Permit n CITY OF TIGARD ELECTRICAL PERMIT
111 11 CO MMUNITY DEVELOPMENT Per #: ELC2011 -00081
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2011
Parcel: 25111 CD00300
Jurisdiction: TIGARD
Site address: 15670 SW 98TH AVE
Project: Tigard Church of God Subdivision: ALDERBROOK FARM Lot: 0
Project Description: (4) branch circuits for audio /video system.
Contractor: 3 PHASE ELECTRIC/WRIGHT 1 ELECTRIC Owner: TIGARD CHURCH OF GOD
493 NE 3RD AVE SUITE B200 15670 SW 98TH AVENUE
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 889 -6615 PHONE.
FAX: 503 - 651 -3540
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 02/03/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/03/2011 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 95 - 001 -0090. You may obtain a cop oft = - - •irec . • -stions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 's 1
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 the next available inspection date.
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 Aoolica C,,E lent OFfl( 1. SF
Ci s of Ti ! L Tigard, 0R97222 ffA Perit NO.' / j—n(
Plan Review !�/
jj Phone: 503.7111.2439 Fat: 503,59, [�) O 2 Due /Dv: Other Pemnt
Inspection Line: 503439.4175 Date Rcady/B)r 0 Sec Psge 2 for
Intexnd: www.tigai'd- or.gov NotiScd/Method: . SYppk lnfor, uauaa
'.:.:. ;:, ^ Picase that ly (sub,nit t Beta of plans w /items checked below):
❑ New wnslruction dAdditi0n/alterption /replacement check all app
0 vies nr feeder 400 an>,a or more
0 Iiullliivg over three stories.
❑ Demolition ❑ Other: where the available fault etment ❑ Marinas and boatyards.
c e ; t ;.;G:: pP. ; rr exceeds 10,000 amps at 110 volts or ❑ Floating buildintp,
... .
_ . ' less to Krotmll, or exceeds 14.000 (] Comm ercial -use aKricultural
❑ 1- and 2- family dwelling V Comniereiallindustrial ❑ Accessory building amps for all otherinstallatkmx. buildings.
O Multi- family ❑ M aster builder ❑ Other 01'irs isuot O lnstallation of 75 KVA sr
.. ❑ Emorpp o f n 6 ew n tor larger s eparately derived system.
.. �• �::•!�,�, C+��� ?•��; ' •• ' [1 Addition oew nn kid of ❑
Job no.: rii O $o c Job site address: /S 7 0 W $ S TN l oeHP or more, oc��toa y.
_ _,3 �V k ❑ Six or rmrc residential ttrdts. ❑ Rccrcational vehicle parks.
Ci /Statc/�: T ��/� .+y /� (/ 0 ltenith -earn fdlitiet. 0 Sy,ply vehicle for more than
ry ` 1 `� ' ` �e ` /� ,•7 0 Hazerdoto locatioro 600 volts numinal.
Suite/hldg. /apt no.: , Prvjet name f //( M ,� G. o ❑ service or seeder 600 amps or tm ro,
Cross street/directions to job site: "; ;
Wtnlptb>• _ 1 triy. l For. i Total _
New residential single- or multi - family dweUiva unit.
Includes attached garage.
Subdivision: Lod no.: 1,000 ay. 0, or less 168.54 4
� - - Ea. add'I 500 ay. n. or ptertiott 33.92 l
Tax map/parcel no.: - nited energy, cai tial -
Lit r 75.00 2
DEsclul'lLON OF WO :;,., ;• ,.., • . (with ahnvc s ft.
Limited enery, multi- family
A r (4 )1 f Q b i r s p0g A cv s .S ?b w redential (with above 4. ft, ,
75.00 2
Y Services or feeders installation, alteration, and/or relocation
200 amps or len ' 100.70 2
t T T 201 snips to 4110 amps 133.56 - 2
Name 401 amps to 600 amps 200.34 2
h(ll amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volta 552.26 2
City /SttttrJ7.I P: re Te �� n s or feeders insWtl*don, alteration, and/or
Phone: ( ) Fax: ( ) 2011 amps or leas 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
intaidtxl for sale, lease, rent, or exchaugc, according to ORS 447, 449, 670, and 701 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or eatensiou, per panel
Owner signature: _ _ Datc: A. Fcc for branch circuits with
above servitx or feeder fpc,
.. � ;� .. :,�f.. .... r•'.r:!�'��: e�chbraucbcircuit 7,
Business name. R. Fcc for branch circuits without T
servicear teedcr fee, fast ( Sb.la ,'��, f , 2
Contact name: branch circuit
Each add'l branch circuit 7,42 1��, ).s,, 2
Address: Miacdlaneous (service or feeder et4t ioctudcd) —
City/State/LIP: Each manufsclureed or modular 67.84 2
. dwellin; service anti/or feeder
Phone: ( ) Fax :: ( ) Recottnoct only - 67 ,84 2
- Pump or irrigation circle 67.114 2
E -mail: ,
• Sim or outline lighting 67.84 2
,,_,_- . ,.r., ..,.,; Signal circuit(s) ur fimlloA- encreY
r3usinessname: t _p+me:l, alleralion , orcxWtsinn. Pa� 2
�Ai11,Ti i. r g 7 q 1� ��M l� L� CT � Lech additional lnspectlon over allowable in any of the above
Ad dress: (/4p /a 3 Kd 1q�U r� Additional inspection (I hr min) 61,.25/ hr
r 9ty /State/7. P: G � N D �•. 7 7 0 f1 lnvegtigatinn (l hr min) 66.25 / hr
10 3 - lndustrial plan((t hr min) 78.18/ hr
Phone: ($'43 ) a„S's Fax: (S 03) C S I - 3511 0 lnspcctiexrs firr which no fee 90.00 / hr
g�elt'rCallY listed (♦h h7 min) _ .
CCII Lie .: / 6 ai Electrical Lic.: 3 ` 3 g C Suprv. Lio,: 3 $ q� MPJCTICAL;a U MIT' FEES
Subtotal; 7 S . - (j
Suprv. Electrician signature, required:
_ Plan review (25%ofpermil fee):
Print name: �N� • t �lV L C ,'I Date. 02 jZ - / ,-- State sunibarge (12% of ptamit fee 9. 9 1
TOTAL PERMIT FER: g? .
Authorized signature: Tee.
_ pelmet application ixpirta if i permit 4 not eelrtataM within 1110
Print name: Dutc: • Numbcr of days tiom nilutuweed p a r aceted m complete
spec ' ra I m
L�Bsdtia Pamir+�F.LC.PamitApp.ka07/Ol /Ill 440 /f0WWEU
Z/6 d J .Qaia esei4d 05£-659-£0 O -?O -6 M