Permit r.
5 , CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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° ; ° COMMUNITY DEVELOPMENT Permit #: ELR2009-00330
TIG;ARD,, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2009
,,, , ,, , 4 Parcel: 2S110AC01700
Jurisdiction: Tigard
Site address: 11305 SW BULL MOUNTAIN RD
Subdivision: Lot: 0
Project: Christ the King Lutheran Church
Project Description: Restricted energy for fire alarm.
FEES
Owner:
CHRIST THE KING Description Date Amount
LUTHERAN CHURCH, 11305 SW BULL MTN RD Restricted Energy Permit 10/22/2009 $67.84
TIGARD, OR 97224 12% State Surcharge - Electrical 10/22/2009 $8.14
PHONE:
Contractor:
PROTECTION ONE ALARM MONITORING
15500 SW 72ND AVE
PORTLAND, OR 97224
PHONE: 503 - 624 -0244
FAX:
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1 '
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: Y
HVAC: N Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Required Items and Reports. (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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'thro gh 0 R 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 9 or 1.800.332.2344.
Issued By: _Cti /KZ Permittee Signature: r y---
OWNER INSTALLATION ONLY
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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' Date:
LICENSE NO.
Ca11°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.
3 '. a, 4 1 y " ,.� 1 V dwvV� 4 i 464 ∎!; , .1 : 7 r AV_∎' a'" � Y *, y+' - A p � :i1 1 �i H x ' `1 V, t!!R i�?
��ee tr><cal Permit Application � ` �� E: iew iv � �t FORuOE FIC L e�,t E O L � II
' pp , USE ON 1 .
, City o Tigard �X P 7
° 13125 SW Hall Blvd., Tigard, OR 97223
'',, -`, Phone: 503.639.4171 Fax: 503.598.1960 OCT 2 2009 DateB : Other Permit:
4 Inspection Line: 503.639.4175 Date Ready /By: • ® See Page 2 for '
ii* e's, dl Internet: www.tigard- or.gov CITY OF TIGAR s Notified/Method: _ M Supplemental Information
' , . ' 1 TYPE OF WORI8UILOIN i UIVIS° ,,: . , '
PLAN 'REVIEW . ; •
❑ New construction ® Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
1 - and 2 dwelling CATEGORY _ COmm rctal/Olndu RU'TION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
• less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1:1 y g ® ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ : Fire.pump. ❑ Installation of 75 KVA or
JO SITE INFORMATION AND LOCATION , . ❑ Emergency system. larger separately derived system.
'
' _ � 0 Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: 11.305 SW i3„11 MDUN4 Sixorm r R ceation.
iA7/`� ❑ Six or more residential units. ❑Recreational vehicle parks.
City /State /ZIP: CJ( /� rC O� , c-1-7 U I a L ❑ Health -care, facilities. ❑ Supply voltage for more than
/ !I' ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: �l Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE, ', - •
Cross street/directions to job site: De ► Qty. 1 Fee. 1 Total 1 *
New` residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or -less 168:54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel . no.: Limited energy, residential . .
,- . :
Li sid 67.84 2
. .. _, DESCR IPTION OF.' WORK '., - . . (with above sq. ft.)
(� I [ Limited energy, multi - family 67.84 2
I -ef 11a et_ I I v e 4' lac/x-1/4 9 014.€ 1 0/�/ "NO tde tg I, residential (with above sq. R.)
Services or feeders installation, alteration, and/or relocation
13 8 s r'trAe DE{'C -c { 200 amps or less 100.70 2
❑PROPERTY OWNER • ❑ ,_TENANT . 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to_1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according. to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. - .:.
"
APPLICANT - 1' ❑• CONTACT PERSON . ^ . • above service or feeder fee,
7A2 2 • each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first,branch.circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax. . ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
- ' ' - :CO■TRACTOR , ,..,... Sign or outline lighting 67.84 2
1 I Signal circuit(s) or limited -
Business name:
P(0'�te Oive 4tfr% Mot, 1d-prrN, IN energy panel, alteration, or
'�, L �J extension. Describe: Page 2 2
Address: I SS D S 1-..) 7aNc1 �W li IOU
City /State /ZIP: Pfl h .} IAN 8 � K C{7 Z 2 C I Each additional inspection over allowable in any of the above
/ Per inspection 66.25
Phone: (SOS )1-1L( a-e(02- Fax: ( say ) 11/3 a R t( 9 ) Investigation' perhour(1 hr min) 66.25
CCB Lic.: /((p2,.5" Electrical Lic.:,3L1- LI ZraF Suprv. Lic.: Industrial plant per hour 78.18
' - ELECTRICAL PERMIT.,FEES: °. ""
Suprv. Electrician signature, required: Subtotal: `5
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
�` �� This permit application expires if a permit is not obtained within 180
Print name: 4, I C tl Date: /Q . Z2 - Oel days after it has been accepted as complete.
� * Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard '
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r RESIDENTIAL WORK•ONIY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
[,COMAIERGIALAWORKONLY,
Fee for each commercial $67.84
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system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
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❑ Nurse Calls "
❑ Outdoor Landscape Lighting*
❑ Protective Signaling 0 .
El Other •
Total number of commercial systems:
*No licenses are required. Licenses are required
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for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09