Permit CITY F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I!I DEVELOPMENT SERVICES PERMIT #: ELR2006 - 10027
DATE ISSUED: 3/24/2006
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 •
PARCEL: 2S102BD -00100
SITE ADDRESS: 09905 SW MCKENZIE ST ZONING: R -12
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT: 052 JURISDICTION: TIG
Project Description: HVAC.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
ROMAN CATHOLIC ARCHBISHOP OF AMERICAN HEATING
PORTLAND IN OREGON 1339 SW GIDEON ST
2838 E BURNSIDE PORTLAND, OR 97202
PORTLAND, OR 97214
Phone: Contact #: PRI 503- 239 -4600
FAX 503- 239 -7038
FEES Reg #: ELE 26- 993CRE
LIC 33135
Description Date Amount
[ELPRMT] ELR Permit 4/5/2006 $75.00
[TAX] 8% State Surcha 4/5/2006 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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.
Issued By: 7 jtl 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 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.
Electrical Permit • It I . 0 n W� "7.z. ?'Y u b ` a ' `i *NE ` w �K_ f.
t ' p J n � I y f y �j t � ' (�� / +tq FOR.OFFIG E U SE ONLY vs �
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City of Tigard ._ Date/By:, Received- ) y 0 iiU%--- Permit No.:6'�� (7/ '7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 0 4 ‘.44:4060114 Other Penmt:
2006 y
Inspection Line: 503.639.4175 IAR 2 't 3' DatelB Date Ready/By: fur 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Ivfethod: / f� Supplemental Information
p x '"•,- e '.3t P d Via A _ 1y.::`�• , -f` -IW.a- 3..��".' at�� QW .r NPLALV„REYIEW
❑ New construction oil ►' i4e i o V. 'eitatidii/replacement Please check all that apply:
❑ Demolttlon ❑ Other:
['Service over 225 amps, comm'l ['Hazardous location
i r w ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
, V y main CI trO ti ;� -� a p 4 of 1- and 2 - family dwellings 4 or more new residential
❑ 1- and 2- family dwelling 0.1CommerciaVindustrial 0 Accessory building
❑System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi family 0 Master builder 0 Other ❑Occupant load over 99 persons ❑Manufactured structures or
Y _F 4 s am, ,•: xxx vd':�ae-�,,4°u. 316-14„ 6 "K- t
,�.: x.5, , . f /W E rRf IO p_ ` . °' " O `;J.. _% ,;k : '` w�', ❑ Egress/lighting plan
RV park
� � �� ��w A �- �� ❑Health -care facility ❑Other:
Job no.: a C( 0 lY I I Job site address: Cr C U 5 S tO rn C JT a Submit 2 sets fa of plans with any of the above.
City /State /ZIP: i ( e_D 0 q--)? -a 3 The above are not applicable to temporary construction service
L(- t rte ,' ,,,, k,,,,,r i,..., CI ED
Suite/bldg. /apt. no.: f Project name:. n- [ Vt 6 S � G�(.V� ` '" "``'' ,_„,,,,,.,,,,,,,,,,,,.,,..,.,„,....,,,,,,,,.,.s..,
t Description ' Qty. I Fee. I Total
Cross street/directions to job site: J New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
ay` P �, s k Limited "energy, non-residential 75.00 2
I k S ,t #11 'x, e V ar -. lbi' .try Each manufactured or modular
� / t dwelling, service and /or feeder 90.90 2
l I t (�d ! G �W L] "' lJ� Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2
x y ..- r 2 n 201 amps to 400 amps 106.85 2
r * .t • ; : - _ ,. R'')(� `° � �. � � s fit 401 amps to 600 amps 160:60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 _ 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
t : ", y rg T i 0 - '^ a l • ' " fi t 0 11 '' n' ` rx' A. Fee for branch circuits with
er:A C • tt :, ' ^. ,, ".',,,,,4 , OV.ss 0.1 ali ,t- j*:^'- , ., 'r service or feeder fee, each
Business name: , ( J\ lea 1
i _L- I l , branch circuit 6.65 2
\ B. Fee for branch circuits
Contact name: v iN n ' l o / v_ to I � without service or feeder fee, 46.85 2
/ r 1 1 each branch circuit
Address: \-7) _ • e (�, ( U ` t Each add'I branch circuit 6.65 2
City/State/ZIP: 1 6 Miscellaneous (service or feeder not included)
Phone: (Sob) 0,3 9' 0 ( ( ) Fax: : ( 2 ) 6 1 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
" S y P Nsz r CONT QR ., ce X1 3 :: t y, e #,.,.9. S
`* ,.vw x ��' i s.rr x ` a �€ , energy panel, alteration, or
L S. 5 kt 5ta�:
j extension. Describe: S Page 2 2
Business name: Affk i C.giv` `1 --ea AG t a ,
Address: I33Gi 6.k (i )A, v-4 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: � PQY_\ i (�/`kC 0 `" 1 -." �.-- Investigation per hour (1 hr min) 62.50
Phone: ( a :9_4 6 c Fax: ,- `-7 %- Industrial plant per hour 73.75
a t , t „t ua E,` L CMX:60L �ERI I ? M , r, t. ; ¢ O
CCB Lic.: X'3 \ Electrical Lic.: % We Suprv. Lic.: �" („L1 O LEE Subtotal
Suprv. Electrician signature, required: „ :, x - Plan review (25% of permit fee)
t�-t State surcharge (8% of permit fee)
Print name: I I Le v.Pf\ ` i v tr0 Date: , 3. - __d
Plytnta_ TOTAL PERMIT FEE
Authorized signature: ` frky� This permit application expires if a permit is not obtained within 180
}E /_ days after it has been accepted as complete
Print name: el� I Vi (- 0,, a Date: \ 1,- iq".�( • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
is\ Building \ Permits \ELC- PernutApp.doc 12/03 440- 4615T(10 /02/COM/WEB
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BUILDING DIVISION ^^ PERMIT #: ELR2y>O8.1UU�7
1312SSVVHaUB|vd..Tlgavd.ORQ7223 DATE ISSUED: 3
Phone: (503) 639-4171
|napo��ionRoque�o(24Hmj:(GO3)63A'4175 .�J��� '
INSPECTION WORKSHEET FOR DATE: 6J2112006 TIME: 7 . 07 AM PAGE: 33
SITE ADDRESS: 0!)905 SW MCKENZIE ST CLASS OF WORK:
SUBDIVISION: NO. T|GARDViLLE ADDITION AMEND LOT #: 057 TYPE OF USE:
PROJECT NAME: 37' ANTHONY'S CATHOLIC CHURCH
DESCRIPTION: HVAC.
OWNER: ROMAN CATHOLIC ARCHI3ISHOP OF. PHONE #:
CONTRACTOR: AMERICAN HEATING PHONE #: 605
Inspection Request Scheduled For: Date: 6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
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I 9ART|ALAPPROVAL �� CANCEL El NOACCESS
�� FAIL 7 CALL FOR INSPECTION II] ADDITIONAL FEES ASSESSED
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Inspector: "~ ~��� �~c�^ Date: tit ~"�~~n7 Phone #: (503) 718- u��T��
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BUILDING DIVISION ELR3OO�1UU27
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PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3X24/20(]6
Phone: (503) 639-4171
Inspection Requests (24Hmj:(5O3)G3Q'4175 .&311r I.
INSPECTION WORKSHEET FOR DATE: 602005 TIME: 71O2AM PAGE: 37
SITE ADDRESS: 09905 SW MCKENZIE ST CLASS OF WORK:
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT #: 052 TYPE OF USE:
PROJECT NAME: S[ ANTHONY'S CATHOLIC CHURCH
DESCRIPTION: HV&C.
OWNER: ROMAN CATHOLIC ARCHBISHOP OF, PHONE #:
CONTRACTOR: AMERICAN HEATING PHONE #: 50
inspection Request Scheduled For: Date: 6/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Lmwvu|togw 031172'01 505-572'8230 N
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Corrections/Comments/ Instructions:
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pi PASS �� 0 ALAP�ROVAL CANCEL N�AC�ESS
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FAIL fl CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
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Inspector: �~ �c�� �_�� Date: xJ ��'^^�c) Phone #: (503) 718- 200,