Permit CITY OF TIGARD PERMIT
AL PE
PERMIT #: E AL PE -00480
a,r DEVELOPMENT SERVICES ELECTRIC
DATE ISSUED: 8/12/03
i 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: Parking Lot Lights
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: 1 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 KELSO ELECTRIC INC
12930 SW SCHOLLS FERRY RD 545 SE 3RD
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: Phone: 503 - 648 - 6360
Reg #: LIC 116254
SUP 4270s
FEES ELE 34 -433c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/12/03 $53.50
[TAX] 8% State Tax 8/12/03 $4 Elect'I Final
Total $57.78
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: I a
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
FROM KELSO ELECTRIC INC FAX NO. : 0000000000 Aug. 04 2003 01:25PM P1
./
.....,,_
RECEIVED
' ■ ii a 4 ft OFFICE'. ESE -'• - . : '
Electricfil Permit Application003 FOR ONLY
Receive, E5ectrlaal
CITY CF P tNe.e.€6.. OT3 - IV 10
City of Tigard Test FormIG DIY SION Da
Plamito g Approva3
10/11111111.111.11111111111
13125 SW Hall Blvd.. Flan Review •
Tigard, Oregon 97223 Dotaatx: Puma No.;
Phone: 503.6394171 Fax: S03-598.1960 ,:.,„ . PcstArrisw Land Us.. 1
, . , • i Dete/Ely: Oise No.:
Internet www.eLtigtud,orms •
• l .4/ Came* /uric! LI See Page 2 kr -- 1 •
24-liour lr_spectiou Request: 503-639-4175 ".' - ' -- StarrustMethod: Su • . mental infernal:den.
. .
j'• ", : ••: 7 .• 1 •:= 4 :'...ilrl'IMOF . WPRKzE;;it'Irli'liC . I.■:Ff,r;::: 1 4.':iVAt ii.1._,::0 ; '..'••••.
'I New construction • Demolition 1011111ScwIcs over 225 amp- gill hlealth-care facility
onmsereial 0 Hazardous lomdoc
* Additontalteration/replacemers • Other:
.. , El Service ovcr 920 vnps-rating of 0 Building over 10,000 squire fee;
• . .. .. .. • - - ..COSSTR • c s ic" --, l'-'4' -.. 1 a 2 &nil) dweuings four or more ossmensial unite In
1 • 1 & 2-Famil dwellin: I 74 Commercial/Industrial 0 System over 600 Vohs nonilns) orte MCI=
1
• Accesso Buildio• k• Multi-Fail 0 Building
a ver three meet FeetkEll, 400 arms or There
0 Octintatic land over 99 persons E M.lotifuturod arum res or RV peit
• Mester Builder • Other: 0 Egrccillighting pian 0 Other:
, •• - • ••:: ;; JOE SITE INFORMATIOM. Snit 7:0:CATTOW.f2... G.: 4' Submit' send replan* with any of the above.
Tits above ars not appliciLlgs to tw000rsv co ?labeled° n vervioe.
l Yob site address: - g0 .
. etf- 424 / 1-; re'r V -.::::;:..f:,:"
S , x*.:.e... , :.l . ":A. : iii' s .'!'' , ' :i*
1 , — ." - • • ••• ••-•.• •,„ • • ,,. . •
: utte #: Bld • JA . t,#; Numbu or inflections per poling *flowed
Project Name: ,--- 4 --A-- 64 • - 7...4 Duerinuon oil 1 1 Taut 1
Cross street/Directions to job site: Ncw roldeallsholnzio or man-ramify per I
dwelling wilt. Includes attached garage.
Service Inch:did:
100(714 ft or kw 141_15 4
, .
_FACh itaLlional 50,0 so.11, or zorVoti drool' 33.40 l
Subdivision: 1 Lot #: Wand trim. redeermal • 75.00 2
Limited away. 110a rendentis1 — 75.00 2
Tax maphareel #: Bach manufnaored home or modulirdwelling
: : : ..* :. • - .".: '''! 13BSCgrinicilk 6 F WriRM::'•:•:•:'•:aP•1.:::=:*:1:',i!..p AilLiiiM aaNer ruder 9C.90 2
ServiccS or toedars - instillation.
L_ 4 teor 4164 altaratloo or roloutloa:
200 unps ar leis 2010 ' 2
:01 ernze 10 4 00moi 10615 2
401 . to 602 • • - 160.60 2
4 TEISS6237.0.1:::'....i.. ..:. : ;;;; ED ....,...:, ... ...
000'1000mm - or volts 454.65 2
Name: i,jrszprir 0,4,17s5 - Clivar-kr - _
• rut 9 6615 2
I
I Address; Temporary services or feeders - Intaal/atioo,
alteration, or relosandoo:
[ City/State/Zip: 200 ems °rites ass 1
Phono: I Fax: 201 mos to CD =es — j 100.30 2 j
It. • 4 IC ,..:•:-.-,•::; 41 t15 6M ltrila
- w,
Name:
r g -
Branch drain ne afterat or
ioa,
eateasina per panel: 133.75 2
i MdreSS: A. Fee far Wald ctionin with purchase of
service or feeder fee, ash twanes eiropie
6.65 2 I
CiryiState/Zip: D. Psi tor branch circuits withellt Pludine ef / . • -
I Phone: I P or ax: servicr %dor too. first branch circuit t 46
_ Bun addidonal branch &wit • 46.55
... ,
6.62 .
Eqr_ail: Miso(Serties or reader:tat '• . .- '
2: ; - -. .-: CORIWZ'011t:1',7:' i"':•-::•: :'. Eith airrip I" Iffiguign drat 5340 2
E sim or outline 1:Flelwe E3.40 2
Job NO:
Stasi 'oiresit(s) er a .uninal mazy panel,
Business Name: MCZ,...1,› '&72.4"c:ii 7:7JC la 1, i - • - , • ° , - t-. , - s s.. 2
nlasenpriere •
Address: krii ir 3 f:. ' ,T )..41 fr. I .
i
City/State/Zip: 4 2 0,44 0 a q '7 1 2.3 'I nett addltIonal laspection ever the allowable in any of the above:
! P h one: Phone: 6 I Fax 6yff - ez/1 i l .. i .„--..•-• • • hour- min. 1 hour
1 : Inv - - • • on .., i l 62.5
. i
CCP. Lc. #: //‘ 23 I Li. #: CV- 4'r53 C I i Qa ' . Mil
1 :•711:i&L .:•'''-`• • .•;',147•%tr.f.'..t6 ' .... -•:"1
Supervising electrician
1
sigiaature required: , - , 1" Su ..... i '
I
• Plan Review (23 Vs ofPerrdit It S
e ' S
Print Name: I Liz. $ : .•
. State Sureisare (8% of Permit Pee) S
TOTAL PERMIT FEZ 1311.
Authosized Notice Tale pensle applleatIna ceplras II a perrait Li eat 0 heilabed 'Attila
Signanre: Dam 211111 daye dwelt has been moulted al geosplete.
__ _______ ___ 'Feel nietbrehidef0/ &X by T$-County Building Industry Semler Board,
(Please print nzne)
t no 01 fr17VA T T jr 7 1 V1
1.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) ¢3,9 -4175
INSPECTION DIVISION Business e: (503) 639 -4171 MST
BUP
Received 7 36 Date Requested 3 — Z Z AM PM BUP
L do �. Suite MEC
Contact Person Ph ( ) -5 7a PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 3 Oa e/crd
Footing _ 0 3/
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors ,
Ext Sheath/Shear
Int Sheath/Shear �-,•
Framing �Q�� AU- 1 5 cod.) t�lL�-fJr PAN t_ .
Insulation
-1 0 �JpE
Drywall Nailin•
C!p'� t �0[�
Firewall
Fire Sprinkler
Fire Alarm 0�3 e
Susp'd Ceiling " /� MA t N 1 .
Roof
Other:
Final
PASS PART FAIL _ • ((����
PLUMBING • - - • - 1� 1?-�
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole -Pg( N Y e
Storm Drain i "
Shower Pan �4 .20
Other:
Final
PASS PART FAIL Pms8D >
` �� AL 011
MECHANICAL 1_
Post & Beam W
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
•
Low Voltage
Fire Alarm \_ ‘ 1"
. ASS PAR FAIL fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE fl Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA --01A � J r Ext
Approach/Sidewalk Date ' Inspector �
Other:
Final DO NOT REMOVE this inspection recor from the Job site.
PASS PART FAIL