Permit CITY OF TIGARD ELECTRICAL PERMIT
11 1 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00425
TIGARD 13125 SW Hall Blvd Tigard OR 97223 503.718.2439 Date Issued: 07/28/2011
Parcel: 2S102BD01600
Jurisdiction: Tigard
Site address: 9845 SW WALNUT PL
Project: United Methodist Church Subdivision: Lot:
Project Description: (1) 200 amp service and (4) branch circuits for sub -panel and outlets
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: TIGARD COMMUNITY METHODIST
PO BOX 3948 CHURCH
WILSONVILLE, OR 97070 9845 SW WALNUT
TIGARD, OR 97223
PHONE: 971 - 563 -8211 PHONE:
FAX: 503 - 266 -1349
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/28/2011 $100.70
Specifics: amps or less
4 crt Branch Circuits w /Purchase 07/28/2011 $29.68
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/28/2011 $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 0 952 -s ! -0090. 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: v // / G/ e,9-770
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 Applicat C � 11 1 !I . .
8 � 1 t FOR OFFICE USE ONLY •
City of Tigard Receive • 13125 SW Hall El1vd-, Tigard. OR 97224 U L 2 8 2011 Date /By: ' / /1 i• • Permit r � .: � // 1 y�e
' C P hone: 503.63),4171 Fax: 503.598.1960
Plan Review
Date/By: Other Permit
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD DateReady /By: r °r i s:
and -or, ov H See Supplemental Information
$ B N Supplemeotal
Internet: www•ti on
r'rl 111 r1iA1f_ n! \11q1M1 • TYPE OFi/ORVk' PLAN REVIEW
❑ New construction Addition /aIteration/replacemetit 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.
CI Demolition ❑ Other:
where the available fault anent ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps ct 150 volts or ❑ Floating buildings
❑ 1 - and 2- family dwelling , less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
.12
❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder
❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
❑ Addition anew motor load of 0 "A ", "E ", "1-2
Job no.: [ Job site address: 641 5--- /AIN er ? L. IOO y
r ❑ Six or mor ore more. occupancy.
residential units. ❑ Recreafional vehicle parks.
City /State/ZIP: ❑ Fteallh - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominaL
Suite/bldg. /apt. no.: i Project name: D Svicc or feeder 600 amps or mon's.
Cross street/directions to job SRC: F EE SCHEDULE
Description I Qty, I Fee: I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1,000 tt
Lot no.: q• or less _ 168.54 4
Tax map/parcel no.: Ea. add'l 500 sq. ft- or portion 13.92 l
Limited energy, residential
DESCRIPTION OF WORK (with above se. ft.) 67.84 2
�+� Limited energy, multi - family
57�d1( � 9�`l►V - FOC coffee: (j (7 Z c-#21 residential (with above sq- n.) 67.84 2
rest cock, � Z �• r l ` Services or feeders installation, alteration, and/or relocation
0" PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 1 t'7 2
_ 201 amps 10 400 amps 133.56 2
Name: 11 &e MY ti N lT j fivrtitv,,r C e b f t , j 401 amps to 600 amps 200.34 2 _
Address: 1 601 amps to 1,000 amps 301,04 2
Over 1,000 amps or volts 552.26 2
City /State/ZIP: 1 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 5936 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 •` 2
Owner signature: Date: Branch circuits-. new, alteration, or extension, ter Mod APPLICANT A. Fee for branch circuits with
❑ CONTACT PERSON above service or feeder fee,
Business name: _ each branch circuit 7.42 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: ( ) dwelling, service and/or feeder 67 84 2
Fax:: ( )
E -mail:
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: J O C/1 `u/ E LFc. ' 1 � � Signal circuit(s) or limited -
l� energy panel, alteration, or
Address: P <
a < i Q . extension. Describe: Page 2 2
City /State/ZIP: uj��+�0 (�� ( 0 7 0 Each additional inspection over allowable in any of the above
Phon . (11/ ) .51,3 I Fax: { '�) �� r Per inspection 66.25
t 3� 4( Investigation per hour (t Itr min) 66.25
I B Lic.: ( � Z Electrical Lie.: ✓ -
"��� < Suprv. Lic.: Si 0 7. 5 Industrial plant per hour 78.18
11 Suprv. Electrician signature, required: I ELECTR PERMIT FEES
Subtotal: la t'D
• Print name: L atta_ AT C + Date: 10 2z_o9 Plan review (25% of permit fee):
Authorized signature: t State surcharge (12% of permit foe):
TOTAL PERMIT FEE: Mb .0 1 : G"
Print name: _ I Date: This permit application expires ifn permit is not ohtnincd within ISO
days after it has been accepted as complete.
E: lauildinglPermi�aOFr .C- PermirApp.doc I OlDi.9? ' Number of inspections allowed per permit.
440-46 15T(I 1 /05,COM/WE3
Z'd 6b£L99ZEO9 ou }oal3 )inoai� of d0E 66 LL LZ In(