 5034360 - 4240 N
Corrections /Comments /Instructions:
N o R-E4 fe cc S ,
viNto bib- , s Lj I
AAMIIM■
❑ PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL 0 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G N 68 LE Date: V ”. i Phone #: (503) 718- itqL__.
CITY OF TIGARD ( •
BUILDING DIVISION PERMIT #: Et 0200 -00&12
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: i1/19/2008
Phone: (503) 639 -4171 "anop I ll
Inspection Requests (24 Hrs.): (503) 639 -4175 „Jai— -:_..
INSPECTION WORKSHEET FOR DATE: 12/2972008 TIME: 7 :00AM PAGE: 1
SITE ADDRESS: 12176 SW GARDEN PL BLDG 3 CLASS OF WORK:
SUBDIVISION: PARK 217 LOT #: 002 TYPE OF USE:
PROJECT NAME: COLOSSAE CHURCH
DESCRIPTION: Ti
OWNER: SPIEKER PROPERTIES LP, PHONE #:
CONTRACTOR: RELIANT ELECTRIC LLC PHONE #: 503 662
Inspection Request Scheduled For: Date: 12129/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
'120 Electrical rough-in - x79235.01 503-860 -4240 N
- 1 ZS WALL, e Avl fis
Corrections/Comments/Instructions:
0 k, — ,C— os∎r'L WALLS V{AIR,Q 14-1t).5
tt'il-I I5 MI R
PASS H PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
FAIL n CALL FOR INSPECTION fI ADDITIONAL FEES ASSESSED
Inspector: �r 0 t 6 Date: 11--' 29 11 Phone #: (503) 718- 1/46___