Permit CITY OF TIGARD ELECTRICAL PERMIT
= ::` COMMUNITY DEVELOPMENT Permit #: ELC2011 -00383
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/12/2011
Parcel: 2S110AC01700
Jurisdiction: Tigard
Site address: 14460 SW 114TH AVE
Project: Christ the King Lutheran Church Subdivision: Lot:
Project Description: Add (1) 200 amp service and (4) branch circuits for office
Contractor: OREGON ELECTRIC CONSTRUCTION INC. Owner: CHRIST THE KING LUTHERAN CHURCH
1709 SE 3RD AVE 11305 SW BULL MTN RD
PORTLAND, OR 97124 TIGARD, OR 97224
PHONE: 503 - 234 -9900
PHONE: 503 - 684 -8225
FAX: 503 - 234 -1001
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/12/2011 $100.70
Specifics: amps or less
4 crt Branch Circuits w /Purchase 07/12/2011 $29.68
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/12/2011 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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 OA' 95 -401 -00.0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: o ,-/- ' /(
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 Application FOR OFFICE 1JSE ONLY
City of Tigard . D .,:cc,,cd 7/40 ,,,
Dateil3y. ..„0(1,— Permit isio.:476 — 3,3
4/
. - " 13125 SW Hall Blvd., Tigard, 0 . . EIVE
/......'
11
Plan Review
Other Permit:
• 2 • Phonei 503.718.2439 Fax: 503.598.1960 ' Datelt3v:
T - I ci A RE , Inspection Line: 503.639.4175 JUL 0 8 2011 Date Readyffiy. lulls. ,... „....., 63 See Page 2 for 1
Internet: w‘vw.tigard gov • Notificdrmelhod: 1 t li Supplemental Information
:.:4:; .:::'.'
D slew construction E AdditialOP .ti, .T Please dices all Mai apply (submit 2 sets of plans winenis checked below).
0 Service or feeder 400 amps or more 0 Building over three stories
0 Demolition 0 Other: where thc available fault current D Marinas and boatyards.
; ,..., i: : : i 7 ,... , " . exceeds 1 o,noo :mips at 150 volts or 0 Floating Imildines
...., .. ..
less to ground, or exceeds: 14,01)0 0 (ommercial-use agricultural
r;,9 1- and 2-family dwelling ..ommerciallindustrial 0 Accessory building amps t all other installations. buildings.
161 NItilti-famil) • Master builder 0 Other: 0 Fire pump. 0 Installation 475 KVA or
larger separately derived system.
.: - .:. '.. :. ''. :'. . . - ..: - . -.... • •.-., • ,,.• k• • , •-• r - • : . •- :.• ,., •.:,..----.-.,: •••• ::•: o Additk. f intot kW of
I0
Job no.: 80122 1 lob site address: 14460 SW I 1 e Avenue 014P or more occupancy.
0
0 Six or more residential units. Recreational vehicle. park.
Cit Tigard, OR 97224 0 1-lealth-c:are facilnies. 0 Supply voltage for more than
._.__.. 0 Hazardous locations. 600 volt nominal.
Suite/bldg./apt. no.: 1 Project name: Oregon Food Bank 0 Scivice ni feeder 600 amps or more
? .. ; ;l'.:1: : i : ::',:i':
Cross street/directions to job site: newiption cl - Fee. Total *
New residential single- or multi-family dwelling unit.
Includes attached garage.
. ,
• 1.000 sq. ft. oi less I 168.54 4
Subdivision: Lot no.:
Ea. add'I 5or.1 sq. ft. or portion I :3.3_92 1
Tax mapiparcel no.: 1 I i
I dinned mei gy, residential i
• : „ , ... ....,.... . .. . . .. . . .. .. - • • 75.00 si .
, .,. . , .., ..... ., .. :...: .:..,-. ...'........DESCAIPTION OF xvpAN ... :. •,..• ..,, :: .i• (with above sc] II) i
.-
, i
Add 200amp Service with 4 new circuits for use in office !mimed energymulmiarmly
residential (with above sq. ft.1 I 75.00 I 2
Services or feeders installation. alteration, and/or relocation
200 amps or less I 100.711 100.70
4;1, 201 amps to 400 arms 1.33 56
.....
401 amps to 600 amps 200.34 I 2
Name: Portland Vineyard Church ----
601 amps to 1 000 snips 31(1.04 I 2
Address: 11305 SW Bull Mountain Road Over 1,000 amps or volts 552 .'6 i --4
2
- .... ... .
: Temporai". services or feeders installation, alteration, and/or
(:ity/SlateiZIP: Tigard, OR 97224
relocation
Phone: (503)684-8225 I Fax: ( ) 200 amps or less 5 1
,... 201 amps to 400 amps ! 125.08 t 2
• Owner installation: 'Fills install-''on is being made on property that I own which is not
s to 599 amps 1 68 . 54 ,
intended for sale, lease. rent. or exchange, according to ORS 447, 449, 670, and 701. 401 amp I - 54 ! ‘
Branch circuits - new, alteration, or extension, jr panel
i i Owner signature: Date: A. Fee for branch circuits awl/ I
'.1: .... above service or feeder fee, 4
7 42 29.68 1
each ranch circuit 1-1-11
13tt siness name: 13 Fee for branch circuits without
service or feeder tee. first
56.18 2
Contact name: branch circuit
---4 Each add'l branch circuit 7.42 2
Address:
Miscellaneous (senice or feeder not included)
..._
Each manufactured or modular
City/State/ZIP: 67.84 2
dwelling., service and/or fleecier
Phone: f ) Fax: : ( ) Reconnect onl I 677.34 '2 i
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighti :
ng 67.84
r—
•.•'; (300,04.70t.::; -;-:.....!.. 1 74181 circuit(st Cu limited-enerav —
,
Business name: Oregon Electric Construction, Inc. __amyl alteration. or extenstor. Pane 2
_ Each additional inspection over allowable in any of the abov
-- I
Address: 1709 SE 3r A venue Additional inspection (1 hr min) 66.25/ In
...__
Investig,ation (1 hr flirt 66.2.5! hr
CityiStateIZIP: Portland, OR 97214 ___
Industrial plant (1 hr rain) 78,18' hr
• Phone: (503) 2349-9900 Fax: ( 35-2763 hispections for which no the is
e" specf ficany listed CA hi mill) 90.00/ hr
(B .ic.: 203 '/ I Electrical Lie.: 26-95C V Suprv. Lie.: 4549 .:: 71,:.',:;'t LE(1 .;t .:.....':':'..,.
r , ...Siy) ,. ,\ . ,,- ; Subtotal: 130.38
Suprv. Electician signature, required P1 in re
: ( 31,:)t501,.t,,c \ rx,.
Pviev, (25% of pennit. fee.): — 0.00
..,.....__ ----
Print name: Rick McElliott Dati: -8-11 State surcharge (12% of permit fee): 1;5441 . g
! )
.,
Authorized signature: . ' Ty -----j \ -----N TsC — TOTAL PERMIT FEE: I 2. :16.6 /1/6 . 0_1
Nr-:4;'•ti.‘,,V.:,i % ‘‘.. ' . . \-
_ l'his permit application expires if a permit is nut obtained within 180
4./
days after it has been accepted as complete.
Print name: Rick McEllion ! Date: 7
. Mill) l:•er 01 inspections allr oval per permit.
7
1•:i3inidiriTe'n:.E1..(:-Pe■loilApp.ths, ri7A 1-1!J-46157(1 i -(..
/9 ee 97
FAX
TRANSMISSION
To: 5035981960
From: Heidi Bennett
Subject: Electric Permit
Message: Please see attached electrical permit application.
We have a trust account with City of Tigard, please charge fees to that.
If anything further is needed, please let me know.
Thanks!
Heidi Bennett
Oregon Electric Group
Assistant Project Manager
Direct# 503-535-2652
Cell# 503- 421 -9075
Oregon Electric Construction
1709 SE 3 AVE
Portland, OR 97214
Tel: 503 -234 -9900 Fax:503- 234-1001
Jul. 22. 2011 4:31PM PGE PORTLAND SERVICE CTR No. 4412 P. 2/2
cL C 21( —c )3T-S
0111 Request to Energize an Electrical Installation / LtLe(f2 e) st/v
�y s�3L
,,.,: R�Qf.t rS° fING1j, 5, Up, R1I lSlNGnEL�G.`�?I�AN;INF(�RMA7IQN ;:,..; `% �`_r _
Name of supervising electrician: RICK IVICELLIOTT Date of request: 7/19/11
Supervising electrician's license number: 4549S Date installation was completed: 7119111
Electrical permit no.: E LC2011.00383 If a temporary permit is posted at the job site, please include a copy oft! with this form.
CALgCONTRACTOR, INEORMA7iQN: "'a' ` : ,
Name of electrical contractor; OREGON ELECTRIC GROUP _ License no,: 26 - 95C
Business address: 1709 SE 3 R1, AVE
City: PORTLAND State: OR ZIP: 97214
Phone: 503.234 -9900 Pax: 503 - 535.2763 E - mail:
".. l. ..,, <, r•„ ,b, . , '.,., i, 7c.,i, , ^,, .. ,;., ; ' � ►.11 =�' „I . Ir4I,R1�lA?I "14[� 1 �_.-.
Customer's name: PORTLAND VINEYARD CHURCH
Customer's address:
•
City: TIGARD pk fi p F 9 17 State: OR ZIP: 97224
/
Address of installation if different than customer's address: 7fi
City: State: ZIP:
IN PGC U:T RITY NQ,RMATI
Authority having jurisdiction to inspect: CITY OF TIGARD Phone: - -
Address:
City: TIGARD State: OR ZIP:
Name of electric utility receiving request: PORTLAND GENERAL ELECTRIC Phone: 503-735 -5450
Address'
City: PORTLAND State: OR ZIP:
R ASONREOfttli 0 ES
A. Restoring electrical service that was interrupted or disconnected because of either a:
® Service change or ❑ Uncontrollable event, such as fire, flood, or severe weather;
or
B. Electrical service at a remote location needs to be:
❑ Initialized ❑ Restored
,:. '" ':COMPLETION: iiN ,TRIJCTION,S, A D,,;'SIGNATURE_
Supervising electrician Electrical contractor
Note: After sending this form to the electric utility Note: By close of business on the first business day following
named above, you ntttst send a copy of this form to; energizing of a completed installation in response to the above
(1) the electrical contractor, (2) the customer, and request, you must: (1) notify the authority having jurisdiction
(3) the inspecting authority. I that the installation has been energized, and (2) request that the
t. . 3, 7 -19 -11 authority inspect the completed installation.
Supervising electrician's signature Date Electric utility
Note: Please consider notifying the inspecting authority
identified in this request - wheat an is energized
before inspection.
pti6V E