Permit =CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00332
DEVELOPMENT SERVICES DATE ISSUED: 7/18/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S133AD -02200
SITE ADDRESS: 12930 SW SCHOLLS FERRY RD
SUBDIVISION: ZONING: R -7
BLOCK: LOT : JURISDICTION: TIG
Project Description: Replace damaged 200 amp meter main for modular D.
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: 0 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 NW ELECTRICAL SPECIALTIES
12930 SW SCHOLLS FERRY RD 2110 NW ALOCLEK DR.
TIGARD, OR 97223 SUITE 609
HILLSBORO, OR 97124
Phone: Phone: 503 - 844 -4788
Reg #: ELE 24 -450C
LIC 121328
SUP 4622S
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 7/18/02 $66.85 2720020000( Elect'I Final
5PCT CTR 7/18/02 $5.35 2720020000(
Total $72.20
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, - = • OR. Specialty Codes and all other applicable
laws. All work will be done in acoordance with approved plans. This permit will exp'-- if work is not , arted within 180 days of issuance, or if
work is suspended for more than 180 days. ATTENTION: Oregon law requires y•u to follow rules adop't by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952-001-6080. You may obtain cop' s of these rules or direct questions to
Permit Signature: � — l I . ued By: ► jjj� / / /
mr.- –
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: C ( DATE:.
LICENSE NO: 41
Call 639 -4175 by 7:00pm for an inspection the next business day
'`Electrical Permit Application
Date received: 7 /f 02- Permit no.: 6.e, , _aa..33 iiZ.
A ,t' t. City of Tigard Project/appl.no.: / xp -date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: 1 m,' eceipt no.:
Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: .
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family 0 Tenant improvement
0 New construction 0 Addition /alteration/replacement §.Other: D4/nM6E . 0 Partial
JOB SITE INFORMATION
Job address: / "j3 0 5 . 5C /e4Ls / (..f)( al e ! ) Bldg. no.: / Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: W r-57 ATE. , AP1f 5 r I Description and location of work on premises: R 6= p acpc g 1aA 41 /6 et) 2 o0 A
Estimated date of completion/inspection: / /0Z / E r & R m' ,n) Fog ODutA2 •
.. = _,.,CONTRApTo' APPLICA ION ',, _ i,:,. _, .i ,.::,. . i i- -_'_; , '; ;. zFEEa >L.g.... y _.k:_„, s l.,,r' .
Job no: Fee Max
Business name: Description Qty. (ea.) Total no. insp
N W F. P C t r i r' a l G pQ c i a l ti e s New residential - single or multi- family per
Address: 2110 NW Aloe 1 e k Dr., Ste 609 dwelling unit. Includes attached garage.
City: H i l l s ho r I State: OR' ZIP: 9 7 1 7 4 Service included: .
Phone: 844.4788IFax844.9524E -mail: 1000sq.ft.orless 4
CCB no.: 121328 I 3 4 5 O C Each additional 500 sq ft or portion thereof
Elec. bus. lic. no: Limited energy, residential 2
City /metro lic. no.: 004899 Limited energy, non - residential • 2
• Each manufactured home or modular dwelling
Signal o s rvts ng a ciao required) Date Service and/or feeder 2
Sup. elect. name (print): R a . _ - a License no: Services orfeeders — installation,
' alteration or relocation:
PROPERTY OWNER 200 amps or less / 6 '$S 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: 'State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - . -
•
which is not intended f or sale, lease, rent, or exchange according to installation, alteration, or relocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701..
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: • _ A. Fee for branch circuits with purchase of
Address: • service or feeder fee, each branch circuit 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc . (Serviceorfeedernotincluded):
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 0 Hazardous location Each signor outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension' 2
O Building over three stories 0 Feeders, 400 amps or more - *Description: .
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other: Per inspection I I 1
Submit sets of plans with any of the above. • Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, pleas. call jurisdiction for more information. Notice: This permit application Permit fee $ (p (O 85
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ S , 3 5
Expires accepted as complete. TOTAL $ 7 2 r 2 /0 .
Name of cardholder as shown on credit card
$
Cardholder signature - Amount 440 -4615 (6/00/COM)
•
4.
CITY OF TIGARD , 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7/i q AM PM BUP
Location / I/ �LL� uite MEC
Contact Person � 1 Ph ( ) O 9 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC r-9 00 3 3
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear !�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall ` 4" \C\N
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
*T'
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SIT El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk
Date � � Inspector %Ge-al/ - Ext
Other:
Final DO NOT REMOVE this inspection record from the site.
PASS PART FAIL