Permit CITY OF TIGARD ELECTRICAL PERMIT
`R' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00323
T I G AR.Di 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/29/2012
Parcel: 2S102DA00701
Jurisdiction: Tigard
Site address: 13405 SW HALL BLVD
Project: Tigard Christian Church Subdivision: BARNUM PARK Lot: 9
Project Description: Lighting retrofit
Contractor: FRAHLER ELECTRIC CO Owner: TIGARD CHRISTIAN CHURCH
11860 SW GREENBURG RD 13405 SW HALL BLVD
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 05/29/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/29/2012 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 OAR -001 -0 0. You m � obtain a opy of the rules or direct questions to OUNC by calling 550 1 800.332.2344.
Issued By: �`�CS�/1 Permittee Signature: MU X11
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 ApplicationREC FOR OFFICE USE ONLY
City g ceived 6i l i �— p y
Cit of Tl and Date/By: ( ` Permit No.: ,e a,., (�
4 13125 SW Hall Blvd., Tigard, OR 97223
M AY 2 52012 Y'
Plan Review
Q /�� q� a ��oo //�
503.718.2439 Fax: 503.598.1960 Date /By: Other Permit: �/G( dV / Oar
Phone: 503.718
TIGARD Inspection Line: 503.639.4175 Ci ^ /�� �� t Q Date Ready /By: luri El See Page 2 for
Internet: www.tigard- or.gov t� OF 1 Notified /Method: Supplemental Information
_ RI I I I f11Ri!'/ fl itzin
E - .y, „ � TYPE OF WORK r 4 r � "4 =" rO CANgRE'1?IEW '- , 3
❑New construction ®Addition /alteration /replacemen 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
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
N 1" sg � -� ss - n° . x ., =
.- GAT EGORY `DF'tCONSTRUCTION 0 -- i s -
exceeds ground, amps at 150 volts or Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
t _ Emergency system. larger separately derived system.
, JOB SITU I N O ,, ,,, N AND 4 , . � ❑ Addition of new motor load of ❑ "A" "E» "1 -2" "1 -3"
Job no.: 69432 Job site address: 13405 SW HALL BLVD I00HP or more. occupancy.
❑ Six or more residential units ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. - 600 volts nominal
Suite /bldg. /apt. no.: Project name: TiGARD CHRISTIAN CHURCH ❑ Service or feeder 600 amps or more
4 r ; .:EE SCirtit LE : y
Cross street /directions to job site: Description I Qty. I Fee. I Total I
New residential single- or multi - family dwelling unit.
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
/.� - , - _ i tSCRIPTION OF WORK f (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
LIGHTING RETROFIT residential (with above sq. ft )
Services or feeders installation, alteration, and /or relocation _
200 amps or less 100.70 2
4-444: p, ROPER7'Y OWt`IER ' 4 _ ,'r ENZANTT y - 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
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: 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
.,. I v W� , ,
AAPP,LICAIVT C( PER SON `� 7.42 2
,,.m . . . .... , „,-..-....,,,,,,,,,,..m- ,- , . ..• "4 - above service or feeder fee,
branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 2 7 42 14.84 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
y dwelling, service and /or feeder
Phone: ( ) Fax:: ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign or outline lighting 67.84 2
` a , " CONTRA TOR .. v.,;"„,,,;-..; _ � Si gnal circuit(s) or limited- energy
Business name: FRAHLER ELECTRIC COMPANY panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 11860 SW GREENBURG ROAD Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: TiGARD, OR 97223 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78 18/ hr
Phone: (503) 639 - 4627 Fax: (503) 639 - 4673 inspections for which no fee is 90.00 / hr
specifically listed (m/ hr min)
CCB Lie.: 34710 Electrical Lie.: 34 -13C Suprv. Lie.: 511OS ZS : WELEG`CRIoA PERMIT FEES
Suprv. Electrician signature, required:, ^ / ) �_ Subtotal 71.02
Plan review (25% of permit fee):
Print name: ADAM ETHERINGTON Date: 052312 State surcharge (12% of permit fee): 8.52
TOTAL PERMIT FEE: ' 79.54 ✓
AUthOriZed signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
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