Permit CIT OF ELECTRICAL PERMIT
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DEVELOPMENT SERVICES DATE E ISSUED: 11/3/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S126DC - 00901
SITE ADDRESS: 09640 SW GREENBURG RD
SUBDIVISION: LEHMANN ACRE TRACT ZONING: R
BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: (1) branch circuit for computer in parish hall.
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: 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:
GETHSEMANE EVANGELICAL BURNS, CHARLES W
LUTHERAN CHURCH 8815 SW69TH ST
9640 SW GREENBURG RD TIGARD, OR 97223
PORTLAND, OR 97223
Phone: 503 - 685 -3707 Phone: 503 - 246 -0768
Reg #: ELE 1804S
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/3/2004 $46.85
[TAX] 8% State Surcharge 11/3/2004 $3.75 Rough -in
Elect'I Final
Total $50.60
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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: Permit Signature: fivt_—&---
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 7:00pm for an inspection the next business day
Eli. a .
' cal Permit Application FOR`OFFICE USE ONLY
Received Ci y of T � � 8��� A Date/By: //-17-4/79/ PermitNo.:eG, J 762:0 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 dili i Date/By: Other Permit:
Inspection Line: 503.639.4175 NOV o 3 2004 I Date Ready /By: Suds: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: kr- Supplemental Information
(ITV _nc rh -' rir
R T �PE r r t i a PLAN REVIEW
❑ New construction 21 Ad_dition/alteratio _ rep aceme_nt 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 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
' .. _ ❑Building over three stories El Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑Other:
IV "{ ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
� ❑Health -care facility ❑Other:
Job no.: Job site address: (�� L s �� 6;,....L.,..,, // Submit 2 sets of plans with any of the above.
City /State /ZIP: O 1 a� 7 Z 2 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no Project name: / `��k,,, '�� ®, C?�Z ^"_(` FEE* SCHEDULE ._
'�'`� Description Qty. Fee. Total
Cross street/directions to job site: Ciy s et) 6? p� . ��� , New residential single- or multi - family dwelling unit.
"" T � f i / �t 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
DESCRIPTION OF WORK Each manufactured or modular
-., /J dwelling, service and/or feeder 90.90 2
0 � �j ,� 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
0_ � f ezi,� 401 amps to , a 600 amps 160.60 2
Name: 601 amps 1
s to 1,000 amps 240.60 2
Address: t��o s� f - p y Over 1,000 amps or volts 454.65 2
I / - ""`� l Reconnect only 66.85 2
City/State /ZIP: q*' 7 a_ . j Temporary services or feeders installation, alteration, and /or
Phone: (,�'5) 6 D .2 5 5 200 Fax: ( )
relocation amps mps 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
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❑ 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,
each branch circuit / 46.85 2
Address: Each add'l 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 -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: / 0 c:�S' Subtotal 0 /6 " 25"
Suprv. Electrician signature, required: r S J Plan review (25% of permit fee)
Print name: t �� y, � �, s Date: f I 3-Q State surcharge (8% of permit fee) /75-- ` TOTAL PERMIT FEE . t� 6 I
Authorized signature: 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 Tn- County Building Industry Service Board
** Number of inspections per permit allowed.
1:\Bwlding\Permits\ELC- PermitApp doc 12/03 440- 4615T(10/02/COM /WEB
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:
. n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial 'system $75.00
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(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
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n Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
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 24 -Hour
BUILDING Inspection Lime: 1503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
/ BUP
Received Date Requested / l — 7 AM PM BUP
Location 9(, % 1 Suite MEC
Contact Person Ph ( ) qe' -0 76e) PLM
Contractor Ph ( ) SWR �+
BUILDING Tenant/Owner ��J2 � �y�t,c�lt! ELC &DO -tea 7& 13
Footing
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Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ; SIT
Post & Beam •
Shear Anchors
Ext Sheath /Shear .I_4 / -
Int Sheath/Shear _=
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
( YV
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
PASS PART FAIL
ELECTRIC A L
Service
Rough -In
UG /Slab
Low Voltage
Fi�Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- co PART FAIL
SITE _ 111 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA /
Approach /Sidewalk Date / � Inspector /L a i 4 Ext
Other:
Final DO NOT REMOVE this Inspection record 'rom the Jo - site.
PASS PART FAIL