Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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a..,; COMMUNITY DEVELOPMENT Permit #: ELR2010 -00122
T [ G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/13/2010
Parcel: 1S133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE
Subdivision: Lot: 0
Project: Westgate Baptist
Project Description: Low voltage for Kitchen Fellowhip Hall.
FEES
Owner:
WESTGATE BAPTIST CHURCH Description Date Amount
12930 SW SCHOLLS FERRY RD Restricted Energy Permit 07/13/2010 $75.00
TIGARD, OR 97223 12% State Surcharge - Electrical 07/13/2010 $9.00
PHONE:
Contractor:
ADVANCED SECURITY & FIRE
2218 NE SUNRISE LN
HILLSBORO, OR 97124
PHONE: 503 - 519 -4550
FAX: 503- 640 -8311
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 $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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 rul-. • • - • • • .. Oregon Utility Notification enter. Those rules are set forth in OAR
952- 001 -0010 . 952- 001 -0100. You thr . ray • • - • , jjii •les or direct questi•.ns to OUNC by calling 4.
50 , 6.6699 or 1.800.332
411 � ��
Issued By: P e r mittee Si gnature:
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' 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 Application � ��,; •
�I OIt Ol I Icl `„,..i. �I
vo. _ City of �
. , • :: Tigard 1 3 1^ Dateiv 7 P No.: �p 4 _
114 13125 SW Hall Blvd., Tigard, OR 97223 `` `` 1 plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 `I "' 'JD : Other Permit: ` i .7 r 0
i _ i ri A i 1) Inspection Line: 503.639.4175 ! 1 ° �C Wafe Ready/By: See Page 2 for
Internet: www.tigard- or.gov c (� ti.; Notified/Method: �Gi). Supplemental Information
T �
OF WORK .
PLAN REVIEW
1:1 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
f less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
.
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: l fir] 30 5w (3 o rt-1. ❑ I Six or or more residential R occupancy.
Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: { ❑ Health -care facilities. ❑ Supply voltage for more than
T t � •� — 0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: .61/4)1....m f&l, / ❑ Service or feeder 600 amps or more.
� /' J+J, f' FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. l Fee. l Total l *
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
OF WORK _ • (with above sq. ft.) DESCRIPTION 75.00 2
�� Limited energy, multi - family 75.00 2
Z
,lKEfv FetcpbJ S - (�te Lf1 LL residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER . I ❑ TENANT , 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
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 7.42 2
each branch circuit
Business name: r B. Fee for branch circuits without
t�l� 5 L d�IZl service or feeder fee, first
Contact name: {� branch circuit 56.18 2
`�+ 2 �r"� ‘1)
1/4) Each add'I branch circuit 7.42 2
Address: 14,775 S ( PO/Lc 3 C J 7 Miscellaneous (service or feeder not included)
Ci City/State/ZIP: Each manufactured or modular
ty (,,K- is g 3 Z O - 9 70 3S dwelling, service and/or feeder 67.84 2
Phone: (E03 ) S 7 z 735 z c I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy I
Business name: �,� < panel, alteration, or extension. L Page 2 /� 2
(t k7�//+NGLI`CtCIJ� tTu 1 'Z Each additional inspection over allowable in any of the above
Address: ,9-1 ' V �_ $urn r . / f Additional inspection (1 hr min) 66.25/ hr
f, 7/1-7 Investigation (1 hr min) 66.25/ hr
CitylState /ZIP:
I!.gatr . V/ - q Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) I Fax: ( ),...---�/ Inspections for which no fee is 90.00/ hr
�j specifically listed (%Z hr min)
CCB Lic.: , 64,, t 7( I Electrical Lice $ � Suprv. Lic.: ELECTRICAL PERMIT FEES
\O IL i 1 I O Subtotal: 7,� ; c 0
Suprv. Electric) sr ature, required:
7// // Plan review (25% of permit fee): _ .
Print name: 1 Date: State surcharge (12 %ofpermit fee): cl. if
TOTAL PERMIT FEE: 0 0...c1-- Authorized signature: in )/y` -b J "i `Cam This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name ,a i i, u . -� Dat 7 _ / 3 -I C5 • Number of inspections allowed per permit.
I: \Building\Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORKONLY: j
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems* .
❑ Other:
COMMERCIAL 'WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
H Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
F ire Alarm Installation
H HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \ Building \Permits\ELC- PermitApp.doc 07/01/10