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Permit
• I —,, CITY OF TIGARD ELECTRICAL PERMIT I, 1, COMMUNITY DEVELOPMENT Permit #: ELC2011 -00687 'rIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2011 Parcel: 2S112CC01100 Jurisdiction: Tigard Site address: 15800 SW HALL BLVD Project: Tigard Community Friends Church Subdivision: 2002 -002 PARTITION PLAT Lot: 2 Project Description: (1) hour of inspection time for replacing flourescent light fixtures and ballasts. Contractor: CHEROKEE ELECTRIC CO Owner: TIGARD FRIENDS CHURCH 13211 SW SUMMERWOOD DR 7130 SW BEVELAND TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503 - 209 -9039 PHONE. FAX: FEES Quantity Description Date Amount 1 hr Hourly Electrical Rate 12/07/2011 $90.00 Specifics: 1 ea Hourly Electrical 12% 12/07/2011 $10.80 Surcharge Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $100.80 Required Items and Reports (Conditions) This permit i . . .s u b j e c t to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be don= n accordance wi - pproved 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 lay - quire. • to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 601 -0010 thr•( gh OAR 952 -0090. ' u m. obtain a copy of , e rules or direct questions to OUNC by calling 503..2 987 or 1.8 .332. Iss ed By: / / t / / Permittee Signature: en..--,-- • 1 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: CONT• •'CTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' , V Date: / - 7 _ /7 LICENSE NO. • c9 ea /6 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 _ T � / CJ olz OrrlcE _USE;ONLY City of Tigard Date/By: `717 / / I� Permit No.: LG 1'1(I �(on ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review flEJ , 7 Jf ' C . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: T7 GA R D Inspection Line: 503.639.4175 Date ReadyBy• Juris: El See Page 2 for Internet: www.tigard - or.gov Notified/Method: 0 Supplemental information TYPE OF WORK PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): El New construction MAddition/alteration /replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling CM Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ", �/�7 7 /� IOOHP or more. occupancy. Job no.: Job site address: /�O f/ 0 Su/ / / O / ❑ Six or more residential units. ❑ Recreational vehicle parks. I Q � j ' `� ❑ Health -care facilities. ❑ Supply voltage for more than City /State /ZIP: V / a p w \ p ©k ? ` Z2-3 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 4a a Fri ` P.vt 5 c�V , ! U (2 ❑ Service or feeder 600 amps or more. / FEE SCHEDULE Cross street/directions to job site: 5,a, e) f- - a (7•u l/ J .. ox Description I Qty. I Fee. I Total r lI New residential single- or multi - family dwelling unit. K2_ inn.( I ' P _ Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) (( all I // Limited energy, multi - famil 75.00 2 Gh.a e OcC+ a -P -Plow ( (7Wf - -IIV - c -ck res residential (with above sq. ft.) / Services or feeders installation, alteration, and/or relocation T- 0 erg y l.'Pc c i e2i k `j &((c . f ' f )c y75 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) 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 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit Business name: l . ree C_e' -'L- ,i( -1\•(_. B. Fee for branch circuits without c G service or feeder fee, first 56.18 2 Contact name: � �p S r I � iAer branch circuit Each add'I branch circuit 7.42 2 Address: f3_ t \ _s1,0 S0n~.wter t o 00,62_ b r , Miscellaneous (service or feeder not included) City/State/ZIP: ,p Each manufactured or modular ity /State /ZIP: 67.84 2 �t q ,,, © ie q7 2-.23 dwelling, service and/or feeder Phone: (� p3) 24 q - 7037 Fax:: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: 5Lt; iVhe-rr0t/1 0-0i • cps Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: (` r r`�,e ---(8_4-11-1(C... panel, alteration, or extension. Page 2 2 �Y{ F Each additional inspection over allowable in any of the above Address: (.37._(l SW s alm wL er u i6p c 1,2 h Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: ?\J ct_Q OK r7 u3 Investigation plant (I hr min) 7818 / hr min) 66.25/ hr Industrial plant (I . Phone: (57)3 ) zO ct _ c?03 r Fax: ( ) Inspections for which no fee is ��, � 90.00/ hr e / specifically listed (%x hr min) CCB Lic.: 35 s/j Electrical Lic.: 3 - (z7c k uprv. Lic.: 2,6 /6 5 ELECTRICAL PERMIT FEES �` , Subtotal: 90, 4..., Electrician signature, required: �! Plan review (25% of permit fee): Print name: vii D ate: ( ,.._ _ 7 - 7 / State surcharge (12% of permit fee): /Dl17 ,,(ec_t_. / TOTAL PERMIT FEE: AS • 80 Authorized signature: G This permit application expires if a permit is not obtained within 180 Print name: Date: * days after it has been accepted as complete. Number of inspections allowed per permit. I.\ BuildingTermits \ELC- PermnApp.doc 07/01/10 440- 4615T( I1 /05 /COM /WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 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* n Vacuum Systems* ❑ • Other: 'COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC ❑ Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I \ Building \Permits\ELC- PermitApp.doc 07/01/10