Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00231
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/04/2011
Parcel: 2S110AC01700
Jurisdiction: Tigard
Site address: 11305 SW BULL MOUNTAIN RD
Project: Christ the King Lutheran Church Subdivision:tULL MOUNTAIN HGTS. APARTMENT; Lot:
Project Description: (2) branch circuits.
Contractor: MCCOY ELECTRIC CO INC Owner: CHRIST THE KING
2014 SE 9TH AVE LUTHERAN CHURCH
PORTLAND, OR 97214 11305 SW BULL MTN RD
TIGARD, OR 97224
PHONE: 503 - 234 -7521 PHONE:
FAX: 503 - 234 -9473
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 05/04/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/04/2011 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 952 - 001 -0090. You may o. • - - _ • .•e rule direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. •
/ 1
Issued Bye— �i i� Permittee Signature: • — - 5 ' 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 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.
May, . 21 12 t‘ No, 4648 P. 1
„ 301
Ma 14 2 1 111 12 t! I1ca
City of & Blvd., Datet3 Received PermitNo.: Ltr)Cri J
III v 13125 SW Hall Blvd., Tigard, OR 91my 3 2011 Plan Review
Phone: 503.718.2439 Fax: 5015984960 DateBy: Other Pewit:
r 1(1A It 13 Inspection Line: 503.639A175 Date ReadyB ruri3: !B See Page 2 for
Internet; www.tigard- or.gov B (( CITY nt � Noufied/Meih . Supplemental Information
. TYPE OF ORK t PT
❑ New construction El Addition/alteration / replacement Please check all that apply (submit 2 sets of plans tt• /items checked below):
['Service or Feeder 400 amps or more n Building over three siorios.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
e s '' it ` -' ? '' volts or Q Floating buildin : r,. < b =;�rl:. :WfL Al,:. I J L P . .,. .:., exceeds 10 amps a l 150 g s-
.
"" 1 0 6 5 1 0 ❑ Commercial -use agricultural
❑ l and 2- family dwelling tg] Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: []Piro pump, ❑ Installation 0'75 KVA or
JOB SITE INFORIIIATION AND :LOCATIOt y � = {' . ❑ Emergency system. larger separately derived system.
- k rr UAddit i onofnewmotorloadof ❑ "A ",`F', "1 - "1 -
Job no.: D5460 Job site address: 11305 SW BULL MOUNTAIN RD ar more. occupancy.
❑ Six x o or r more residential units. ❑ Recreational vehicle parks,
City /State /ZIP: 97224 ❑ health-care facilities. ❑ Supply voltage for more than
° ❑ ilazardous locations, 600 volts nominal.
Suite/bldg./apt. no.; Project name: Christ the King Lutheran ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: e
E .ar-" ^ 'aw::;FEE SCHE1?Ui ` 4„ l' .;±.`;';;?.',; `
] Deserimron I Qty. Fee. I 'rota! I
New residential single- or multi - family dwelling unit,
_ includes attached garage.
Subdivision: f Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'i 500 sq. ii, or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
. DERIPTCON OF WORK r s" , ` ti.. Alfa,`+ With above sq. ft -) 75.00 2
SC
' Limited energy, multi- family 75.00 2
replace guts in ten parking Iot Iights resift tialwith above sq. ft.) i
' Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPER'TI! OWNER I x , ... ' .. , ' ❑ 0NT' K s,: "' 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
Ci /State /ZIP^ Temporary services or feeders installation, alteration, and /or
ry 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 OILS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel _
Owner signature: Date: A. pee for branch circuits with
1 .. a fee,
. ❑'APPLICAIiti ° ..: El_. , It ?. 0 ` 1tRgO above service or feeder fee
each branch circuit 7.42 2
Business name: D, Fee for branch circuits without
service or feeder fee, first 1 56.18 56 -1S 2
Contact name: branch circuit
— Each add'i branch circuit 1 7.42 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or City /State /ZIP:
dwelling, service and f eeder 67.84 2
Phone; ( ) I Fax : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
:,.,-,.:;:,7...- � Sign or outline lighting 67.84 2
. CONTRACTOR ;, 3Q °"'0'W'f4;i • Signal circuit(s) or limited-energy
Business name: MCCOYELECTRIC panel, alteration. or extension. Page i 2
Each additional inspection over allowable In any of the above
Address: 2014 SE 9 AVENUE Additional inspection (1 hr min) ' 66,25/ hr
City /State /ZIP; PORTLAND, OR 97214 Investigation (1 hr min) 66.251 hr
Industrial plant (1 hr min) 78.18 /hr
Phone: (503) 234752I I Fax: (503) 2349473 Inspections for which no fee is 90,00 / hr
specifically listed (% hr min)
CCB Lie.: 8277 Electrical Lie.: 26-82C I Suprv. Lie.: 5208S I ' 'z ' ` ,', •
p je . ,, !ELECTRICAL min) AL P ERM
Suprv. Electrician signature, required: o Subtotal: 63.60
Plan review (25% of permit fee):
Print name: ZACK ARMSTRONG Date; 5 -3 -11 State surcharge (12a / of pennit fee): 7.63
TOTAL PERMIT FEE: 71.23
Authorized signature: This permit application aspires If a permit is not obtained wilhia 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I: Pe,mil App.dot 07/01/10 440- 4615T(1 /CONOVER