Permit C ITY OF TIGARD ELECTRICAL PERMIT
i — PERMIT #: ELC2004 -00501
m. DEVELOPMENT SERVICES DATE ISSUED: 8/10/2004
`� Il n ' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103DC -01100
SITE ADDRESS: 11075 SW GAARDE ST A
ZONING: R - 3.5
SUBDIVISION:
BLOCK: - LOT : JURISDICTION: TIG
Project Description: Wire (2) AC units: 1 service and 3 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: 1 W /SERVICE OR FEEDER: 3 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:
FIRST BAPTIST CHURCH OF TICE ELECTRIC
TIGARD, THE PO BOX 15009
11075 SW GAARDE 2139 SE BELMONT ST
TIGARD, OR 97223 PORTLAND, OR 97293 -5009
Phone: Phone: 503 - 233 - 8801
Reg #: LIC 166
SUP 2586S
FEES ELE 26 -126C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/10/2004 $100.25
[TAX] 8% State Surcharge 8/10/2004 $8.02 Elect'I Service
Rough -in
Total $108.27 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 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: er?- e
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
08/09/2004 15:26 503 - 872 -8290 TICE ELECT.SERV.DEPT PAGE 03
„.•
E��e Permit tion tv�aFFICle USE ONLY Recei Electrical 61
. ,e S B Date :. /v Oev, ; Permit Nvt., _ /I -- �t 5 7
City Cl[ of Tigard Q Planning Approval Sign
g � � 04 Date/t3 Permit No.: : — — •
• 13125 SW Hall•Blvd. Uv Plan Review Other
Tigard, Oregon 97223 A Date/13; Permit No.: — _
.� D Post- Review and Use
Phone: 503 - 639 - 4171 Fax: 50 u 3 - i, 111*A - r
,t � Date /8 ; Case No.:
c r \ SW r 'j►�l o
Internet: tvwv✓.ci.tigard.or,us GS p \
NCa .w.7 Ail Contact + Sre Pagc 2 for
34- hour .lnspection Request: Olt 9 4175, Name /Method: Su Iemental tnfortuatiu,,.
TYPE OF WORK. PLAN REVIEW (Please check all that apply)
• .` Ill New construction • Dirmolition Cl Scrvice over 225 amps - . ❑ .Health -care facility ��
commercial ❑ Hazardous location
Addition/alteration/re • lacerrierit �� Othe ❑ Service over 320 amps -rating of ❑ Building over 10,000 square lee..
• CATEGORY OF CONSTRUCTION i & 2 family dwellings four or more residential units in
• • I• & 2 - Famil dwelling Le!; Commercial /Industrial ❑ System over 600 volts nominal one structure
ID Building over three stories ' El 1- ceders, 400 amps or mire
. ! ,• Accessory Buildin ` r ❑ Occupant load over 99 persons ❑ Manufactured struelyres ur RV hai;
• Master• Builder . IN Other:. • ❑ Egress/lighting plan ❑ Other: -
' JOB SITE INFORMATION and LOCATION :'.'' • • • ' Submit sets of. plans with any of the above.
The above are not ap licable to temp orary construction service-
J ob site address: ••11075 S W Cr .a.ade _St T :IEE'� SCHEDULE ._ _ — . •
Suite #: Sanctuary. B]t3g Bid_. /A•t. #; Number of inspections per.permit all
Pro'ect Name: .• • • w• • Desert. lion Qty Fer(ea.) Totel I I ,
j Cr055 StTet�lYeCt1Qn5 to job site: New residential- single or multi - family per
,1 dwelling unit. Includes attached garage. •
Service Included;
• 1000 sq. IL or less _ 145.15 i .4
Each additional 500 sq. ft or portion thereof 33.40 l
Limited enem residential 75.00 • 2
subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel lit: Each manufactured home or modular dwelling
• • DESCRIPTION OF WORK service and/or feeder _ 90.90 2
- Services or feeders - installation, I
Wire 'two air conditioning units in alteration or relocation:
san uary •ui • ng • . • 200 amps or less , l 80.30 80. 30 ` , ,
-- 201 amps to 400 amps_ 106.85 _
401 amps to 600 amps .
160.60 2
■' PROPERTY OWNER 0 601 ain s to 1000 amps 240.60 _ ? j
Over 1000 amps or volts 454.65 2
• ame: . • Reconn only ' • 66.85 I '
Address: , Temporary service3 or feeders - Installation, 1.
CIiV /�t3i2/�1 alteration, or relocation: 66.85 I I
200 amps or less •
• : Phone: Fax: • 201 amps to 400 amps . 100.30
-- 71
• ' 401 to 600 amps 133.75 2
NI APPLICANT , • ' III E ONTA'CT ?P RSO •;;: Branchclreults - new,alteration,or
' Name: . • . ' extension per panel: i
Address: A . Fee for branch circuits with purchase of G .65 19, 951 2 '
____ service or feeder f ea bran circuit 3 _
' C 1 t /S tat.e /,Z! • ' E, Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85
Phone: Each additional branch circuit 6.65 ^ i 2
E . M isc,(Sei vice or feeder not included):
CONTRACTOR:. .. ' .. ., , . Each pump or irrigation circle 53.40 1 2
' Each sign or outline lighting 53.40 — I?
Job No: Signal circuit(s) or a limited energy panel, • alteration, or extension Page 2 2
Business Name: Tice Elect Description: — —
' Address: PO Box• 15009 • •
Port ari• •' - '1 1 ° P er i nspec t ion per hour (m I hour) 62 . 50
Each additional Ins ection overthe allowable in am' of the above:
City /State %Zi•: • _
•Phone:.. 503_233 -8801 Fax: 503- 872 -8290 Investigation foe: . '- '
CCB Lie #: 166 • - Lie. #: 26 -126C Other: i
•
Riectrit:al Perth Fees * .
• 5uperi'ising electrician / Subtotal 100.25
signature re. uired: ' . / plan Review (25% of Permit Fcc) $ 8_02
Print Name; . • • • . w • - , ; ° State Surcharge (8% of Permit Fee) $
• TOTAL PERMIT FEE. $ a . _• ,
. Authorized • • • • Notice: This permit application expires if a permit is not obtained within
. S rgnarure • ' , . ...Date; .. 180 days after it has been accepted as complete.
• • *Fee methodology set by Tri- County Building Industry Service Board.
. (Please print name) . • • •
1 '.i2sts\Perrnit Forrns \ElcPermitApp.doc 01/03 . •
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Li _.z,"9 -4175
INSPECTION DIVISION Business Line: (5 3) 639.4171 MST
BUP
Received Date Requested ` (� AM PM BUP
Location Suite q MEC
Contact Person Ph ( ) r'3 1✓3 t /3 PLM
Contractor Ph ( ) j SWR 1
BUILDING Tenant/Owner g -1YL A62-7/92,4-.6C�UU'/ t.ELC �� - T — '6 - 6 /
Footing ELC 6:04 6 ,5 - 6?---
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors M
MAW
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall A
Fire Sprinkler _ ���''�
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
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
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
/ PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line 1 ( / 9 ADA Dat I 0 7 actor e4 l /�, U5-I3
Approach/Sidewalk p
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL