Permit CITY OF TIGAR® ELECTRICAL PERMIT
PERMIT #: ELC2005 -00600
� l� l. [ DEVELOPMENT SERVICES DATE ISSUED: 8/17/2005
"°'i`"' . 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 102 B D - 00800
SITE ADDRESS: 12630 SW GRANT AVE ZONING: R - 12
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT : 009 JURISDICTION: TIG
Project Description: Location: Food pantry. 3 branch circuits.
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 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:
ROMAN CATHOLIC ARCHBISHOP OF ALLIED ELECTRIC
PORTLAND I N OREGON PO BOX 1640
2838E BURNSIDE NORTH PLAINS, OR 97133
PORTLAND, OR 97214
Phone: Phone: 614 - 8000
FEES Reg #: LIC 38538
SUP 3195S
Description Date Amount ELE 34 - 112C
[ELPRMT] ELC Permit 8/17/2005 $60.15
[TAX] 8% State Surcharge 8/17/2005 $4.81 REQUIRED ITEMS AND REPORTS
Total $64.96
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty 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 Qregonlitilit , otification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these pale; or direct q e'tions to OUNC at
503 - 246 -6699 or 1- 0 -332 -2 44. —
Issued By: ,�,, ,� � 2,&e....._ Permittee Signature: _` y
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: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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 Appl>ccatioi>If�' FOR OFFICEUSE ONLY . .
Il U l‘— / t- J NY
Rec eived
City of Tigard Perm N o .:�
_
Date /By. t / ` J' �� r'
13125 SW Hall Blvd., Tigard, OR 97223 r''� 7 2005
Phone' 503.639.4171 Fax: 503.598 1960 `4 ! / /ai�rd+�iM�U y �' �� +,, Date/By.
e Other Pemut /�
Inspection Line: 503 639 " Date Ready/By t ® See Page 2 for
Internet www.ci.tigard.or.us CITY OF TIGARD Notified/Method: L Supplemental Information
TO 'li i'("'^'' V161V1 '
E OF i VVORK PLAN VIEW
❑ New construction %Addition/alteration/replacement Please check all that apply
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑ Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling `I Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE. INFORMATION AND LOCATION : ❑Egress/Iighting plan RV park
. Job no.: Job site address: /2 (30 �' 6,, 'h El Health-care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: 'TZ C_, ®,(L-- The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name:
FEE* SCHEDULE
Description I Qty. I Fee. I Total
Cross street/directions to job site: WC LU New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq ft. or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
1i -0\•T - t - . l w �� 7 dwelling, service and/or feeder 90.90 2
I V1 �� (/L �" ~ ` Services or feeders installation, alteration, and /or relocation
I e _ _______ 200 amps or less 80.30 2
❑ PROPERTY OWNER. EN • T y 201 amps to 400 amps 106.85 2
i JP" �� 401 amps to 600 amps 160.60 2
Name: : rl la •tom 1._ , . /1 4. 4•
. _ ' i� 601 amps to 1,000 amps 240.60 2
U
Address: $' C Over 1,000 amps or volts 454 65 2
`�J Reconnect only 66.85 2
City /State /ZIP: D . 914a-14 Temporary services or feeders installation, alteration, and /or
ti relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
5•! g
Contact name:
without service or feeder fee, ,i
each branch circuit 46.85 2
Address: Each add'I branch circuit .2„ 6.65 / '350 2
City /State /ZIP: Miscellaneous (service or feeder not included)
`\ Pump or irrigation circle 53.40 2
Phone: ( ) Fax :: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: I1t-- . -L:
Address: / Each additional inspection over allowable in any of the above • �� [ �' L� Per inspection 62.50
City /State/ZIP: ;(,) T? — / (AL e 7 /1 3 Investigation per hour (I hr min) 62.50 .
Phone' ( ) t t L.1 — /tai Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* ,
CCB Lic.: Z6 l j3 �j' Electrical ' .. // 2 (Suprv. Lic.: �j i4 s S
Subtotal [�C/ ' ^.'5
Lk •
Suprvecttitian sig tture, requir d: 4 / o /D /- Plan review (25 %ofpermit fee)
■ State surcharge (8% of permit fee)
4SI
1 ,
Print name: j ,; iq't_ 0 4 t f , („--1._. Date:
I TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained wit in 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri County Building Industry Service Board
•• Number of inspections per permit allowed.
i \Building\l'ermits\ELC-PermitApp doc 12/03 440 4615T(t0 /02/COM/WEB
Electrical Permit Application - City of Tigard -
Page 2 -. Supplemental Information
LIMITED ENERGY PERMIT FEES:
4 RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems* •
❑ Other:
COMIVIERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ - Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i \Bwiding\Permns\ELC- Perm itApp doc 04/03
CITY•OF TIGARD . .
BUILDING DIVISION PERMIT #: ELC2005 -00600
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 13/17/2005
Phone: (503) 639 -4171 ,� �,�i�Np��gpip li
Inspection•Requests (24 Hrs.): (503) 639 -4175 - -.
INSPECTION WORKSHEET FOR DATE: 8/25/2005 TIME: 7:12AM PAGE: 05
SITE ADDRESS: 12630 GRANT AVE CLASS OF WORK:
SUBDIVISION: NO. TIGAR ADDITION AMEND LOT #: 009 TYPE OF USE:
PROJECT NAME: ST. ANTHON 'S CHURCH
DESCRIPTION: Location: Food • ntry. 3 branch circuits. •
OWNER: ROMAN CATHOLI .: = RCHBISHOP OF, PHONE #:
CONTRACTOR: ALLIED ELECTRIC PHONE #: 614 -8000
Inspection Request Scheduled For: Date: 8/25/2006 Pour Time:
Code # Inspection D - _ i •tion . it - • Contact # Message
199 Electrical final ' +14220 -01 503- 81 Y
Corrections/ • • -- AP • _ • - ctions• ! nip
*
PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Gi 1\10"8 Lk Date: t 2 -6 -- Phone #: (503) 718- 2-413