Permit : C ITY OF TIGARD ELECTRICAL PERMIT
Ph
a
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00629
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/24/2009
T t G A R Parcel: 1 S 134AA01800
Jurisdiction: Tigard
Site address: 10180 SW NIMBUS AVE J1A
Subdivision: SCHOLLS BUSINESS CENTER Lot: 0
Project: City Edge Community Church
Project Description: Add /alter (2) branch circuits for lighting.
Owner: FEES
ROBINSON, CONSTANCE A & Quantity Description Date Amount
ROBINSON, LYNN ET AL, BY KG INVESTMENT
MGMT, 10240 SW NIMBUS AVE #L3 2 crt Branch Circuits 11/24/2009 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 11/24/2009 $7.63
Electrical
Contractor:
ALL AMERICAN ELECTRICAL CONTRACTORS
PO BOX 1426
GRESHAM, OR 97030
PHONE: 503 - 657 -4351
FAX: 503 - 496 -3995
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the 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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 4 6 A . . - .1 ' ♦ ♦ � l Permittee Signature:
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:
c // CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' U . ` 1 , ` Date:
LICENSE NO.
Cali 503.639.4175 by 7:00 a.m. for an Inspection that business day.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Please check all that apply (submit 3 sets of plans wiitema checked below):
El Service or feeder 400 imps or more ❑ Melding over three stories.
vdKre the available fault etmen t ❑ Marinas and boatyards.
exceeds 10,000 amps m 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
amps fbr of other 030311600M buildings.
Q Fire pump. ❑ installation of 75 KVA or
❑ Emergency system. larger sepannttiy derived sysxm.
❑ Addition of new motor load of 0 `A' "E", - 1 -2' "1 -3
I00HP or more. may.
❑ Sit or more real arms. ❑ Recreational vehicle pelts.
❑ Health -care facilities. ❑ Supply voltage for more than
D Hazardous locations. 600 volts nominal.
❑ Service or feeder 600 amps or more.
FEE SCREDULE
Desatpdeo 1 Qtr. 1 Fee. I Tee 1 •
New residential single- or multi -family dwelling unit
includes attached garage.
1,000 sq. fL or less o
Commeidal/industrial •
145.15
• Multi- family
4
Ea. add' 500 sq. ft. or portion
33.40
l o b site a d d r e s s : /018D S.W. /TWA b s El) YI b
i
Limited energy, residential
(with above sq. ft.)
Suiteibldg. /apt no.: � . , 1
75.00
Cross street/directions to job site:
2
Limited energy, tmdti family
residential (with above sq. ft.)
Tax map/parcel no.:
75.00
4 `~, - f - wo a: v-t-L, As - 1 -5EI4
2
Services or feeders installadon,aiferatios, and/or relocation
200 amps or less
8030
City /State/ZIP: �• a l o, q ^) 2. z3
2
201 amps to 400 amps
106.85
Business name:
2
401 amps to 600 amps
160.60
Phone:( ) ! F ax ::
2
601 amps to 1,000 amps
240.60
•� /
Address: P. br Box I V2L
2
Over 1,000 amps or volts
454.65
Suprv. Lic.: Li? 3J_ C
2
Temporary services or feeders Installation, alteration, and/or
relocation
200 amps or less
Authorized signature:
66.85
' ca :
I
201 amps to 400 amps
100.30
2
401 amps to 599 amps
133.75
2
Broneh circuits - sew, alteration, or extension, per panel
A. Fee for branch circuits with
above service or feeder fee,
each branch circuit
6.65
2
B. Fee for branch circuits
without first branch ciirrcuiitf ee
i
46.85
y6, i7s
2
Each add'l branch circuit
I
6.65
4 i
2
Miscellaneous (service or feeder not fee luded)
Each mwiu hctu ed or modular
dwelling, service and/or feeder
90.90
2
Reconnect only
66.85
2
Pump or irrigation circle
53.40
2
Sign or outline lighting
53.40
2
Signal circuit(s) or limited-
energy panel, alteration, or
extension. Describe:
Page 2
2
Each addidonal inspection over allowable in any oldie above
Per inspection
62.50
investigation per hour (1 hr min)
62.50
industrial plant per hour
73.75
ELECTRICAL °PERMIT `FEES
Subtotal:
+; o
Plan review (25% of permit fee):
,,4r
State surcharge (12% of permit fee):
Z.
•I5L 7
TOTAL PERMIT FEE:
Electrical Permit Application
City o�� »a
13125 SW Hall Blvd., Tigard, OR 97223 NO V 4P os
Phone: 503.639.4171 Fax: 503.598.1960
ZOO El
inspection Lint 503.639.4175 At putime Date Ready/By:
Internet: www.tigetd- or.gov Notified/Method
1t8u5dI ermIWELC 05/23/06
j ��
1„ I
,
44046 sip I/05/COM/WEB
aINHII ' TIN'
Other Permit:
Jurici B See Page 2 for
� Septa' lnfonnauaa
PLAN REVIEW
flub permit appUwtloa expires if a permit b net obtained rousts ISO
days after it has bees accepted as tomptete.
• Number of inspections allowed per permit.
£L1717T66E0g XVI TO :60 6002 /£Z /TT
❑ New construction FrAdditiontalterationtreplaceman
❑ Demolition ❑ Other.
CATEGORY OF CONSTRUCTION
• 1- and 2- family dwelling
0
Commeidal/industrial •
Accessory building
• Multi- family
Master builder ■
Other.
Job no.: 1
l o b site a d d r e s s : /018D S.W. /TWA b s El) YI b
City/State/ZIP: -'-•
01 of 2Z 3
Suiteibldg. /apt no.: � . , 1
Project name:
Cross street/directions to job site:
Subdivision: Lot no.:
Tax map/parcel no.:
DESCRIPTION OF WORK
4 `~, - f - wo a: v-t-L, As - 1 -5EI4
.
OWPFI�l. i _.. ... ... TENANT
Name: AN $4a kA-d✓1
Address: 1 og 0 S b ws B/ lb- Z
City /State/ZIP: �• a l o, q ^) 2. z3
Phone: (5. 13 7729 1 Fax: ( )
Owner installation: This installation is being made on property that I own which is not
intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Owner signature: Date:
0 APPLICANT ❑ CONTACT PERSON
Business name:
Contact name:
Address:
City/State/ZIP:
Phone:( ) ! F ax ::
E-mail:
CONTRACTOR
Business name: A ll_ name: / 4 ( ( ( Ec$� OL i ci f
•� /
Address: P. br Box I V2L
City/Stat tZlP: eery 14 4et,, b/z (no 30
/
Phone: (.501) (t7 51— 3 s 1 I Fat: (So3) 'f 9(0- 3?9J
CCB Lic.: Igzg90 � Electrical Lic.: 26,- / /qiG
Suprv. Lic.: Li? 3J_ C
Suprv. Electrician signature, required: r1 4.61
Pratt nonce: p M I(' L.f and ' - i I
Date: ®f / �3/e4q
Authorized signature:
Print name: 6 4
' ca :
Date: //23/09
Electrical Permit Application
City o�� »a
13125 SW Hall Blvd., Tigard, OR 97223 NO V 4P os
Phone: 503.639.4171 Fax: 503.598.1960
ZOO El
inspection Lint 503.639.4175 At putime Date Ready/By:
Internet: www.tigetd- or.gov Notified/Method
1t8u5dI ermIWELC 05/23/06
j ��
1„ I
,
44046 sip I/05/COM/WEB
aINHII ' TIN'
Other Permit:
Jurici B See Page 2 for
� Septa' lnfonnauaa
PLAN REVIEW
flub permit appUwtloa expires if a permit b net obtained rousts ISO
days after it has bees accepted as tomptete.
• Number of inspections allowed per permit.
£L1717T66E0g XVI TO :60 6002 /£Z /TT