Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00321
r"- DEVELOPMENT SERVICES r DATE ISSUED: 6/4/03
II 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 •
PARCEL: 1S133AD-02200
SITE ADDRESS: 12930 SW SCHOLLS FERRY RD
ZONING: R -7
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of temporary service to construction trailer.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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:
WESTGATE BAPTIST CHURCH PREMIER ELECTRICAL CONTRACTORS
12930 SW SCROLLS FERRY RD PO BOX 1132
TIGARD, OR 97223 NEWBERG, OR 97132
Phone: Phone: FX
Reg #: 15136-537- 30Q6461
SUP 4891S
FEES ELE 36 -79C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/4/03 $66.85
[TAX] 8% State Tax 6/4/03 $5.35 Elect'l Service
Elect'l Final
Total $72.20
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 95 -I! -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-
Issued By: ;! - I � Permit Signature: X ��� / /
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 NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: OUR DATE:
LICENSE NO:
•
Call 639 -4175 by 7:00pm for an inspection the next business day
• FOR OFFICE USE ONLY
Electrical Permlt Application Received //__ �" 2 Electrical
Date/By: (.C/ C' d O' Permit No.: f CC p�3 - � 3-1 r �
City o TI and Planning Approval Sign
g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.: -
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 Oy �u 1 � Post - Review Land Use
�ip,l t Date/By: No.:
Internet: www.ci.tigard.or.us a Contact Juri " ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 '"""- Name/Method: — 0 Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Hcalth -carc facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement l Other: ❑ 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
❑ I & 2- Family dwelling ['Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
t PSJ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: lZ 'SO SC-NOLO crC -etIV KO FEE* SCHEDULE
Suite #: Bldg./Apt.#: Number of inspections per permit allowed
Project Name: k) ESTCT (tom vet -e< kS c Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential-single or multi-family per 1
] dwelling unit. Includes attached garage.
Service included: \I
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
2 • Services or feeders - installation,
"r6tv�Q O QtQ V PJRfk■Ct- C try Cu I C alteration or relocation:
• 200 amps or less 80.30 2
c ! ` C O Ca t3 CT \O N `VA fc t l.kin, 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
' IRPROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: 0 t a t✓ fu; V6 S) Kt 1 C ki0 (LC 0 Reconnect only 66.85 2
Address: t Z4 30 51r.N S c tto LCS FC)2RW lZb Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: TLC --&-2,b i b 12. qZ 7 ZZ s 200 amps or less / 66.85 e,4. $ s 1
Phone: 563 S Zy Z5 Fax: c253-5V1 (456 6 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
❑ APPLICANT 'CONTACT PERSON Branch circuits - new, alteration, or
Name: 6 it t / v rya a extension per panel:
A. Fee for branch circuits with purchase of
Address: I 1,t1 75 S i S j„ Pt4I g" Cot:. SST a L'! IN service or feeder fee, each branch circuit 6.65 2
City /State /Zip: L (kK 0 5i„3 6 EO C rz is e 70 3S B. Fee for branch circuits without purchase of
/ service or feeder fee, first branch circuit 46.85 2
Phone: s 2 y 67s -531 o I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: PRE trl►t;2 CC 'C'2tC Geikrt. Description:
Address: {`p,p , box (.l 3z. • . _ _ Each additional inspection over the allowable in an of the above:
City /State /Zip: (; Ct C-r t tZt l�Oa Per inspection per hour (min.lhour) 62.50
Phone: X03 -537- / - Fax: � Investigation fee:
CCB Lic. #: /A6 4 /6/ r /'4 Lic. #: 3( 7ci L' outer
.2 Electrical Permit Fees*
Supervising electrician 4 , , / % Subtotal $ (0 (o . es
si: ature re , uired: 1 ', , (/U , , Plan Review (25% of Permit Fee) $
Print Name: W,� i� ' State Surcharge (8% of Permit Fee) $ 6. g6
TOTAL PERMIT FEE $ '7 A.
Authorized , ,,^ Notice: This permit application expires if a permit is not obtained within
Cw
Signature: /f / i Zate: ct — ZS — 0 3 180 days after it has been accepted as complete.
*Fee methodology set. by Tri -County Building Industry Service Board.
? r{1P%I0 61Jrt - o1■)
(Please print name)
i:\Dsts\Permit Forms\ElcPerrnitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information /
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Burglar Alarm
Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
Vacuum Systems
• Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
• Audio and Stereo Systems
❑ Boiler Controls
0 Clock Systems
▪ Data Telecommunication Installation
0 Fire Alarm Installation
HVAC
❑ Instrumentation
El Intercom and Paging Systems
Landscape Irrigation Control
❑ Medical
0 Nurse Calls
Outdoor Landscape Lighting
ED Protective Signaling v ..
n
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
•
•
CITY OF TIGARD 24 -Hour tit
BUILDING Inspection ' (5 ' ) 639 -4175 MST
• INSPECTION DIVISION Business ine• 503) 639 -4171
BUP
Received Date Requ -sted F AM PM BUP
Location d die MEC
Contact Per . lL - Ph ( /) - 732- PLM
Contractor v A+. ��� ( ) SWR
-
BUILDING Tenant/Owner ELC
3 -bd3a
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 5,/ ,(I. .. Zri f�
Drywall Nailing �1 �
Firewall
Fire Sprinkler
Fire Alarm (4L A 14 / g
Susp'd Ceiling CC` L
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
F = larm
na Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
.u!titi' PART FAIL
SITE Please call for reinspection RE: 111 Unable to inspect no access
Fire Supply Line
ADA , c Ext
�.
Approach/Sidewalk Date ,4la' /5
- U- Inspector _ _i •
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL