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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2010 -00140 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/29/2010 Parcel: 2S101 BB01400 Jurisdiction: TIGARD Site address: 12178 SW GARDEN PL, BLDG# 3 Subdivision: PARK 217 Lot: 0 Project: Colossae Church Project Description: Low voltage for HVAC FEES Owner: WALTON CWOR PARK BC 8 LLC Description Date Amount BY TTA/EPROPERTYTAX DEPT 325, PO BOX Restricted Energy Permit 07/29/2010 $75.00 4900 12% State Surcharge - Electrical 07/29/2010 $9.00 PHONE: Contractor: OREGON HEATING & AC PO BOX 241 DUNDEE, OR 97115 PHONE: 503 -691 -9699 FAX: 503 -691 -8556 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: N HVAC: Y 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 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: ' AA ✓ Permittee Signature: C>N A peL Te A 4— c"i✓ 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 (llz (1 rr i(E u`E ONLY City of Tigard • JUL 2 8 ?O h}e e a Permit No.: g L 0 2010 -0Ul CIO ' " 13125 SW Hall Blvd., Tigard. OR 97223 _ Phone 503.639 6 [ 71 Fax: 503.598.E 960 CITY OF T1G •' Other Permit: LAr1 _ 1 r. n it ll: Inspection Lint: 503.639.4175 a- l�epd El See Page 2 for Internet: www.tigard- or.gov BUILDING DI I • I' ..12T11041: Supplemental Information TYPE OF WORK 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 ❑ E3uilding over three stories. ❑ Demolition Other: where the Available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14.000 ❑ Commeroial - ase agricultural ❑ 1 - and 2- family dwelling JJ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. 1=I Multi-family ❑ Master builder ❑ Other: LI Fire pump, ❑ Installer of 75kVA or • JOR SITE INFORMATION AND LOCATION ❑ Emergency o system. larger separately derived system. ❑ Addition of new motor load of ❑ "A", "E ", "1 -2 "', "I -3 ", Q 1 QOI� or more. occupancy. Job no.: 10-4()9_04 Job sit pddre3S: \ Q �.7 ( y � Q/ ❑Six or more residential units. ❑ Recreational vehicle panes. City /State /ZIP: ` — t (''�, -7� �^y r' 0 Health-care facilities. 12 supply voltage for more than "� 1 p"Q `"� © Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.; Project name: ❑ S or feeder 600 amps or more. .. FEE SCHEDULE Cross Street/directions to job site; Description 1 Qtr. f Fee. 1 Total - i • , New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: ... 1,000 sq. ft. or less 168.54 4 . Ea. addi 500 sq. B. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK with above sq. ft...) 75 2 - " '�1 V �� i V 4 A Limited energy, multi-family 75.00 2 residential (with ilt a bove l>ova sq. q. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 A( PROPERTY OWNER 0 TENANT 201 amps to 400 arnps 133.56 2 / J 1 �t 401 amps to 600 amps • 200.34 2 Name: c C�C .� �� 60t 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: �1r � Cil. ti, 1� ` . relocation Fax; ( ) 200 amps or Ices 59.36 1 Phone; ( ) 201 amps to 400 .amps 125.08 2 Owner installation: This installation is being made on property that 1 own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent. or exchange, according to ORS 4.47, 449, 670, and 701. /Breach circuits- new, alteration, or extension, per panel Owner signature: - Date: A. Pee for branch circuits with APPLICANT ❑ CONTACT PERSON - - above service or feeder fee, 7.42 2 each branch circuit _ Business name: al * L l __+ B. Fee for branch circuits without 11 ♦ �. a• service or feeder fee, fist * 1 , I - _ branch circuit 56.18 2 Contact name: --- % r � � � Each add'I branch circuit 7.42 2 - Address: ( 3.%, 1 Miscellaneous (service or feeder not included) C u ACLU_ L � Each manufactured or modular 67 8d 2 City /State /ZIP: t, l S dwelling. service and/or feeder CIA Reconnect only 67.84 2 Phone: ( ) It 41�.t.�t Fax:: ) ( �a l �5 L� L pomp or irrigation circle 67.84 2 E _ _.. ..- Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited -energy ;a LI r '. �� _panel, alteration, or ecnsion. I _ Page 2 2 Business name 1 / . � `L III_ ! '' �l " Each additional inspection over allowable in anv of the above Address: 1 , , a1-1 1 Additional inspection (1 hr min) 66.25 /hr City /State /ZIP: it i ( Investigation (1 brmrn) 66.25/ hr 1 0._ , , I - Industrial plant (1 hr min) 78.18/ hr Phone: ) 1 • 1.K.• - Fax: 5.3) ( - l,-4 inspections for which no fee is 90.00/ hr sperifically_listed ('A hr min) _ CC)) Lic.: 1 . au? Electrical Lic.:L • l 4 ./0 Suprv. Lic.:r7915/ E ELECTRICAL PERMIT 1F°EES � - ...� Subtotal; `( Suprv. Electrician signature, required: -- • — plant review (25% of permit fee): Print name: f �, , � • jj � Date: State surcharge (12% of permit fee): q � signature: ' TOTAL PERMIT FEE: c Q Authorized signature: �f /, � 1 This permit applicat expires if a permit is not obtained within 180 days after it has been accepted as complete. Prins name: � � 4 i` /, Date: . • Number of inspections allowed.per permit. t/ ' ii �- 1: 0filding 'Permital£1.C- permitApp.doc 07/01110 445- 4615T111 /05ICOM/WEB 90/T0 30Vd ONIIflH NOJ3aO 9958- 169 —E09 9b :0t 0102/8Z/L0 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESLENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglax Alarm ❑ Garage Door Opener* • ❑ Heating, Ventilation and Aix 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: • ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation • ❑ Fire Alarm Installation • 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 1:13Uildin \Perm0AELCBermitApp.dot OMI /I0 90/Z0 30dd 9NIld3H N003H0 9598 -169 -605 917:01 0102/8Z/L0