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Permit C ITY O F TIGARD ELECTRICAL PERMIT Lam- PERMIT #: ELC2004 -00423 DEVELOPMENT SERVICES DATE ISSUED: 7/14/2004 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 25111 BC -02800 SITE ADDRESS: 10445 SW CANTERBURY LN ZONING: R - 3.5 SUBDIVISION: BLOCK: LOT : 3 - JURISDICTION: TIG Project Description: Install Milbank metered service. Job # 7320. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: PRESBYTERY OF PORTLAND THE NORTHSTAR ELECTRICAL CONTRACTORS CALVIN PRESBYTERIAN CHURCH 19450 SW CIPOLE RD SUITE 107 10445 SW CANTERBURY LN TUALATIN, OR 97062 TIGARD, OR 97224 Phone: 503 - 639 -3273 Phone: 503 - 612 -0840 Reg #: LIC 90454 ELE 34 -359C FEES SUP 661S Description Date Amount Required Inspections [ELPRMT] ELC Permit 7/14/2004 $80.30 [TAX] 8% State Surcharge 7/14/2004 $6.42 Elect'I Service Elect'I Final Total $86.72 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1-800- 332 -2344. Issued By: Permit Signature: St, -e__ ,0 \ , 7 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'N: �� -� s �� R:\y\ �. CSC'\ U DATE: 7 �` �� G / LICENSE NO: 6 4 1 5 Call 639 -4175 by 7:00pm for an inspection the next business day 07/13/2004 10:37 5036120891 NORTHSTAR PAGE 03/03 .t iectrncai rermut Application FOR. OFfICE USE ONLY Received E lectrical i r t_ ,., Pate/By: •1 — /3 — o 1 Q97Perns ;t No.; e� c�2oO9 04 .' City of Tigard < Planning Approval Sign SW Hall Blvd, D � X11 Q Date/By: ,• Permit No„ Plan Review Other Tigard, Oregon 97223 Date/13y: Permit No.: Phone: 503- 639 -4171 Fax: 503 -5 1M Post- Review Land Use Internet: W ww.ci.tigard.or.us �� -�, __ V i t • � - C ris.: .: . t =' �� Contact ontact uns.: ta See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 \O'�,t" -`" A ,_ " N arttc /Nctitod: 1 5 Supplemental Information. ;.,;;•,,,: TYPE _ PLAN :REVIEW " 1'ea'se cheek: all that apply) `I New construction Delnolltjon Service over 225 amps- Health-care facility Addilxon/alterarioxl/re • lacelxlerit commercial El Hazardous location Other: 0 Service over 320 amps-rating of :, �' R S [] Building over 10,000 square feet, • • ' • ''' : CATEG ORY' OF CON STRUCTIO�E '` '; ', • " = ;, ' _ 1 & 2 family dwellings four or more residential units in • ❑ 1 & 2- Family dwellin r ,J Commercial/Industrial ❑ System over 600 volts nominal one structure . Accesso ,...., Buildin • il Multi- 1~'x11111 ❑ Building over three stories ❑Feeders, 400 amps or more • Master Builder ❑ Occupant load over 99 persons © Manufactured structures or KY park Other: ❑ Egress/lighting plan ❑ Other: .. `w'yi'" B�� OITEThi Y.OR1V;9:T'TON;;'itaU' `I:V.0 �jr'`;s' +;w,'.'::.' . Submit — ts of plans with any of the above. Job site address: / a ` r ' r T The above are not applicable to tern ors construction service. Bldti- /Apt. #; Number of ins . ections er r ermlt allowed Pro'ect Name: 4. - ■ • ' A K1 ' . a U . ' !Descri.tion Qty Total Cross street/Directions to job site: New residential -single or multi - family per dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 s•- ft. or • •rtion thereof 33.40 1 Subdivision: Lot .#: Limited energy, residential 75.00 2 Limited energy non residential 111 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling II W ,'l?:u 'lt ;; :': .'lb.g it`'sRIPTYON O. ' O i e .q: d�{ ` - service and/or feeder 90.90 �v Services or feeders - igstaliatioa, i . tai LL L4 IL:. ;r l.. ... . - h - I alteration or relocation: 17 : l G, : 200 amps or less 80,30 :40 n 2 201 amps to 400 amps I. 106.85 m 401 am.: to 600 ath.s MIEN 160.60 JiM,' i :PR ® ;E '..O ER=,:. !iti'i" 11 t , :'EN' TN."L`. i" ', •'ik'ri ; J 601 am's to 1000 am' 240 -60 Over 1000 amps or volts 454,65 ini Name: CiALAIM P P , r sf5- E K 1 4 1 \ - 1 -11, Cr Reconnect only NMI 66.85 Address: (O 4-15 • i . 0 • . ,w \J A) Temporary services or feeders - installation, �` alteration, or relocation: Cl /State/Zit,: G .. 0 200 amps or less 66.85 MI Phone: , Effi Fax: Z0 1 a ps 400 amps 1.1. t:.,., 40 am 1C49.3° 111= ®:AP ri C�ib�t: . . t:• ' :: � GCJD ETA CF PERSON i'sh� ' ..; - Branch.arcuits - new, alteration, or Name: extension per panel: Address: A. Fee for branch circuits wirh purchase of service or feeder fee, each branch circuit II 6.65 2 Cl r /State /Zi : B. Fee for branch circuits without purchase q f Phone: service or feeder fee, first branch circuit 46.85 2 Fax: Each additional branch circuit 6-65 2 E1: misc.(S. rYice or feeder not included): III ,.,,.•'. !'s::. . L ion circle E,y n'k'sYP ?:�ar•('•i:i q y: . hyl• ql , E 'am' orir a 53.40 2 Job No: Each Si: . or outline li>htin• MN 53 -40 2 c2- 6 Signal circuit(s) or a limited energy panel, Business 1 • la r1 e� 7•�p y� lC/�� . alteration[ or extension ■ 2 ir. — t ll I Q� - Description: III Address: Igzc SUJ C I VOLF CD . Cl Address: ✓Z) • .: Each additional ins ectioo over the allowable in an of the above: r r . / Per inspection per hour (min. 1 hour) _ 62.50 Phone : crz, (v tz. Or (7 Pax: (0 i Z, ()Act I investigation fee: CCB Lic. #: • c„ L' #: pG other: Supervising electrician Subtotal 1U Electr ca ll i 4,l y�+ , ? +�' ' i s total $ Si • attire re. uired: ,t � Plan Review 25% of Permit Fee $ Print Nam _;,; • rte ; e + - - State Surcharge (8% or Permit Fee) $ 6, Lf2 �..,. • Authorized TOTAL PERMIT FEE. , $ a(, ) , '9.2 Notice: This permit application expires if a permit is not obtained within Signature: Date: _ 180 days after It. has been accepted as complete. 'Fee methodology set.by Trl -County Building Industry Service Board. (Please print name) - . i :\osts\Permit Forms \ElcPermiLkpp -doe 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection,jine:.(503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST l r C' BUP Received `� Date sted �� a AM PM BUP Location I 0 L L — 0w Suite MEC Contact Person e t4 t�, Ph (_`. v j �o / r PLM Contractor . Ph ( j SWR , / BUILDING Tenant/Owner di - V1� � �G `� e ` /4 ELC a (� ci — �`f. Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing `\ Drywall on Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam , Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post& Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL TRIC ervice Rough -In UG /Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SITE Please call for reinspec ion RE: ❑ Unable to inspect — no access Fire Supply Line ADA / Approach /Sidewalk Date f Inspector l Ext Other: Final DO NOT REMOVE this inspection record from t ob site. PASS PART FAIL •