Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00568
i� DEVELOPMENT SERVICES DATE ISSUED: 9/11/03
'�� II 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 103DD -00900
SITE ADDRESS: 13855 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical service for sanctuary.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS 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: 10 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:
COMMUNITY OF CHRIST ELECTRICAL INNOVATIONS
PO BOX 23462 22300 S LEWELLEN RD
TIGARD, OR 97281 BEAVERCREEK, OR 97004 -8733
Phone: 503 - 684 -6620 Phone: No business phone
Reg #: ELE 26 -699C
LIC 66412
FEES SUP 3621S
Description Date Amount •
Required Inspections
CITY OF TIGARD MENU 9/11/03 $221.80
[TAX] 8% State Tax 9/11/03 $17.74 Elect'I Service
Rough -in
Total $239.54 Elect'I Final
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 mor - - ; s • : ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth ' OAR 952 - 001 -0e 0 through OAR - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 .6699 or
1 -8'0- 332 -2344. /
Iss ed By: 014 / % �. Permit Signature: ,r��
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: J e.g(— � LL f -- DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit A licat' FOR OFFICE USE ONLY
R Received Electrical
Date/By: 7 /f . 1 Permit No.:
City of Tigard Planning Approval Sign
`J Tigard Date/By: Permit No.:
13125 SW Hall Blvd. SEP 1 1 2003 Plan Review Other '
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503-W-69. � Post- Review Land Use
Internet: www.ci.tigard.or.us ° � f ' C ' A ' , 4 r% t �� ili ��� Date/By: Case No.:
24 -hour Inspection Request: 50 imi DIV ` 1 �� " '' Contact Juris.: ® See Page 2 for
P q Name/Method: Supplemental Information.
. , ;TYPE• OF WORK, •_r '- . . PLAN REVIEW (P1ea'ie check•all that apply) F.
® New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
ID Addition/alteration/replacement El Other: commercial ❑ Hazardous location
❑ Service over 320 amps- rating of 0 Building over 10,000 square feet,
- . .y .CATEGORY O,F CONSTRUCTION .. ' 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling [] Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION . ' - Submit _ sets of plans with any of the above.
• / -- The above are not applicable to temporary construction service.
Job site address: aksz GU *?,4,//d WO y E '- ' FEE *•SCHEDULE. . •- - ' .
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: am^ 4n ;71/ 0,e (:kis I- Description Qty Fee (ea.) Total
New residential- single or multi- family per j
Cross street/Directions to job site: dwelling unit. Includes attached garage.
4'g4/`4/4/0/ a (.1/o/ ree°/Is Service Included:
V 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
, ' 'DESCRIPTION•OF WORK • ' - ` ` ' - service and/or feeder 90.90 2
c Services or feeders - installation, •
//' ///f r4/' 4ea i _SQmVaGI /^y alteration or relocation: • pp��
�/ 200 amps or less I 80.30 LCJ• 5 ° 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
.e.PR(JPERTY OWNER
''11=1 TENANT /7� . : ` 601 a mps to 1000 amps 240.60 2
Name: // y u . of �,/f /S (A/ C`j Over Reconnect amps or volts 454.65 2
C..17 Ll/' Reconnect only 66.85 2
Address: F a g px L Temporary services or feeders - installation,
C1 City/State/Zip: alteration, or relocation:
h' p: Tiga rd 200 amps or less 66.85 1
Phone: bey , ‘t:L p Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
' { -APPLICANT '. , . ` / . [r CU)'ITACT PERSON - • • Branch circuits - new, alteration, or
Name: Ann 0/lOre extension per panel:
Address: -82 j ,.//4.66-6,- 7Frrae_ A. Fee for branch feeder fee, each purchase ui / CO 2
service or feeder fee, each branch circuit 6.65 l0
City /State /Zip: 4 yt if n giZ 4 7,06V B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: g,7 -gel 75 Fax: 63 - OZ /S' Each additional branch circuit 6.65 2
E -mail: a nn 54614 ee)Anea S>L• nG f" Misc.(Service or feeder not included):
CONTRACTOR ' "`-- - Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel, / page 2 7S do
2
Business Name: al CG5✓a CA ( L t° ✓cvi f 014,5 _ alteration,
ti or extension
�,3
Addre ,22.30 5 L,Gwtil(cvt lecr o n :
� 4 'o
City/State/Zip: � e G e /c ep � Oar 770o Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. 1 hour) 62.50
Phone;, 0- 3 $"�lk7 Fax:S03 -632- 6.57(c/ In vestigation fee
il /e5 CCB Lic. #: 6 '/ Z- Lic. #: 26 X91 L Other:
Supervising electrician % /oy `Electrical_Permit Fees * -
P g o / Subtotal $ ,,,,2,; , 80
signature required: /..---- Plan Review (25% of Permit Fee) $
Print Name:112/ Q,t 5Lic. #: )OOc Z (IC State Surcharge (8% of Permit Fee) $ ` 1
// TOTAL PERMIT FEE $ �, $ 5 '
Authorized 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 Tri-County Building Industry Service Board.
(Please print name)
•
i:\Dsts\Permit Fotms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: . -
. Fee for all systems $75.00
Check Type of Work Involved:
0 Audio and Stereo Systems
Ei Burglar Alarm
0 • Garage Door Opener .
0 Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
0 Boiler Controls
E Clock Systems
El Data Telecommunication Installation .
El Fire Alarm Installation
0 HVAC
0 Instrumentation
E Intercom and Paging Systems .
0 Landscape Irrigation Control
0 Medical -
Nurse Calls
0 Outdoor Landscape Lighting .
0 Protective Signaling .
0 Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03