Permit `t�'ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #. ELC2004 -00502
L , cJ 4 . DEVELOPMENT SERVICES DATE ISSUED: 8/10/2004
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 AC unit in mini`s.
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: 1 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+ amplvolt: > =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
[TAX] 8% State Surcharge 8/10/2004 $6.96
[ELPRMT] ELC Permit 8/10/2004 $86.95 Elect'l Service
Rough -in
Total $93.91 Elect'l Final
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules am set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800 -332- 344.
Issued By: Permit Signature: Yi Q1,1c.l c_�%)�r,. -)
OWNER INSTALLATION ONLY / r
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: . DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
08/09/2004 15:26 503- 872 -8290 TICE ELECT.SERV.DEPT PAGE 04
Elect ? 'erm i_ � r ua oF>�c usE ONLY
I . ���, Received Electrical
patell3y; �lO,Ot/ a� Permit No. I C 0.004 — O to
Sign •
City of Tigard AUG U 9 2004 Da inin Permit NO.: __
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon- 9'7223 CITY OF TIGAR 4 Planning Approval
Date/13 : Permit No.;
Phone: 503 -639 -4171 Fax: i$I{o/pIVf rle,t :!it .< P1;. I h Date /By; Post - Review Land Use •
_ _
Internet: www.ci.tigard.or,us ■ � 1'' ` r , Contact - Case No.: Jun .: — 0 See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ' W Name/Method: / / G Supplemental lnfarntatioi,__
. TYPE OF WORK . • • • . • ` • PLAN REVIEW_(Please check all that apply)
■ New construction , 'k' .Demolition " Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
It Addition /alteration/re elacement I. Other: El Service over 320 amps - rating of ❑ Building over 10,000 square feet.
CATEGORY OF•CONSTRUCTION 1 & 2 family dwellings four or more residential units in .
. 1 & 2- Family dwelling Commercial /Industrial ❑ System over 600 volts nominal one Structure
❑ Building over three stories ❑ Feeders, 400 amps or more
n Accessory Building Multi-Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV pat K
• .Master Builder 0 Other: ❑ Egress/lighting plan ❑ Other:
Submit sets of plans with any of the above.
:JOB SITE INFORMATION and Lr.C1GA'I`IONI' The above are not applicable to temporary construction service.
•
• 'Job site address: 1J 075 SW Gaaride S � ` �_ . . •
ujte is k3Idg. /Apt. #: Number of inspectious per_permit allowed
.Fro ectName: • • • 11111 - .. • . li• • Description qty Fee (ea.l Tatar . 4 r
New residential - tingle or multi - family per j
• Cross street/Directions to job site: dwelling unit. includes attached garage.
• Service Included:
• • . 1000 sq. ft. or less • 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 V I
Subdivision: • . Lot Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax ma ./ • arcel #: . Each manufactured home or modular dwelling
' • service and/or feeder 90.90 2
• DESGIZIPTION OF WORK Services or feeders - installation,
wire. a� conditioning unit in Ministries alteration or relocation:
• 200 amps or less 1 80.30 80_30 2
Center — 201 amps to 400 amps 106.85 _ 2 1
• 401 amps to 600 amps 160:60 2.?
IN PROPERTY :OWNER ® TENANT' -.. 601 amps to 1000 amps 240,60 2
Over 1000 amps or volts 454.65 2
Name; . . Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
• alteration, or relocation:
City /State /Zip: • . , _ 200 am or less 66.85 1
201 amps to 400 amps 100,30
Phone: Fax:. ,, . 401 to 600 am .s 133.75 2
. r APPLICANT:..,, : I�FI ''A
. IFCOC`)<TERS ... , Branch circuits - new, alteration, Or
Name: . . extension per panel:
A, Fee for branch cirCuitS with purchase of 1 • 6.65
Address: service or feeder fee each branch circuit 6.65 2
Cit /State /Zz : . B, Fee for branch circuits without purchase of
y P , .. -. • service or feeder fee, first branch circuit 46.85 _
Phone': FAX: Each additional branch circuit 6.65 - 2
E -mail: Misc.(Service or feeder not included):
Each pump or irrigation Circle 53.40 2 • CONT OR::. ;; . :. E ac h s o r o lighting 53,40 3 I
Job No: S ignal eircuit(s) or a limited energy panel,
alteration, or extension Page 2 2 1
. • Business Name: Tice Electric Co,, Description: 1
_ Address: PO Box 15009 '
•
Portland O �3 5009— Each additional inspection over the allowable In any of the above: __
CItY /Staff£ /Z'Ip. Per inpcCtion per hour (mm. 1 hour) 62.50
Phone: 503- 233 -8801 • ' Fax: . 503- 872 -8290 lnvesti_ationfee: —!
-
• GCB Lie. #: 166 Lic. #: 26.1, Other: 126C Electrlc'aiPe'ririit,Feee . . `, • •
. • Supervising electrician � < Subtotal $ • 86.9`
1 signature required: •� 1 l _ P lan Review 25% of Permit Fee $
Print Name: . ma 1 r° uey _ Lic. #: . 7586s State Surchar a (8% of Permit Fec) $
TOTAL PERMIT FEE $ 93.91 1
•
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: __ Date: 180 days after It has been accepted as complete.
. *Fee methodology set by Tri- County Building Industry Service Board.
• (Please print name)
I: \Dsts \Permit Forms \ElePerrnitApp.dvc 01 /03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Li ..;.i4 4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 7 AM PM BUP
Location /1 D 7 5 .K / Suite q MEC
Contact Person Ph ( ) 639-3 (73 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner r -l�f22 � �Z� LELC gam 7 —6 0,c6
Footing ELC ��`f' `
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi reSal l 51 F mo( I Fire Sprinkler r 1j I Fin/4
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
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
r PART FAIL
El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line 1.,0
ADA
bm t��' (''�
Approach/Sidewalk Date Inspector Ext
PP
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL